Geren Kara I, Lovecchio Frank, Knight Jason, Fromm Robert, Moore Eric, Tomlinson Cheri, Valdez André, Hobohm Dan, Stapczynski J Stephan
Department of Emergency Medicine, Maricopa Integrated Health System, Phoenix, AZ.
Department of Emergency Medicine, Maricopa Integrated Health System, Phoenix, AZ.
Ann Emerg Med. 2014 Nov;64(5):537-46. doi: 10.1016/j.annemergmed.2014.05.021. Epub 2014 Jun 23.
Acute HIV infection is a clinical diagnosis aided by technology. Detecting the highly infectious acute stage of HIV infection is critical to reducing transmission and improving long-term outcomes. The Maricopa Integrated Health System implemented nontargeted, opt-out HIV screening with a fourth-generation antigen/antibody combination HIV assay test in our adult emergency department (ED) at Maricopa Medical Center to assess the prevalence of both acute and chronic unrecognized HIV.
Eligible patients aged 18 to 64 years were tested for HIV if they did not opt out and had blood drawn as part of their ED care. Patients were not eligible if they had a known HIV or AIDS diagnosis, exhibited altered mental status, were a current resident of a long-term psychiatric or correctional facility, or prompted a trauma activation. Reactive test results were delivered by a physician with the assistance of a linkage-to-care specialist. Specimens with a reactive fourth-generation assay result underwent confirmatory testing.
From July 11, 2011, through January 5, 2014, 27,952 HIV screenings were performed for 22,468 patients tested for HIV; 78 (0.28%) had new HIV diagnoses. Of those, 18 (23% of all new diagnoses) were acute HIV infections, and 22 patients (28%) had a CD4 count of less than 200 cells/mL, or an opportunistic infection.
HIV testing with a fourth-generation antigen/antibody laboratory test producing rapid results is feasible in an ED. Unexpectedly, nearly one fourth of patients with undiagnosed HIV had acute infections, which would have been more difficult to detect with previous testing technology.
急性HIV感染是一种借助技术手段辅助的临床诊断。检测HIV感染的高传染性急性期对于减少传播和改善长期预后至关重要。马里科帕综合医疗系统在马里科帕医疗中心的成人急诊科实施了非靶向、主动式HIV筛查，采用第四代抗原/抗体联合HIV检测试验，以评估急性和慢性未被识别的HIV的流行情况。
年龄在18至64岁之间、未选择退出且作为急诊护理一部分进行采血的符合条件患者接受HIV检测。如果患者已知患有HIV或AIDS、精神状态改变、是长期精神病院或惩教机构的现住居民，或触发了创伤激活，则不符合检测条件。反应性检测结果由医生在护理联系专家的协助下传达。第四代检测结果呈反应性的标本进行确证检测。
从2011年7月11日至2014年1月5日，对22468名接受HIV检测的患者进行了27952次HIV筛查；78人（0.28%）有新的HIV诊断。其中，18人（占所有新诊断的23%）为急性HIV感染，22名患者（28%）的CD4细胞计数低于200个/毫升，或患有机会性感染。
在急诊科使用能快速出结果的第四代抗原/抗体实验室检测进行HIV检测是可行的。出乎意料的是，近四分之一未被诊断出HIV的患者患有急性感染，而使用以前的检测技术更难检测到这些感染。
