Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
AIDS Patient Care STDS. 2020 Sep;34(9):373-379. doi: 10.1089/apc.2020.0033. Epub 2020 Aug 14.
Adolescents account for most undiagnosed HIV infections in the United States. Although the Centers for Disease Control and Prevention (CDC) recommends universal HIV screening for all patients ≥13 years, <10% of adolescents have been tested for HIV. To identify earlier opportunities for adolescent HIV prevention and diagnosis in a region of high HIV prevalence, we sought to describe pediatric emergency department (PED) visits made by a retrospective cohort of adolescents who were later diagnosed with HIV as young adults (<25 years) through an adult emergency department (ED) universal HIV screening program. CD4+ count was used to estimate the time of HIV infection before diagnosis and all PED visits in the 10 years before diagnosis were analyzed. Universal HIV screening in the adult ED diagnosed 193 young adults (median 22 years; 90% men; 29% stage 3); 70% had CD4+ at diagnosis that was used to estimate time of infection (mean 3.8 years). Thirty-eight HIV-infected young adults had a total of 109 PED visits in the 10 years before HIV diagnosis. Sexual history was documented in 12% of PED visits and a sexually transmitted infection test was sent in 6%. Ten HIV-infected young adults had 26 PED visits during the time in which they were likely already infected with HIV, each a potential missed opportunity for earlier diagnosis. HIV-infected and at-risk adolescents are underrecognized in PED visits. Implementation of CDC-recommended universal screening may lead to earlier diagnoses and improve outcomes; the PED may also be critical in identifying adolescents eligible for preexposure prophylaxis.
青少年占美国未确诊 HIV 感染人数的大多数。尽管疾病控制与预防中心（CDC）建议对所有≥13 岁的患者进行普遍的 HIV 筛查，但仅有<10%的青少年接受过 HIV 检测。为了在 HIV 高发地区更早地发现青少年 HIV 预防和诊断的机会，我们试图通过成人急诊部（ED）普遍的 HIV 筛查计划，描述后来被诊断为 HIV 的青少年在成年前（<25 岁）的回顾性队列中进行的儿科急诊部（PED）就诊情况。CD4+计数用于估计诊断前 HIV 感染的时间，并且分析了诊断前 10 年中所有的 PED 就诊情况。在成人 ED 中进行的普遍 HIV 筛查诊断出了 193 名年轻成年人（中位数 22 岁；90%为男性；30%为 3 期）；其中 70%的人在诊断时的 CD4+计数可用于估计感染时间（平均 3.8 年）。38 名 HIV 感染的年轻成年人在 HIV 诊断前的 10 年中共有 109 次 PED 就诊。12%的 PED 就诊记录了性病史，6%的就诊进行了性传播感染检测。10 名 HIV 感染的年轻成年人在可能已经感染 HIV 的期间有 26 次 PED 就诊，每次就诊都是早期诊断的潜在机会。在 PED 就诊中，HIV 感染和处于感染风险的青少年没有得到充分认识。实施 CDC 推荐的普遍筛查可能会导致更早的诊断并改善结果；PED 也可能是确定有资格接受暴露前预防的青少年的关键。
