Unsuspected human immunodeficiency virus in critically ill emergency patients.

To determine the prevalence of unsuspected human immunodeficiency virus (HIV) infection in critically ill emergency patients, we examined the anonymous serum samples of 203 critically ill or severely injured patients with no history of HIV infection. We found that six (3%) were seropositive for HIV antibody by both enzyme-linked immunoassay and Western blot analysis. All seropositives were trauma victims between the ages of 25 and 34 years, representing 16% of the trauma patients in that age group (n = 37). All seropositives were actively bleeding, and all required multiple invasive procedures. History of intravenous drug abuse was not discriminating in identifying potential seropositives. We conclude that infection-control precautions are indicated for both emergency department personnel and prehospital care providers (such as paramedics, police officers, and fire fighters) when caring for bleeding patients, whether or not previous suspicion of HIV infection exists.