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CDC HIV/AIDS/Viral Hepatitis/STD/TB Prevention News Update
FRANCE; UNITED STATES: Don't Screen Everybody for HIV in the ER: Study
Frederik Joelving
November 17, 2011
Reuters Health (10.24.11) - Thursday, November 17, 2011

Among the more than 12,700 people tested for HIV in 29 Paris emergency rooms, just 18 new HIV cases were found, according to a new study that suggests universal HIV screening in ERs is not practical.

Dr. Kayigan Wilson d'Almeida and colleagues from the Emergency Department HIV-Screening Group conducted the study among patients ages 18-64 seen at Paris ERs over a six-week period. Almost 21,000 people were offered HIV testing. The new case rate was 14 per 10,000 tests, but seven of those were gay men - a group already at high risk of infection.

"Unexpectedly, nontargeted screening identified only a few new diagnoses, often already at late stages, and most newly diagnosed patients belonged to a high-risk group and had been tested previously," said Wilson d'Almeida.

An accompanying editorial said screening all ER patients is not the best way to find the estimated 240,000 undiagnosed HIV cases in the United States. Dr. Jason Haukoos of Denver Health Medical Center said a study conducted last year at his hospital found just one-quarter of the more than 28,000 patients offered HIV screening consented to the test, resulting in 10 new diagnoses.

"These new studies basically say you need to test thousands to identify a handful of patients," said Haukoos. "The question is, is there a way to use scarce resources to target patients at higher risk?" Haukoos said the HIV test used in the new study costs roughly $10, and unpublished data from his group indicate limiting it to high-risk patients would identify more cases.

The study, "Modest Public Health Impact of Nontargeted Human Immunodeficiency Virus Screening in 29 Emergency Departments," and the editorial, "The Impact of Nontargeted HIV Screening in Emergency Departments and the Ongoing Need for Targeted Strategies: Comment on 'Modest Public Health Impact of Nontargeted Human Immunodeficiency Virus Screening in 29 Emergency Departments," were published early online in the Archives of Internal Medicine (2011;doi:10.1001/archinternmed.2011.535 and doi:1001/archinternmed.2011.538, respectively).