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
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$10, and unpublished data from his group indicate limiting it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