PATIENTS UNAWARE OF THEIR HIV STATUS PRESENT TO AN INNER-CITY ACCIDENT AND EMERGENCY DEPARTMENT WITH RESPIRATORY COMPLICATIONS

Objective-To examine the clinical presentations and management of pati ents presenting to an accident and emergency (A&E) department with an AIDS defining illness (ADI). Methods-Presentations of patients in the A&E department with ADI were reviewed retrospectively. The age, sex, e thnic origin, risk factor for HIV infection, route of referral to hosp ital, presenting complaint, triage category, referral from A&E, admiss ion under medical specialists, diagnosis, and survival from ADI were n oted for each patient. Results-133 patients were registered at St Mary 's Hospital in London with ADI during 1994. A significant minority of these patients (25/133) presented to the hospital without prior knowle dge of their HIV positive status. Thirty two patients presented to the A&E department with their ADI. Of these, 13/32 (41%) were unaware of their HIV serostatus. All 13 patients had an acute respiratory disease (Pneumocystis carinii pneumonia or pulmonary tuberculosis). In contra st, patients aware of their HIV positive status (19/32) presented to t he A&E department with a wide range of non-pulmonary ADI. Conclusions- The study emphasises the importance of respiratory complications in pa tients who present with an ADI to emergency departments but are unawar e of their HIV positivity. These patients presented solely with Pneumo cystis carinii pneumonia or pulmonary tuberculosis, conditions in whic h early diagnosis and treatment significantly reduce morbidity and mor tality.