Pl. Alpert et al., FACTORS ASSOCIATED WITH UNRECOGNIZED HIV-1 INFECTION IN AN INNER-CITYEMERGENCY DEPARTMENT, Annals of emergency medicine, 28(2), 1996, pp. 159-164
Study objective: To determine the prevalence of and risk factors assoc
iated with unrecognized HIV-1 infection among medical patients present
ing to an inner-city emergency department. Methods: We conducted anony
mous HIV-1 testing in subjects interviewed for risk behaviors and know
ledge of HIV status at an inner-city ED in the Bronx, New York. Our su
bjects were consecutive adult medical patients in noncritical conditio
n (N=1,744) who were evaluated by three physicians providing primary e
mergency care. Each patient was given a structured interview for demog
raphic characteristics, risk behaviors, and knowledge of HIV status. E
xcess serum, drawn for clinical purposes, was linked without identifie
rs to responses and tested for antibodies to HIV-1. In subjects who de
nied HIV infection, we tested associations with seropositivity using u
nivariate analyses and logistic-regression techniques (multivariate).
Results: Of the 1,744 patients interviewed, 656 (37.6%) reported HIV r
isk behaviors. Of 970 tested for HIV-1 antibodies, 125 (12.9%) were se
ropositive. The prevalence of HIV-1 infection among those who denied k
nown infection was 4.0% (35 of 875). In the multivariate model, indepe
ndent predictors of unrecognized HIV-1 infection were age 35 to 44 yea
rs, crack cocaine use, history of syphilis, and ED diagnosis of an inf
ection not necessarily related to HIV infection. Unrecognized HIV-1 in
fection was more likely among patients admitted to the hospital, but 2
1 of the 35 with unrecognized infection (60%) were not admitted and in
9 (25.7%) no risk factors were identified. Conclusion: More than one
third of patients who visited one inner-city ED acknowledged HIV risk
behaviors. One quarter of patients with unrecognized HIV-1 infection r
eported no identifiable risk factors. Easily accessible HIV counseling
and testing should be considered in EDs in areas serving persons at r
isk for HIV infection.