INITIAL ASSESSMENT OF PATIENTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS - THE YIELD AND COST OF LABORATORY TESTING

Our objective was to determine the yield and cost of standardized labo ratory testing of HIV-infected patients entering medical care after te sting positive for HIV. An HIV staging and referral clinic in a munici pal public hospital was our site for a cross-sectional study, and 308 patients were evaluated in the clinic between February 1, 1990 and Oct ober 1, 1991. Patients underwent standardized laboratory testing, incl uding hematologic studies, serum chemistries, infectious disease serol ogies, and chest radiographs. The percentage of abnormal results for e ach test was determined. Abnormal results were stratified as mild or s evere. They were also examined with regard to whether injection drug u sers or other patient subgroups had higher percentages of abnormalitie s. Charges and Medicare reimbursements for the tests were also determi ned. There were substantial numbers of abnormalities in all types of l aboratory testing. Only 3% of patients had normal CD4 lymphocyte count s; 85% had counts of <500/mm(3), and 35% were <200/mm(3). Forty-four p ercent of patients had at least one abnormal hematologic study; 8% wer e severe. Nearly 75% had abnormal liver function tests; 20% of these w ere severe abnormalities. Fifteen percent of patients were PPD-positiv e, and >50% were anergic. Fourteen percent had a positive nonspecific test for syphilis, and 7% had a positive confirmatory test. Fourteen p ercent of patients had an abnormal chest radiograph. Injection drug us ers were more likely to have severely abnormal liver function tests (2 5.7% vs. 14.7%; p < 0.001), be hepatitis B core antibody positive (88. 6% vs. 62.0%; p < 0.001) and have a positive syphilis serology (19.8% vs. 6.8%; p < 0.001) compared with non drug-users. Total average charg es for the laboratory panel were $422 per person, and Medicare reimbur sements were $198. In a municipal public hospital clinic, extensive in itial laboratory testing of HIV-infected patients yields a substantial number of abnormalities, many of which are severe and require clinica l intervention. Routine laboratory testing of patients like these ente ring primary care for HIV infection is justified, given the high frequ ency of abnormalities in all groups of patients.