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. 2014 Jul;32(7):775-9.
doi: 10.1016/j.ajem.2014.02.043. Epub 2014 Mar 5.

Validation of an abbreviated version of the Denver HIV risk score for prediction of HIV infection in an urban ED

Yu-Hsiang Hsieh  1 , Jason S Haukoos  2 , Richard E Rothman  3
Affiliations

Validation of an abbreviated version of the Denver HIV risk score for prediction of HIV infection in an urban ED

Yu-Hsiang Hsieh et al. Am J Emerg Med. 2014 Jul.

Abstract

Objective: We sought to evaluate the performance of an abbreviated version of the Denver HIV Risk Score in 2 urban emergency departments (ED) with known high undiagnosed HIV prevalence.

Methods: We performed a secondary analysis of data collected prospectively between November 2005 and December 2009 as part of an ED-based nontargeted rapid HIV testing program from 2 sites. Demographics; HIV testing history; injection drug use; and select high-risk sexual behaviors, including men who have sex with men, were collected by standardized interview. Information regarding receptive anal intercourse and vaginal intercourse was either not collected or collected inconsistently and was thus omitted from the model to create its abbreviated version.

Results: The study cohort included 15184 patients with 114 (0.75%) newly diagnosed with HIV infection. HIV prevalence was 0.41% (95% confidence interval [CI], 0.21%-0.71%) for those with a score less than 20, 0.29% (95% CI, 0.14%-0.52%) for those with a score of 20 to 29, 0.65% (95% CI, 0.48%-0.87%) for those with a score of 30 to 39, 2.38% (95% CI, 1.68%-3.28%) for those with a score of 40 to 49, and 4.57% (95% CI, 2.09%-8.67%) for those with a score of 50 or higher. External validation resulted in good discrimination (area under the receiver operating characteristic curve, 0.75; 95% CI, 0.71-0.79). The calibration regression slope was 0.92 and its R(2) was 0.78.

Conclusions: An abbreviated version of the Denver HIV Risk Score had comparable performance to that reported previously, offering a promising alternative strategy for HIV screening in the ED where limited sexual risk behavior information may be obtainable.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Figure 1A, 1B & 1C. 1A: Prevalence of HIV infection within each risk score category of abbreviated Denver HIV Risk Score in 15,184 patients of two emergency departments (ED) who received a rapid HIV test via ED-based rapid HIV screening program; 1B: Sensitivity analysis by treating all females having sex with a male; 1C: Sensitivity analysis by excluding all sexual-related question Bars, 95% confidence interval For 1C, category of score of ≥50 was collapsed with score of 40–49 since only 21 patients had a score of 50 or more.
Figure 1
Figure 1
Figure 1A, 1B & 1C. 1A: Prevalence of HIV infection within each risk score category of abbreviated Denver HIV Risk Score in 15,184 patients of two emergency departments (ED) who received a rapid HIV test via ED-based rapid HIV screening program; 1B: Sensitivity analysis by treating all females having sex with a male; 1C: Sensitivity analysis by excluding all sexual-related question Bars, 95% confidence interval For 1C, category of score of ≥50 was collapsed with score of 40–49 since only 21 patients had a score of 50 or more.
Figure 2
Figure 2
Figure 2A, 2B & 2C: 2A: Calibration of abbreviated Denver HIV Risk Score to identify patients at risk of HIV infection, Baltimore 2005–2009; 2B: Sensitivity analysis by treating all females having sex with a male; 2C: Sensitivity analysis by excluding all sexual-related question
Figure 2
Figure 2
Figure 2A, 2B & 2C: 2A: Calibration of abbreviated Denver HIV Risk Score to identify patients at risk of HIV infection, Baltimore 2005–2009; 2B: Sensitivity analysis by treating all females having sex with a male; 2C: Sensitivity analysis by excluding all sexual-related question
Figure 3
Figure 3
Figure 3A, 3B & 3C. 3A: Discrimination of abbreviated Denver HIV Risk Score to identify patients at risk of HIV infection, Baltimore 2005–2009; 3B: Sensitivity analysis by treating all females having sex with a male; 3C: Sensitivity analysis by excluding all sexual-related question
Figure 3
Figure 3
Figure 3A, 3B & 3C. 3A: Discrimination of abbreviated Denver HIV Risk Score to identify patients at risk of HIV infection, Baltimore 2005–2009; 3B: Sensitivity analysis by treating all females having sex with a male; 3C: Sensitivity analysis by excluding all sexual-related question
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