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. 2020 Sep;34(9):373-379.
doi: 10.1089/apc.2020.0033. Epub 2020 Aug 14.

Asymptomatic Adolescent HIV: Identifying a Role for Universal HIV Screening in the Pediatric Emergency Department

Colleen K Gutman  1   2 , Lauren Middlebrooks  1   2 , Andres Camacho-Gonzalez  2   3 , Bijal Shah  4   5 , Zena Belay  4 , Claudia R Morris  1   2
Affiliations

Asymptomatic Adolescent HIV: Identifying a Role for Universal HIV Screening in the Pediatric Emergency Department

Colleen K Gutman et al. AIDS Patient Care STDS. 2020 Sep.

Abstract

Adolescents account for most undiagnosed HIV infections in the United States. Although the Centers for Disease Control and Prevention (CDC) recommends universal HIV screening for all patients ≥13 years, <10% of adolescents have been tested for HIV. To identify earlier opportunities for adolescent HIV prevention and diagnosis in a region of high HIV prevalence, we sought to describe pediatric emergency department (PED) visits made by a retrospective cohort of adolescents who were later diagnosed with HIV as young adults (<25 years) through an adult emergency department (ED) universal HIV screening program. CD4+ count was used to estimate the time of HIV infection before diagnosis and all PED visits in the 10 years before diagnosis were analyzed. Universal HIV screening in the adult ED diagnosed 193 young adults (median 22 years; 90% men; 29% stage 3); 70% had CD4+ at diagnosis that was used to estimate time of infection (mean 3.8 years). Thirty-eight HIV-infected young adults had a total of 109 PED visits in the 10 years before HIV diagnosis. Sexual history was documented in 12% of PED visits and a sexually transmitted infection test was sent in 6%. Ten HIV-infected young adults had 26 PED visits during the time in which they were likely already infected with HIV, each a potential missed opportunity for earlier diagnosis. HIV-infected and at-risk adolescents are underrecognized in PED visits. Implementation of CDC-recommended universal screening may lead to earlier diagnoses and improve outcomes; the PED may also be critical in identifying adolescents eligible for preexposure prophylaxis.

Keywords: HIV; adolescent; emergency department; screening.

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Conflict of interest statement

ACG has received funding personally from Theratechnologies Inc. for consulting. CRM is the inventor or co-inventor of several UCSF-Benioff Children's Hospital Oakland patents/patent-pending applications that include nutritional supplements, and biomarkers of cardiovascular disease, is an inventor of an Emory University School of Medicine patent application for a nutritional supplement, is a consultant for Pfizer, Nestle Nutritional Institute and Calithera Biosciences, Inc, and has received research support from MAST Therapeutics, the United States Food and Drug Administration, and the National Institutes of Health. BS has received salary support for FOCUS HIV screening in the ED from Gilead Sciences, Inc. Grady Health System FOCUS is partially funded by the Gilead Sciences FOCUS program. This program limits its support to testing and linkage to care. FOCUS does not support treatment efforts and remains agnostic to partners' treatment decisions.

Figures

FIG. 1.
FIG. 1.
Flow diagram of young adults included in cohort. PED, pediatric emergency department.
See this image and copyright information in PMC

References

    1. Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (CDC), US Department of Health and Human Services, Atlanta, Georgia. HIV Surveillance Report, 2018 (Preliminary). Centers for Disease Control and Prevention, 2019
    1. Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (CDC), US Department of Health and Human Services, Atlanta, Georgia. Estimated HIV Incidence and Prevalence in the United States, 2010–2016. Atlanta, GA: Centers for Disease Control and Prevention, 2019
    1. Zanoni BC, Mayer KH. The adolescent and young adult HIV cascade of care in the United States: Exaggerated health disparities. AIDS Patient Care STDS 2014;28:128–135 - PMC - PubMed
    1. Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (CDC), US Department of Health and Human Services, Atlanta, Georgia. Diagnoses of HIV Infection Among Adults and Adolescents in Metropolitan Statistical Areas United States and Puerto Rico. Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, 2017
    1. HIV/AIDS Epidemiology Section Epidemiology Program Division of Health Protection Georgia Department of Public Health, Atlanta Georgia HIV Surveillance Summary, Georgia 2017. Georgia Department of Public Health, HIV/AIDS Epidemiology Section, 2019

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