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2015, October 7-11
San Diego
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HIV Testing Rate Only 16% in High-Risk Hospital Pneumonia Patients
  IDSA/IDWeek 2015, October 7-11, San Diego
Mark Mascolini
Despite US recommendation for routine HIV screening in adults seeking medical care, only 16% of people admitted to a North Carolina hospital with bacterial pneumonia--a high-risk population--got tested for HIV [1]. Many people not screened during their hospital stay tested positive HIV in the following years.
Nearly 10 years have passed since the CDC recommended routine opt-out HIV screening for 13- to 64-year-olds during any medical encounter. Yet as many as 25% of HIV-positive people in the United States remain undiagnosed. Duke University researchers who conducted this study noted that HIV-positive people run a high risk of bacterial pneumonia and that bacterial pneumonia predicted HIV infection in prior research. They designed this study to examine trends in HIV testing among people admitted to the hospital with bacterial pneumonia.
The analysis involved 18- to 64-year-olds admitted to the Duke University Health Systems with a primary diagnosis of pneumonia between January 1996 and December 2014. Of the 6858 people admitted to the hospital with pneumonia, 49% were men, 53% white, and 41% black. Median age stood at 50 years (interquartile range 40 to 58).
Of the 6858 people admitted with pneumonia, 345 (5%) already had an HIV diagnosis. Of the remaining 6513 people, 19 (0.3%) got diagnosed with HIV during their admission. Another 46 people (0.7%) got diagnosed with HIV later, a median of 807 days (2.2 years) after admission. In a random sample of 207 pneumonia inpatients not previously known to have HIV, only 34 (16%) got tested for HIV during their admission for bacterial pneumonia. Another 16 people in this sample (8%) got tested for HIV sometime after their discharge.
While 28% of people got tested for HIV before or during any hospital admission before the CDC recommended universal adult screening in 2006, 39% got tested after the guidelines got issued, but that improvement lacked statistical significance (P = 0.09). Among people admitted to the hospital for pneumonia, HIV screening rates were 13% before the 2006 guidelines and 20% afterwards, also a nonsignificant change (P = 0.18).
Earlier, the researchers determined that US residents admitted to the hospital with pneumonia have a 10-fold higher HIV prevalence (5.0%) than the general population (0.47%). Despite this high risk of HIV and recommendations for universal adult HIV screening, the Duke team concluded that HIV testing rates remain low in people hospitalized with pneumonia. "We are bad at screening for HIV," the researchers warned, "and [testing] rates did not change with guidelines for universal HIV screening." They recommended opt-out HIV testing for pneumonia inpatients to permit "earlier HIV diagnosis and improved outcomes."
1. Clifton D, Clement M, Holland T, Cox G, Dicks KV, Stout J. HIV testing among patients admitted with pneumonia. IDWeek 2015, October 7-11, San Diego. Abstract 121. https://idsa.confex.com/idsa/2015/webprogram/Paper51225.html 2. Hall HI, An Q, Tang T, et al. Prevalence of diagnosed and undiagnosed HIV infection--United States, 2008-2012. MMWR Morb Mortal Wkly Rep. 2015;64(24):657-662.