Abstract
OBJECTIVE: To examine the seroprevalence of undiagnosed HIV and variation by season among patients admitted to the general internal medicine (GIM) and trauma services of two urban hospitals.
DESIGN: A cross-sectional blinded HIV-1 seroprevalence survey.
SETTING: A 725-bed academic medical center’s hospital and an affiliated 324-bed tertiary care hospital.
PARTICIPANTS: Residual serological specimens were obtained for unique patients aged 17 to 65 to study services in summer (June 16 to September 4, 2001) and fall to winter (November 1, 2001 to January 8, 2002).
METHODS: Hospital files provided data on demographics, service type, and discharge clinical categories (fall-winter group only). HIV ELISA (enzyme-linked immunosorbent assay) tests with confirmatory Western blot were linked to subjects’ de-identified files. We excluded 34 subjects with known HIV. Of the remaining unique admissions in summer (n=604) and fall-winter (n=978), 60% and 55% were tested, respectively. Predictors of undiagnosed HIV infection were examined using multivariate analysis.
RESULTS: The summer cohort (n=362) had significantly lower unadjusted seroprevalence of undiagnosed HIV infection (1.4%; 95% confidence interval [CI], 0.4% to 3.2%) than the fall-winter cohort (n=539; 3.7%; 95% CI, 2.3% to 5.7%; P=.04). Overall, undiagnosed HIV was somewhat less likely in women (adjusted odds ratio [AOR], 0.45; 95% CI, 0.19 to 1.07) but more likely in black patients (AOR, 3.46; 95% CI, 0.70 to 17.06). In the fall-winter cohort, undiagnosed HIV was more likely for discharges with the following clinical categories versus those with a cardiac condition: dermatologic/breast (AOR, 14.90; 95% CI, 1.20 to 184.77), renal/urological (AOR, 22.43; 95% CI, 2.12 to 236.75), or infectious (AOR, 31.08; 95% CI, 2.40 to 402.98).
CONCLUSIONS: The higher seroprevalence of undiagnosed HIV in the fall-winter admissions to GIM and trauma services supports especially targeting HIV testing in these months.
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References
Fleming PL, Byers RH, Sweeney PA, et al. HIV prevalence in the United States, 2000. Presented at the Ninth Conference on Retroviruses and Opportunistic Infections, Seattle, WA, 2002.
Palella FJ Jr, Chmiel JS, Moorman AC, Holmberg SD, Investigators HIVOS. Durability and predictors of success of highly active antiretroviral therapy for ambulatory HIV-infected patients. AIDS. 2002;16:1617–26.
Anonymous. Incorporating HIV prevention into the medical care of persons living with HIV. Recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2003;52:1–24.
Samet JH, Freedberg KA, Savetsky JB, Sullivan LM, Stein MD. Understanding delay to medical care for HIV infection: the long-term nonpresenter. AIDS. 2001;15:77–85.
Walensky RP, Losina E, Steger-Craven KA, Freedberg KA. Identifying undiagnosed human immunodeficiency virus: the yield of routine, voluntary inpatient testing. Arch Intern Med. 2002;162:887–92.
Lubis N, Baylis D, Short A, et al. Prospective cohort study showing changes in the monthly incidence of Pneumocystis carinii pneumonia. Postgrad Med J. 2003;79:164–6.
Sorvillo F, Beall G, Turner PA, Beer VL, Kovacs AA, Kerndt PR. Incidence and factors associated with extrapulmonary cryptococcosis among persons with HIV infection in Los Angeles County. AIDS. 1997;11:673–9.
Saynajakangas P, Keistinen T, Tuuponen T. Seasonal fluctuations in hospitalisation for pneumonia in Finland. Int J Circumpolar Health. 2001;60:34–40.
Dales RE, Schweitzer I, Toogood JH, et al. Respiratory infections and the autumn increase in asthma morbidity. Eur Respir J. 1996;9:72–7.
Fleming DM, Cross KW, Sunderland R, Ross AM. Comparison of the seasonal patterns of asthma identified in general practitioner episodes, hospital admissions, and deaths. Thorax. 2000;55:662–5.
Weiss KB. Seasonal trends in US asthma hospitalizations and mortality. JAMA. 1990;263:2323–8.
Gallagher KM, Sullivan PS, Onorato I. A National System for HIV Behavioral Surveillance in the United States. National HIV Prevention Conference. Atlanta, GA: Centers for Disease Control and Prevention; 2003.
Anonymous. HIV Prevalence Trends in Selected Populations in the United States: Results from National Serosurveillance 1993–1997. Atlanta, GA: Centers for Disease Control and Prevention; 2001:1–51.
Martinez-Selles M, Garcia Robles JA, Prieto L, et al. Annual rates of admission and seasonal variations in hospitalizations for heart failure. Eur J Heart Fail. 2002;4:779–86.
Frost L, Johnsen SP, Pedersen L, et al. Seasonal variation in hospital discharge diagnosis of atrial fibrillation: a population-based study. Epidemiology. 2002;13:211–5.
Sonnenberg A, Wasserman IH, Jacobsen SJ. Monthly variation of hospital admission and mortality of peptic ulcer disease: a reappraisal of ulcer periodicity. Gastroenterology. 1992;103:1192–8.
Sonnenberg A, Jacobsen SJ, Wasserman IH. Periodicity of hospital admissions for inflammatory bowel disease. Am J Gastroenterol. 1994;89:847–51.
Gemmell I, McLoone P, Boddy FA, Dickinson GJ, Watt GC. Seasonal variation in mortality in Scotland. Int J Epidemiol. 2000;29:274–9.
van Rossum CT, Shipley MJ, Hemingway H, Grobbee DE, Mackenbach JP, Marmot MG. Seasonal variation in cause-specific mortality: are there high-risk groups? 25-year follow-up of civil servants from the first Whitehall study. Int J Epidemiol. 2001;30:1109–16.
Serraino D, Puro V, Boumis E, et al. Epidemiological aspects of major opportunistic infections of the respiratory tract in persons with AIDS: Europe, 1993–2000. AIDS. 2003;17:2109–16.
Mont MA, Mears SC, Jones LC, et al. Is coding of diagnoses, comorbidities, and complications in total knee arthroplasty accurate. J Arthroplasty. 2002;17:767–72.
Cooper GS, Chak A, Lloyd LE, Yurchick PJ, Harper DL, Rosenthal GE. The accuracy of diagnosis and procedural codes for patients with upper GI hemorrhage. Gastrointest Endosc. 2000;51:423–6.
Kashner TM. Agreement between administrative files and written medical records: a case of the Department of Veterans Affairs. Med Care. 1998;36:1324–36.
Glanigan TP, Hogan JW, Smith D, et al. Self-reported bacterial infections among women with or at risk for human immunodeficiency virus infection. Clin Infect Dis. 1999;29:608–12.
Northfelt DW, Polsky B. Bacteremia in persons with HIV infection. AIDS Clin Rev. 1991;59–79.
Selik RM, Byers RH Jr, Dworkin MS. Trends in diseases reported on U.S. death certificates that mentioned HIV infection, 1987–1999. J Acquir Immune Defic Syndr. 2002;29:378–87.
Turner BJ, Markson LE, McKee L, Houchens R, Fanning T. The AIDS-defining diagnosis and subsequent complications: a survival-based severity index. [Erratum appears in J Acquir Immune Defic Syndr. 1992;5:214.]. J Acquire Immune Defic Syndr. 1991;4:1059–71.
Park JC, Buono D, Smith DK, et al. Urinary tract infections in women with or at risk for human immunodeficiency virus infection. Am J Obstet Gynecol. 2002;187:581–8.
Harrington RD, Hooton TM. Urinary tract infection risk factors and gender. J Gend Specif Med. 2000;3:27–34.
Herman ES, Klotman PE. HIV-associated nephropathy: epidemiology, pathogenesis, and treatment. Semin Nephrol. 2003;23:200–8.
Ross MJ, Klotman PE, Winston JA. HIV-associated nephropathy: case study and review of the literature. AIDS Patient Care STDS. 2000;14:637–45.
Winston JA, Burns GC, Kotman PE. The human immunodeficiency virus (HIV) epidemic and HIV-associated nephropathy. Semin Nephrol. 1998;18:373–7.
Manfredi R, Calza L, Chiodo F. Epidemiology and microbiology of cellulitis and bacterial soft tissue infection during HIV disease: a 10-year survey. J Cutan Pathol. 2002;29:168–72.
Nascimento MC, Pannuti CS, Nascimento CM, Sumita LM, Eluf-Neto J. Prevalence and risk factors associated with perianal ulcer in advanced acquired immunodeficiency syndrome. Int J Infect Dis. 2002;6:253–8.
Rothman RE, Ketlogetswe KS, Dolan T, Wyer PC, Kelen GD. Preventive care in the emergency department: should emergency departments conduct routine HIV screening? A systematic review. Acad Emerg Med. 2003;10:278–85.
Tardiff K, Marzuk PM, Leon AC, Hirsch CS, Portera L, Hartwell N. Human immunodeficiency virus among trauma patients in New York City. Ann Emerg Med. 1998;32:151–4.
Janssen RS, St Louis ME, Satten GA, et al. HIV infection among patients in U.S. acute care hospitals. Strategies for the counseling and testing of the hospital patients. The Hospital HIV Surveillance Group. N Engl J Med. 1992;327:445–52.
Irwin KL, Valdiserri RO, Holmberg SD. The acceptability of voluntary HIV antibody testing in the United States: a decade of lessons learned. AIDS. 1996;10:1707–17.
Barbacci M, Repke JT, Chaisson RE. Routine prenatal screening for HIV infection. Lancet. 1991;337:709–11.
Lindsay MK, Johnson N, Peterson HB, Willis S, Williams H, Klein L. Human immunodeficiency virus infection among inner-city adolescent parturients undergoing routine voluntary screening, July 1987 to March 1991. Am J Obstet Gynecol. 1992;167:1096–9.
Trepka MJ, Davidson AJ, Douglas JM, Jr. Extent of undiagnosed HIV infection in hospitalized patients: assessment by linkage of seroprevalence and surveillance methods. Am J Prev Med. 1996;12:195–202.
Zuckerman CJ, Masters CF. Prevalence of human immunodeficiency virus-1 infection in a Baltimore acute care hospital. Md Med J. 1993;42:765–9.
Nagachinta T, Brown CP, Cheng F, Temple W, Kerndt PR, Janssen RS. HIV-1 seroprevalence in an inner-city public hospital. J Natl Med Assoc. 1994;86:358–62.
Murrill CS, Kuncl KA, Weeks HR, Whyte BM, Petersen LR, Janssen RS. HIV seroprevalence in hospital patients in rural Georgia. South Med J. 1992;85:969–71.
Beltrami JF, Franko EA, Toomey KE. Human immunodeficiency virus seroprevalence trends: five hospitals in south Georgia, 1993 through 1997. South Med J. 2001;94:421–6.
Anonymous. Routine testing shows benefits in urban hospital. Atlanta effort finds more HIV-positives. AIDS Alert. 2001;16:134–5, 122.
Anonymous. Revised guidelines for HIV counseling, testing, and referral. MMWR Recomm Rep. 2001;50:1–57; quiz CE-19a1-CE6-19a1.
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Each author warrants that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the article. All funding sources supporting the work and all institutional or corporate affiliations of the authors are acknowledged in a footnote in the work.
The work presented here was supported by the University of Pennsylvania’s Council on Health Promotion and Disease Prevention and a grant from the Philadelphia Department of Public Health.
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Brady, K.A., Berry, S., Gupta, R. et al. Seasonal variation in undiagnosed HIV infection on the general medicine and trauma services of two urban hospitals. J GEN INTERN MED 20, 324–330 (2005). https://doi.org/10.1111/j.1525-1497.2005.40300.x
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DOI: https://doi.org/10.1111/j.1525-1497.2005.40300.x