Four patients per 1000 screened with fourth-generation tests received a new diagnosis of HIV infection. The Centers for Disease Control and Prevention recommend nontargeted screening (i.e., screening everyone, not just those with risk factors) for HIV infection in the emergency department (ED) setting when the diagnosis rate is at least 0.1% of patients tested.
Newer “fourth-generation” HIV tests detect not only antibodies to the virus but also the HIV-1 p24 antigen, which is present before antibodies. Thus, these tests can detect infection earlier.
These authors reviewed data from HIV screening programs that used the fourth generation Architect HIV Antigen-Antibody Combo test (Abbott Diagnostics, Abbott Park, IL) to screen ED patients from 2012 to 2015.
The study included data from nine EDs in six U.S. cities. Of 214,524 patients screened, 0.4% received a new diagnosis of HIV infection. Of these new diagnoses, 14.5% were acute HIV infection, which might have been missed by older HIV tests.