Unrecognized Human Immunodeficiency Virus Infection in Emergency Department Patients

To determine the extent of unrecognized human immunodeficiency virus (HIV) infection, we examined blood samples drawn from patients presenting to an inner-city emergency department. We found 119 of 2302 consecutive adult patients (5.2 percent) to be seropositive for HIV. Although 27 patients presented with known symptomatic HIV infection, 92 of the remaining 2275 patients (4.0 percent) had unrecognized HIV infection. The highest seroprevalence rate (11.4 percent) was found among black men 30 to 34 years of age. Blacks, other nonwhites, and patients under the age of 45 had high rates of unrecognized infection. The clinical team established risk-factor status in only 29.0 percent of the patients. Of the 276 patients with identified risk factors, 13.0 percent were seropositive, whereas 3.1 percent of the 1616 patients with unknown risk-factor status were seropositive. None of the 102 patients who reported no risk factors were seropositive. Although penetrating trauma (seroprevalence, 13.6 percent) was the only clinical presentation associated with an increased seroprevalence rate independent of other known predictors of infection (P = 0.02), seropositive patients were found in all categories of clinical condition. These data, although based on observations in one emergency department setting, support the concept of universal blood and body-fluid precautions by all health care workers whether or not HIV infection is known. (N Engl J Med 1988; 318:1645–50.) THERE have now been 11 reported cases of human immunodeficiency virus (HIV) infection in persons without identifiable risk factors who were exposed to the acquired immunodeficiency syndrome (AIDS) virus while providing health care. 1 2 3 4 5 6 7 8 What has largely escaped notice is that four of these occupationally related transmissions occurred during emergencies or in outpatient settings, 1 2 3 4 and three of the source patients were not recognized to have HIV infection at the time of the exposure. 1 , 8 Thus, the documented occurrences of nosocomial transmission underscore the potential risk of exposure for emergency personnel. In the United States alone, there are more than 500,000 emergency allied . . .