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Michael Wallace, Dev Sahni, Eric Peterson, Christopher Leffler, Vikram Brar; Testing for human immunodeficiency virus (HIV) in the eye clinic. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4185. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
The Centers for Disease Control (CDC) recommends that HIV screening should be performed for most adults in healthcare settings unless the rate of undiagnosed HIV has been documented to be less than 0.1%. In contrast to this recommendation, the Wills Eye Manual offers HIV testing as a consideration for a few conditions but only recommends it in the setting of known syphilis. Our study was a retrospective review that determined if the rate of undiagnosed HIV infection among ophthalmology patients likely to have laboratory studies is greater or less than 0.1%.
We studied patients age 18-64 who were evaluated by VCU ophthalmologists between July 1, 2013 and September 30, 2016 and had conditions for which bloodwork is often sent by ophthalmologists. Patients not previously known to be HIV positive or have a history of syphilis were studied. Patients were separated into 2 groups: 1. a group presumed to be at lower risk of HIV consisted of patients who presented with Hyphema. 2. from the Wills Eye Manual we identified several conditions that could be at higher risk of undiagnosed HIV. This group included Anterior Uveitis, Panuveitis, Scleritis, Behcet’s Disease, and Vogt-Koyanagi-Harada Syndrome (VKH). The index episode of care was defined as the initial encounter during the study period for which the patient was seen with the condition of interest. The incidence of HIV was defined as the percentage of patients with previously undiagnosed HIV infection and was defined as the number of patients discovered to be HIV positive within six months of presentation of the index episode of care divided by the number of total patients within the group. The 95% binomial confidence interval (CI) was determined.
The number of patients newly diagnosed with HIV was 1/169 with Anterior Uveitis (95% CI 0.01-3.25%), 1/291 with high risk conditions (95% CI 0.01-1.90%), or 1/446 for all eye patients studied (95% CI 0.01-1.24%).
Based upon the confidence interval we were unable to demonstrate that the rate of newly-diagnosed HIV among ophthalmology patients studied was less than 0.1%. According to CDC recommendations, HIV testing is indicated for all patients age 18-64 in our practice. Patients with Anterior Uveitis may constitute a high risk subset. These results may apply to similar academic institutions.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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