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Missed Opportunities in Acute Care Settings

Amy C. Weintrob, MD; Julieta Giner, RN; Prema Menezes, PA-C; Ericka Patrick, RN; Daniel Kelly Benjamin, Jr, MD; Jeffrey Lennox, MD; Christopher D. Pilcher, MD; Joseph J. Eron, MD; Charles B. Hicks, MD

Arch Intern Med. 2003;163:2097-2100.

Although primary human immunodeficiency virus infection (PHI) is usually symptomatic and early management is likely important, the diagnosis is infrequently made. We examined a prospectively enrolled cohort of individuals diagnosed as having PHI in the southeastern United States to determine problems associated with the diagnosis of PHI. The following information was collected on each individual: site of initial presentation, number of visits to health care settings before diagnosis, diagnosing physician, alternative diagnoses, presumptive therapies, and time to diagnosis of PHI. Data were available for 29 of 30 patients (17 white, 12 nonwhite). Most patients were seen at least 3 times before the diagnosis of PHI was made. White persons were seen more frequently by primary care providers (P = .09). Nonwhite persons were diagnosed more quickly (P = .045). Only 5 patients (17%) were correctly diagnosed during their first encounter with the health care system, while 5 (17%) remained undiagnosed for more than 1 month after first presentation. Infectious diseases specialists diagnosed 83% of the cases. Human immunodeficiency virus is infrequently diagnosed during primary infection. More expeditious diagnosis of human immunodeficiency virus infection is a clinical and public health imperative.

From the Department of Internal Medicine, Duke University Medical Center, Durham, NC (Drs Weintrob and Hicks and Ms Giner); Department of Internal Medicine, University of North Carolina, Chapel Hill (Ms Menezes and Drs Pilcher and Eron); Department of Internal Medicine, Emory University, Atlanta, Ga (Ms Patrick and Dr Lennox); and Duke Clinical Research Institute, Durham (Dr Benjamin). The authors have no relevant financial interest in this article.

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