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Publications (2)4.99 Total impact

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    ABSTRACT: The Centers for Disease Control and Prevention (CDC) recommends offering HIV testing to persons admitted to emergency departments (EDs). Whether by opt-in or opt-out, many EDs (including our own) have found a seroprevalence of 0.8-1.5% when rapid testing is offered. The true seropositivity rate is unknown. We performed a retrospective chart analysis upon all patients presenting to our ED over a 2-week period in the fall of 2007 who had serum drawn as a part of their emergency care. Demographics and clinical characteristics were linked via de-identified serum, which was sent for HIV testing. Nine hundred fifty nine patients had sera available for rapid HIV testing. One hundred twenty one (13%) samples were reactive via the OraQuick(®) test (OraSure Technologies, Bethlehem, PA), a point of care rapid antibody test. Due to concerns about the appropriateness of sera as substrate for the OraQuick(®) technology, reactive samples were retested via standard enzyme immunoassay (EIA)/Western blot. One hundred twelve analyzable samples were retested-38 were positive and 27 of these were from patients who reported a history of HIV infection. The rate of undiagnosed HIV infection was 1.2% (11/914 potentially analyzable samples). Of all patients with HIV in our ED, 29% of them were presumably unaware of their diagnosis. In conclusion, HIV seroprevalence in our urban ED is high, and a large fraction of the patients appears to be unaware of the infection.
    AIDS patient care and STDs 02/2011; 25(4):207-11. · 2.68 Impact Factor
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    ABSTRACT: Randomized controlled trials with highly active antiretroviral therapy (HAART) have demonstrated over 70% virologic success rates, although patients in an inner city HIV setting likely have lower virologic success. We studied the outcome of all treatment-naive patients beginning HAART in our urban clinic in Philadelphia, Pennsylvania. The primary outcome was virologic success at 12 months for all patients who were initiated on HAART. Secondary outcomes included virologic success at 12 months for only those who remained in care and the determination of which demographics influenced virologic success. Between 2003 and 2005, 109 patients were initiated on HAART: 39% women, 79% African American, 17% Hispanic, median CD4+ count 120 cells/mm3, and HIV-1 RNA 4.9 log10 copies/mL. Twenty-two were lost to follow-up after HAART initiation. Of the 87 who remained in care, 41 maintained a HIV-1 RNA <400 copies/mL through 12 months on their initial HAART regimen. Emerging drug resistance was documented in 7 of 87 patients. NNRTI-based HAART was significantly associated with greater virologic failure due to emerging resistance compared to a PI-based regimen. Our retrospective study demonstrates the difficulties in administering successful HIV care to an urban population, and efforts to help patients overcome barriers to consistent medical care must be a priority.
    HIV Clinical Trials 01/2008; 9(3):186-91. · 2.30 Impact Factor