HIV Prevention and Treatment: The Evolving Role of the Emergency Department

Abstract

Historically, the role of the emergency physician in HIV care has been constrained to treating sick patients with opportunistic infections and postexposure prophylaxis for occupational exposures. However, advances in HIV care have led to medications that have substantially fewer issues with toxicity and resistance, opening up an exciting new opportunity for emergency physicians to participate in treating the HIV virus itself. With this new role, it is crucial that emergency physicians be familiar with the advances in testing and medications for HIV prevention and treatment. To our knowledge, to date there has not yet been an article addressing this expansion of practice. We have compiled a summary of what the emergency physician needs to know, including misconceptions associated with antiretroviral therapy, medication complexity, toxicity, resistance, and usability. Additionally, we review potential indications for prescribing these drugs in the emergency department, including the role of the emergency physician in postexposure prophylaxis, preexposure prophylaxis, and treatment of acute HIV, as well as how emergency physicians can engage with chronic HIV infection.

The Facility-Level HIV Treatment Cascade: Using a Population Health Tool in Health Care Facilities to End the Epidemic in New York State

“…That more than 20 000 PLWH presenting for non-HIV-related services in NYS had no documented care status in clinical records is a troubling finding of the current work, and highlights a clear shortcoming in full adoption of a public health approach to ending the epidemic. This challenge of care status ascertainment was particularly acute in EDs and is of particular concern given their role as primary points of entry into health care organizations for sporadically engaged PLWH seeking medical services [ 26 ]. In addition to EDs [ 27 ], other health care safety net institutions such as public sexual health clinics have reported similar challenges in ascertaining care status [ 28 ].…”

An electronic health record alert increases human immunodeficiency virus screening and case identification in a high-risk emergency department population

“…1,2 In the United States, many persons at risk for HIV lack access to routine care, increasing the importance of ED based screening. 3 Clinical decision support tools integrated into the electronic health record (EHR) have been used to increase screening for multiple conditions in primary care. 4,5,6 Alerts must be user-friendly and integrate smoothly into clinical workflows.…”

HIV detection by an emergency department HIV screening program during a regional outbreak among people who inject drugs

“…Emergency departments (EDs) have been emphasized as essential venues for HIV screening [ 4 , 15 ]. Typically, large patient volumes [ 16 ], 24/7 operation [ 17 ], and availability of treatment regardless of ability to pay [ 18 ] result in ED access to significant numbers of persons with undiagnosed HIV [ 19 ]. Expanding the availability of HIV testing in EDs is a recommended activity to support the diagnosis of all individuals with HIV as early as possible after infection as part of the federal Ending the HIV Epidemic initiative.…”