PROFILE OF PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION PRESENTING TO AN INNER-CITY EMERGENCY DEPARTMENT - PRELIMINARY-REPORT

Increasing numbers of patients with diagnosed HIV infection are presenting to inner-city emergency departments. Unfortunately, there is little information available on the characteristics and emergency clinical problems of HIV-infected patients to guide physicians in patient care and strategies for resource use. Preliminary data from an on-going investigation revealed that there were 254 emergency visits (1.8% of total) by 164 patients with known HIV infection during the four-month period of March to June 1988. Only 171 visits (62%) were likely related to patients' underlying HIV infection. Nine percent of IV drug users (IVDUs) carried a diagnosis of AIDS before presentation compared with 68% of patients who were homosexual or bisexual. Fifty-five patients (21.7%) presented with their first known complication of HIV. Among the 140 risks from patients previously considered asymptomatic, those with homosexual or bisexual risk were 3.6-fold more likely to present with a first-time complication of HIV than were IVDUs. HIV-infected patients were twice as likely to have inadequate insurance compared with a sample of ED seronegative controls. Of the 130 risks by IVDUs, 85% were without adequate insurance coverage compared with 56% of the 91 patient risks from homosexual or bisexuals (P < .05). Generally, patient presentations did not imply an obvious diagnosis; vague constitutional complaints were the most common (42%). Preliminary interpretation of the data is that IVDUs use emergency services as a routine source of care. Because IVDUs probably represent those with more recent infection and HIV infection continues to spread unabated in this risk group, we can expect increasing numbers of patients to present to EDs with symptomatic HIV infection in the future. Unfortunately, very few will be able to bear the costs of emergency services. Because patients with symptomatic HIV infection require a broad range of medical services, it is necessary to know the characteristics of patients to determine current and future health-care needs and costs. © 1990 American College of Emergency Physicians.