Episode 21: HIV Screening in the Pediatric ED

Adolescent Medicine, Emergency Medicine, Infectious Disease, Uncategorized

On this episode, host Jason Woods speaks with Dr. Amy Grover about HIV screening in the pediatric emergency department. Dr. Grover works in both the section of emergency medicine and hospital medicine and has an interest in HIV screening.

The highlights:

  • An estimated 50% of adolescents with HIV do not know they have contracted HIV
  • Acute retroviral syndrome has many non specific symptoms and can be difficult to diagnosis but includes the following
    • Fever
    • Fatigue
    • Myalgias
    • Nausea, vomiting, and/or diarrhea
    • Rash that can involve the hands and feed
    • Pharyngitis is typically not as exudative as EBV
  • CDC guidelines recommend that EVERY person ages 13-64 who is sexually active be screened for HIV at least once in their lives, and yearly if ongoing risk for exposure
  • One of the difficult aspects of setting up a screening program is deciding who is responsible for follow up of the results. Each institution will have to discuss what is appropriate for their setting
  • Do not forget to evaluate for risk of other STI, including Syphilis (prevalence is rising in the US)
  • Most rapid screening tests that do not use whole blood can not detect HIV infection until there is an antibody response (3 weeks – 3 months)
  • The 4th generation HIV test can detect infection starting as early as 15 days after infection. Note that there is still a latent period when detection is not possible.
  • One of the important reasons to screen patients is that there is evidence that knowledge of HIV infection decreases high-risk behavior.
  • The benefit and effect of HIV screening may depend on the regional HIV rates

Guests

Amy Grover MD – University of Colorado School of Medicine, Sections of Emergency Medicine and Hospital Medicine, Children’s Hospital Colorado

Important Resources

  1. CDC HIV Resource Library

References

  1. Wilson KM, Klein JD. Adolescents who use the emergency department as their usual source of care. Arch Pediatric Adolesc Med. 2000 Apr;154(4):361-5.
  2. Kitahadta MM, et al. Effect of Early vs Deferred Antiretroviral therapy for HIV on Survival. NEJM 2009;360(18):1815-26.
  3. Marks G, et al. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr.2005 Aug 1;39(4):446-53.
  4. Cohen MS, et al. Antiretroviral Therapy for the prevention of HIV-1 Transmission. NEJM 2016; 375(9):830-839.
  5. Marks G, et al. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS.2006 Jun 26;20(10):1447-50.
  6. Wood E, et al. Does this Adult Patient have Early HIV infection? JAMA 2014; 213 (3): 278-285.
  7. Mehta AS, et al. Practices, Beliefs, and Perceived Barriers to Adolescent Human Immunodeficiency Virus Screening in the Emergency Department. Pediatr Emerg Care 2015; 31:621-626.
  8. Akhter A, et al. Rapid Human Immunodeficiency Virus Testing in the Pediatric Emergency Department: A National Survey of Attitudes Among Pediatric Emergency Practitioners. Pediatr Emerg Care 2012; 28:1257-1262.
  9. Haines CJ, et al. Pediatric emergency department – based rapid HIV testing: adolescent attitudes and preferences. Pediatr Emerg Care.2011 Jan;27(1):13-6.

Episode 14: UTICalc with Nader Shaikh

Calculators, Emergency Medicine, Infectious Disease, Uncategorized

On this episode, host Jason Woods speaks to Dr. Nader Shaikh about his recent paper on the development of a calculator (UTICalc) to estimate the probability of UTI in pediatric patients. The calculator itself is fantastic and easy to use (see link below) but the discussion centers on the methods behind the calculator. We dig into how these calculators are developed, how to determine if they are accurate/useful, and how to use them in clinical practice.

Important Links

  1. UTI Calculator link – UTICalc
  2. AAP UTI Guidelines, 2016 Reaffirmation of 2011 Guidelines
  3. AAP 2011 UTI Guidelines Update

References

  1. Shaikh N et al. “Development and Validation of a Calculator for Estimating the Probability of Urinary Tract Infection in Young Febrile Children”. JAMA Pediatr. 2018 Jun 1;172(6):550-556. doi: 10.1001/jamapediatrics.2018.0217.
  2. Roberts  KB; Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management.  Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months.  Pediatrics. 2011;128(3):595-610.Lavelle  JM, Blackstone  MM, Funari  MK,  et al.  Two-step process for ED UTI screening in febrile young children: reducing catheterization rates.  Pediatrics. 2016;138(1):e20153023.
  3. Shaikh  N, Morone  NE, Bost  JE, Farrell  MH.  Prevalence of urinary tract infection in childhood: a meta-analysis.  Pediatr Infect Dis J. 2008;27(4):302-308.
  4. Hoberman  A, Wald  ER, Reynolds  EA, Penchansky  L, Charron  M.  Pyuria and bacteriuria in urine specimens obtained by catheter from young children with fever.  J Pediatr. 1994;124(4):513-519.
  5. Hoberman  A, Chao  HP, Keller  DM, Hickey  R, Davis  HW, Ellis  D.  Prevalence of urinary tract infection in febrile infants.  J Pediatr. 1993;123(1):17-23.

Guests

Nader Shaikh MD, Associate Professor, General Academic Pediatrics, Children’s Hospital of Pittsburgh