Previously unrecognized HIV infection among hospitalized patients

We reviewed records of 150 patients found to be HIV-infected while hospitalized between November 1991 and February 1993. One hundred (67%) were uninsured, and 33 (22%) were insured by Medicaid. There were 1606 hospital days, and 24 (16%) were admitted to an intensive care unit (total 153 days). Hospital charges totalled $1.6 million, 69% to uninsured patients. CD4 lymphocyte counts were < 200/mm³ in 50 (57%) and < 500/mm³ in 75 (86%) of the 87 patients in whom they were measured. Diagnoses included AIDS indicator conditions in 21 (14%) and pyogenic bacterial infections in 59 (39%). Since 1988, 141 (94%) had prior hospitalizations (total 103), emergency department visits (543), or clinic visits (160) at this hospital. Despite multiple encounters with the health care system, many patients with advanced HIV infection were only identified during hospitalization. In hospitals with high prevalences of HIV infection, voluntary testing and enrollment in medical care may reduce costs and decrease morbidity from preventable illness.