Background:  In 1993 the US Centers for Disease Control and Prevention (CDC) published a surveillance case definition for AIDS (i.e. AIDS-defining events), which includes 25 clinical conditions that suggest severe immunodeficiencies. The CDC advised that clinicians should be aware that these clinical conditions are highly suggestive of HIV infection and of the potential need for prophylactic and therapeutic intervention. Our objective is to assess the rate of receipt of HIV screening or monitoring among insured members who were diagnosed with suspected AIDS-defining events and who do not have an existing HIV/AIDS diagnosis.

Method:  We used 2006 administrative claims data for 8 health plans from diverse regions of the United States, representing a total of 7.8 million insured lives. Our study sample consists of continuously insured members diagnosed with AIDS-defining events (n = 10,589). We excluded members with a history of HIV or organ transplant, on hospice or taking immunosuppressive medications. We assessed the receipt of an HIV screening test, CD4 count, or HIV viral load in the 150 days prior though 60 days after the presentation of the AIDS-defining event, stratifying by disease category.

Results:  Overall, only 4.9% of members with AIDS-defining events received HIV screening or monitoring tests. Listed by order of the most common AIDS-defining events, the denominator size and rate of HIV screening or monitoring are as follows:  immunoblastic lymphoma or Burkitt’s lymphoma (n = 2945, 3%), recurrent pneumonia (n = 2178, 3%), encephalopathy (n = 1750, 4%), invasive cervical cancer (n = 932, 4%), tuberculosis (n = 695, 9%), candidiasis of bronchi, trachea, lungs, or esophagus (n = 447, 11%), disseminated or extrapulmonary histoplasmosis (n =350, 6%), wasting or cachexia (n = 258, 2%), disseminated herpes (n = 65, 12%), extrapulmonary M. avium or M. kansasi (n = 37, 8%), and Pneumocystis jiroveci pneumonia (n = 36, 5.6%). Among members diagnosed with multiple AIDS-defining events (n = 788), 11% were screened or monitored for HIV. The HIV screening or monitoring rate was 6% (n = 82) in members with AIDS-defining events not listed above.

Conclusions:  Rates of HIV screening or monitoring among members with suspected AIDS-defining events appear to be very low. This suggests that awareness of the link of these clinical conditions to HIV infection may be low among providers. More research based on medical record review is urgently needed to verify these findings and to investigate contributing factors to these low rates.