HIV False-Positive Test in the Setting of CD4 Lymphocytopenia.

In 2016, we implemented a non-targeted Emergency Department (ED)-based HIV screening program at our academic medical center following revised CDC guidelines utilizing the Abbott Alinity 4th generation HIV-1/2 antigen (Ag)/antibody (Ab) immunoassay (Abbott Laboratories, Abbott Park, IL). Following the CDC algorithm, after reactive fourth-generation testing, HIV-1/2 Ab testing is conducted. Patients undergoing acute seroconversion (acutes) may express p24 Ag but have a negative confirmatory Ab test. Acutes have the same laboratory signature during the ED encounter as those that are false positive (False +), and the two patient groups are denoted as "equivocals" until viral load testing specifies a definitive HIV status. Among False + patients (Ab/Ag positive, Ab negative, viral load undetectable), there have been limited studies on those also demonstrating a reduction in CD4+ count, an uncommon phenomenon known as "idiopathic CD4 lymphocytopenia." We review a patient with a reactive fourth-generation HIV Ab/p24 Ag test on two separate occasions. Despite lymphopenia with a reduced CD4 count, his symptoms resolved, and an RNA PCR test did not detect any presence of HIV (False +). This patient was unique as False + patient with p24 Ag reactive, as well as a coincidental low CD4 count in the absence of HIV infection. A low CD4 count is often a sign of significant HIV infection.

Exploring lived experiences of gunshot wound survivors: A key to ethnographically informed public health interventions for curbing firearm violence.

INTRO: The high rates of gun violence in the United States are a recognized public health concern with increased attention since the 1990's. The predominant studies used in gun violence research have been epidemiological approaches and quantitative analyses. This study, instead, examines lived experiences of gunshot wound survivors to better understand their situations. This study also compared the different census categories and their types of gunshot wound injuries. Ethnographic informed analyses may inform public health interventions to decrease firearm injuries. METHODS: Data was collected through a series of semi-structured interviews at the emergency department of an urban, Level-1, academic trauma center. 96 patients with gunshot wounds (GSWs) from 2018-2022 were included in the study. Thematic analysis was conducted after coding interview responses. RESULTS: There was a significant difference found between the 2 census categories (White and Minority populations). Those who self-identified as white had more self-inflicted GSWs (6) than other groups. Those who self-identified in the minority population had more GSWs as a result of an altercation (36) or as an innocent bystander (20). Interview data also demonstrated a trend in changing opinions about firearms in a group of participants with remote previous gunshot wounds (pGSW). When compared to the acute gunshot wound group (aGSW) the previous gunshot wound group (pGSW) responses showed support for increased gun safety and policies that limit firearm access. CONCLUSION: Different injury patterns between census groups demonstrates that multiple public health approaches will be needed to decrease firearm violence. Ethnographically informed approaches, including the support of people with previous GSW injuries, may help craft those interventions to reduce injury. Matched peer support programs represent one potential intervention to decrease secondary injury and firearm violence.