Validation of an abbreviated version of the Denver HIV Risk Score for prediction of HIV infection in an urban ED

Published:March 06, 2014DOI:



      We sought to evaluate the performance of an abbreviated version of the Denver HIV Risk Score in 2 urban emergency departments (ED) with known high undiagnosed HIV prevalence.


      We performed a secondary analysis of data collected prospectively between November 2005 and December 2009 as part of an ED-based nontargeted rapid HIV testing program from 2 sites. Demographics; HIV testing history; injection drug use; and select high-risk sexual behaviors, including men who have sex with men, were collected by standardized interview. Information regarding receptive anal intercourse and vaginal intercourse was either not collected or collected inconsistently and was thus omitted from the model to create its abbreviated version.


      The study cohort included 15184 patients with 114 (0.75%) newly diagnosed with HIV infection. HIV prevalence was 0.41% (95% confidence interval [CI], 0.21%-0.71%) for those with a score less than 20, 0.29% (95% CI, 0.14%-0.52%) for those with a score of 20 to 29, 0.65% (95% CI, 0.48%-0.87%) for those with a score of 30 to 39, 2.38% (95% CI, 1.68%-3.28%) for those with a score of 40 to 49, and 4.57% (95% CI, 2.09%-8.67%) for those with a score of 50 or higher. External validation resulted in good discrimination (area under the receiver operating characteristic curve, 0.75; 95% CI, 0.71-0.79). The calibration regression slope was 0.92 and its R2 was 0.78.


      An abbreviated version of the Denver HIV Risk Score had comparable performance to that reported previously, offering a promising alternative strategy for HIV screening in the ED where limited sexual risk behavior information may be obtainable.
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        • Liddicoat R.
        • Horton N.
        • Urban R.
        • Maier E.
        • Christiansen D.
        • Samet J.
        Assessing missed opportunities for HIV testing in medical settings.
        J Gen Intern Med. 2004; 19: 349-356
        • Centers for Disease Control and Prevention
        Revised recommendations for HIV counseling, testing, and referral.
        MMWR Recomm Rep. 2001; 50: 1-62
        • Centers for Disease Control and Prevention
        Recommendations for HIV testing services for inpatients and outpatients in acute-care hospital settings.
        MMWR Recomm Rep. 1993; 42: 1-10
        • Branson B.
        • Handsfield H.
        • Lampe M.
        • et al.
        Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings.
        MMWR Recomm Rep. 2006; 55: 1-17
      1. Rothman R, Hsieh Y-H, Harvey L, et al. 2009 US Emergency Department HIV Testing Practices. Ann Emerg Med 2011;58:S3-S9.e4.

        • Haukoos J.
        • Hopkins E.
        • Byyny R.
        • et al.
        Design and implementation of a controlled clinical trial to evaluate the effectiveness and efficiency of routine opt-out rapid human immunodeficiency virus screening in the emergency department.
        Acad Emerg Med. 2009; 16: 800-808
        • Hsieh Y.-H.
        • Jung J.
        • Shahan J.
        • et al.
        Outcomes and cost analysis of three operational models for rapid HIV testing services in an academic inner-city emergency department.
        Ann Emerg Med. 2011; 58: S133-S139
        • Haukoos J.
        • Hopkins E.
        • Conroy A.
        • et al.
        Routine opt-out rapid HIV screening and detection of HIV infection in emergency department patients.
        JAMA. 2010; 304: 284-292
        • Haukoos J.
        • Lyons M.
        • Lindsell C.
        • et al.
        Derivation and validation of the Denver Human Immunodeficiency Virus (HIV) Risk Score for targeted HIV screening.
        Am J Epidemiol. 2012; 175: 838-846
        • Hsieh Y.-H.
        • Harvey L.
        • Burah A.
        • Shahan J.
        • Kelen G.
        • Rothman R.
        Rapid HIV testing in emergency departments—comparison of results from 2 different operational programs in inner-city and urban sites in Baltimore, Maryland.
        Acad Emerg Med. 2010; 17: S57
        • Rothman R.
        • Kelen G.
        • Harvey L.
        • et al.
        Factors associated with no or delayed linkage to care in newly diagnosed human immunodeficiency virus (HIV)-1–infected patients identified by emergency department–based rapid HIV screening programs in two urban EDs.
        Acad Emerg Med. 2012; 19: 497-503
        • Haukoos J.
        • Hopkins E.
        • Bender B.
        • et al.
        Comparison of enhanced targeted rapid HIV screening using the Denver HIV risk score to nontargeted rapid HIV screening in the emergency department.
        Ann Emerg Med. 2013; 61: 353-361
        • Hsieh Y.-H.
        • Jung J.
        • Shahan J.
        • Moring-Parris D.
        • Kelen G.
        • Rothman R.
        Emergency medicine resident attitudes and perceptions of HIV testing before and after a focused training program and testing implementation.
        Acad Emerg Med. 2009; 16: 1165-1173
        • Vlahov D.
        • Des Jarlais D.
        • Goosby E.
        • et al.
        Needle exchange programs for the prevention of human immunodeficiency virus infection: epidemiology and policy.
        Am J Epidemiol. 2001; 154: S70-S77
        • Chen M.
        • Rhodes P.
        • Hall I.
        • et al.
        Prevalence of undiagnosed HIV infection among persons aged ≥13 years—National HIV Surveillance System, United States, 2005-2008.
        MMWR Morb Mortal Wkly Rep. 2012; 61: 57-64
        • Moyer V.
        • the U.S. Preventive Services Task Force
        Screening for HIV: U.S. Preventive Services Task Force Recommendation Statement.
        Ann Intern Med. 2013; 159: 51-60
        • Brown J.
        • Shesser R.
        • Simon G.
        Establishing an ED HIV screening program: lessons from the front lines.
        Acad Emerg Med. 2007; 14: 658-661
        • Haukoos J.
        • Mehta S.
        • Harvey L.
        • Calderon Y.
        • Rothman R.
        Research priorities for human immunodeficiency virus and sexually transmitted infections surveillance, screening, and intervention in emergency departments: consensus-based recommendations.
        Acad Emerg Med. 2009; 16: 1096-1102
        • Hsieh Y.-H.
        • Wilbur L.
        • Rothman R.
        HIV testing in US emergency departments: at the crossroads.
        Acad Emerg Med. 2012; 19: 975-977
        • Bayer R.
        • Fairchild A.
        Changing the paradigm for HIV testing—the end of exceptionalism.
        N Engl J Med. 2006; 355: 647-649
        • Chou R.
        Routine screening for chronic human immunodeficiency virus infection: why don't the guidelines agree?.
        Epidemiol Rev. 2011; 33: 7-19
        • Thornton A.
        • Rayment M.
        • Elam G.
        • et al.
        Exploring staff attitudes to routine HIV testing in non-traditional settings: a qualitative study in four healthcare facilities.
        Sex Transm Infect. 2012; 88: 601-606
        • Haukoos J.
        The impact of nontargeted HIV screening in emergency departments and the ongoing need for targeted strategies.
        Arch Intern Med. 2012; 172: 20-22
        • Rothman R.
        • Gauvey-Kern M.
        • Woodfield A.
        • et al.
        Streamlining HIV testing in the emergency department—leveraging kiosks to provide true universal screening: a usability study.
        Telemed J E Health. 2014; 20: 122-127
        • Vlahov D.
        • Junge B.
        • Brookmeyer R.
        • et al.
        Reductions in high-risk drug use behaviors among participants in the Baltimore needle exchange program.
        J Acquir Immune Defic Syndr Hum Retrovirol. 1997; 16: 400-406