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Background and Objective: Emergency departments (ED) play a critical role in acute care delivery and are at the interface of the community and the medical system. Some have capitalized on this role by implementing public health initiatives, such as human immunodeficiency virus (HIV) screening. Lab-based, fourth-generation testing detects acute HIV infection (AHI) when patients are highly infectious, may have symptoms, and often are unaware of exposure. We describe newly diagnosed HIV from EDs across the U.S. with focus on the prevalence of AHI and the proportion of AHI among all newly diagnosed. Methods: We collected data from six urban EDs in geographically distinct areas that have implemented HIV screening algorithms using fourth-generation testing capabilities. Data was aggregated to determine the total number of HIV tests performed, new HIV diagnoses and number of AHI. We defined AHI based on a reactive HIV Ag/ Ab assay, negative HIV ½ antibody differentiation test, and detectable HIV-1 RNA. Results: During the study period ending December 31 2015, 159,102 HIV Ag/Ab tests were performed. In total 2100 patients were identified with HIV; 605 (0.38%) were new HIV diagnoses, of which 98 (16.3%) were AHI. Total prevalence of AHI was 0.06%, and the percentage of newly diagnosed HIV that were AHI ranged from 13.1%-55.6% in the six EDs. Conclusion: EDs are the central component of the acute care delivery system in the U.S. The percentage of AHI among ED patients is likely secondary to these patients seeking care for symptoms attributable to AHI and provides a valuable opportunity for early interventions. [ABSTRACT FROM AUTHOR]