A recent study of emergency department patients demonstrates the value of fourth generation HIV screenings. Over 22,000 people were tested for HIV using an antigen/antibody combination HIV assay test. Physicians delivered positive test results to 78 patients with the assistance of a linkage-to-care specialist. Of particular importance, 18 (23%) of these were acute infections. Acute infections are not likely to be found using previous testing methods. An abstract and podcast are available at no cost.