Hospital emergency services can be a fundamental network for detecting HIV cases that are going unnoticed. This is demonstrated by a Spanish study that will be presented next week at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), to be held in Copenhagen (Denmark) between April 15 and 18.
The work shows that performing diagnostic tests in the ER on patients with certain suggestive signs can be a very useful strategy for uncover hidden cases of infection.
“In Spain it is estimated that 13% of people with HIV do not know they have it”explains Juan González del Castillo, coordinator of the Emergency Infections Group of the Spanish Society of Emergency and Emergency Medicine (SEMES) and leader of the research.
An early diagnosis, continues the head of the Emergency Department of the Hospital Clínico de Madrid, is essential to avoid complications and prevent the virus from continuing to spread. However, this often does not happen. “At the moment, almost half of HIV diagnoses in Spain are made latewhen the immunological situation of the patients is already bad, which entails a worse prognosis”, adds the specialist.
This finding was what led SEMES in 2021 to launch some recommendations aimed at emergency services for the early diagnosis of patients with suspected HIV infection and their subsequent referral for study and follow-up. These guidelines recommend performing a serology test for people who come to the emergency service with disorders or signs that could indicate a greater risk of infection, such as the presence of sexually transmitted diseases, mononucleosis syndromevirus del herpes zster (in patients 18 to 65 years with no known predisposing factors), ncommunity acquired pneumoniapractice of chemsex and use of HIV post-exposure prophylaxis.
To assess the usefulness of the measure, the research compared the HIV diagnoses made in 34 emergency services in the country before July 2019 and after the implementation of the SEMES recommendations.
The results showed a clear increase. The diagnoses, in fact, tripled, going from 65 to 224 in the periods studied, which represents an increase of 220%.
The number of tests carried out grew from 7,080 to 13,436 tests, 75% more. In the same way, the rate of positives also experienced a rise, which reached 1.67% from the previous 0.92%.
On the other hand, the study has also found a Significant reduction in waiting time to receive an appointment with a specialist in infectious diseases (the average went from 30 to 7 days), as well as access to antiretroviral medication (from 24 to 14 days).
“These are very good results that show that the Emergency Services can be key to increasing diagnoses and prevent new infections“stresses Gonzlez del Castillo, who emphasizes that emergencies are the only contact with health care that many individuals have, so they represent a unique opportunity to detect hidden cases of HIV.
Currently, he explains, a total of 103 emergency services throughout the country have implemented the aforementioned recommendations, included in the SEMES program ‘Leave your mark’. This implantation has made it possible to diagnose 888 new cases between 2021 and 2022. “If we take into account that each diagnosis makes it possible to prevent between two and four new future cases, between 1,700 and 3,500 new infections have been averted“adds the specialist.
“Increasing early detection and diagnosis not only has a great impact on people’s health, but is also key to public health and saves on healthcare costs,” he points out.
“In most developed countries, the late diagnosis of HIV infection occurs in about a third of cases. This occurs more frequently in women and heterosexual men, who do not have a perception of risk of having been infected, so they do not they request that they be tested, or on some occasions, the infection is not suspected in the face of non-specific pictures. That is why it is important to look for strategies that allow a broader screening“, points out, for his part, Jess Rodrguez Bao, head of the Infectious Diseases Service of the Virgen Macarena University Hospital in Seville and former president of the European Society for Clinical Microbiology and Infectious Diseases. “The performance of HIV tests in the Emergency Department in certain person profiles is one of these strategies that, according to this study, may be efficient and, therefore, its extension seems reasonable”, concludes Rodríguez Bao, who did not participate in the research.
According to data from the Carlos III Health Institute, in 2021, 2,786 new HIV diagnoses were made in Spain.
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