Análisis de los motivos de solicitud de serología del virus de la inmunodeficiencia humana (VIH) en urgencias diferentes a los definidos en la estrategia de detección dirigida del programa «Urgències VIHgila» y su potencial inclusión en un futuro documento de consenso

Objective

To describe other reasons for requesting HIV serology in emergency departments (ED) other than the six defined in the SEMES-GESIDA consensus document (DC-SEMES-GESIDA) and to analyze whether it would be efficient to include any of them in the future.

Method

Review of all HIV serologies performed during 2 years in 20 Catalan EDs. Serologies requested for reasons not defined by the DC-SEMES-GESIDA were grouped by common conditions, the prevalence (95% CI) of seropositivity for each condition was calculated, and those whose 95% confidence lower limit was > 0.1% were considered efficient. Sensitivity analysis considered that serology would have been performed on 20% of cases attended and the remaining 80% would have been seronegative.

Results

There were 8044 serologies performed for 248 conditions not recommended by DC-SEMES-GESIDA, in 17 there were seropositive, and in 12 the performance of HIV serology would be efficient. The highest prevalence of detection corresponded to patients from countries with high HIV prevalence (7.41%, 0.91–24.3), lymphopenia (4.76%, 0.12–23.8), plateletopenia (4.37%, 1.20–10.9), adenopathy (3.45%, 0.42–11.9), meningoencephalitis (3.12%, 0.38–10.8) and drug use (2.50%, 0.68–6.28). Sensitivity analysis confirmed efficiency in 6 of them: country with high HIV prevalence origin, plateletopenia, drug abuse, toxic syndrome, behavioral-confusional disorder-agitation and fever of unknown origin.

Conclusion

The DC-SEMES-GESIDA targeted HIV screening strategy in the ED could efficiently include other circumstances not previously considered; the most cost-effective would be origin from a country with high HIV prevalence, plateletopenia, drug abuse, toxic syndrome, behavioral-confusional-agitation disorder and fever of unknown origin.