The last few weeks have been ludicrously busy on the Internal Medicine service keeping me away from my PC and the football pitch. But I am back, sort of.
There is a a push for non-targeted (or universal) HIV screening in clinical setting. How effective is this practice in capturing new diagnoses of HIV, especially in an emergency department setting? A paper published in the Archives of Internal Medicine suggests that non-targeted HIV screening may be of modest benefit.
So nontargeted HIV testing in French emergency departments was feasible yet identified only a few new HIV diagnoses. The authors suggest that this approach may be of little benefit.
I am not sure that I fully agree. If non-targeted HIV screening were employed in emergency rooms and primary care clinics, more and more undiagnosed cases would be detected. This would be one more step forward in curbing the HIV epidemic.
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| Fingerstick HIV testing |
During a randomly assigned 6-week period in 29 participating French emergency departments, 18- to 64-year-old patients were offered a fingerstick HIV test. Among 138,691 visits, there were 78,411 eligible patients, 20 962 of whom (27.0%) were offered HIV testing; 13 229 (63.1%) accepted testing and 12 754 (16.3%) were tested.
Only eighteen patients received new HIV diagnoses. These patients belonged to a high-risk group (n = 17), were previously tested (n = 12), and were either symptomatic or had a CD4 lymphocyte count lower than 350/µL, suggesting late-stage infections (n = 8); 12 patients were linked to care.
Only eighteen patients received new HIV diagnoses. These patients belonged to a high-risk group (n = 17), were previously tested (n = 12), and were either symptomatic or had a CD4 lymphocyte count lower than 350/µL, suggesting late-stage infections (n = 8); 12 patients were linked to care.
So nontargeted HIV testing in French emergency departments was feasible yet identified only a few new HIV diagnoses. The authors suggest that this approach may be of little benefit.
I am not sure that I fully agree. If non-targeted HIV screening were employed in emergency rooms and primary care clinics, more and more undiagnosed cases would be detected. This would be one more step forward in curbing the HIV epidemic.
