Evaluation of a HIV screening strategy in the hospital setting to reduce undiagnosed infection.

INTRODUCTION: In Spain, half of new HIV diagnoses are late and a significant proportion of people living with HIV have not yet been diagnosed. Our aim was to evaluate the effectiveness of an automated opportunistic HIV screening strategy in the hospital setting. METHODS: Between April 2022 and September 2023, HIV testing was performed on all patients in whom a hospital admission analytical profile, a pre-surgical profile and several pre-designed serological profiles (fever of unknown origin, pneumonia, mononucleosis, hepatitis, infection of sexual transmission, rash, endocarditis and myopericarditis) was requested. A circuit was started to refer patients the specialists. RESULTS: 6407 HIV tests included in the profiles were performed and 18 (0.3%) new cases were diagnosed (26.4% of diagnoses in the health area). Five patients were diagnosed by hospital admission and pre-surgery profile and 13 by a serological profile requested for indicator entities (fever of unknown origin, sexually transmitted infection, mononucleosis) or possibly associated (pneumonia) with HIV occult infection. Recent infection was documented in 5 (27.8%) patients and late diagnosis in 9 (50.0%), of whom 5 (55.5%) had previously missed the opportunity to be diagnosed. CONCLUSIONS: This opportunistic screening was profitable since the positive rate of 0.3% is cost-effective and allowed a quarter of new diagnoses to be made, so it seems a good strategy that contributes to reducing hidden infection and late diagnosis.

Bartonella Endocarditis in Spain: Case Reports of 21 Cases.

Blood culture negative endocarditis (BCNE) is frequent in infective endocarditis (IE). One of the causes of BCNE is fastidious microorganisms, such as Bartonella spp. The aim of this study was to describe the epidemiologic, clinical characteristics, management and outcomes of patients with Bartonella IE from the "Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España (GAMES)"cohort. Here we presented 21 cases of Bartonella IE. This represents 0.3% of a total of 5590 cases and 2% of the BCNE from the GAMES cohort. 62% were due to Bartonella henselae and 38% to Bartonella quintana. Cardiac failure was the main presenting form (61.5% in B. hensalae, 87.5% in B. quintana IE) and the aortic valve was affected in 85% of the cases (76% in B. henselae, 100% in B. quintana IE). Typical signs such as fever were recorded in less than 40% of patients. Echocardiography showed vegetations in 92% and 100% of the patients with B. henselae and B. quintana, respectively. Culture was positive only in one patient and the remaining were diagnosed by serology and PCR. PCR was the most useful tool allowing for diagnosis in 16 patients (100% of the studied valves). Serology, at titers recommended by guidelines, only coincided with PCR in 52.4%. Antimicrobial therapy, in different combinations, was used in all cases. Surgery was performed in 76% of the patients. No in-hospital mortality was observed. One-year mortality was 9.4%. This article remarks the importance for investigating the presence of Bartonella infection as causative agent in all BCNE since the diagnosis needs specific microbiological tools and patients could benefit of a specific treatment.