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.

Resistencias primarias a los fármacos antirretrovirales en los pacientes diagnosticados de infección por el VIH en Gran Canaria entre los años 2002-2005 / Primary antiretroviral drug resistance among patients diagnosed with HIV infection in Gran Canaria (Spain) between 2002 and 2005

Objetivo. Estudiar la prevalencia de resistencias primarias a los fármacos antirretrovirales en pacientes diagnosticados de infección por virus de la inmunodeficiencia humana (VIH) durante el período 2002-2005 y sus características clínico-epidemiológicas. Pacientes. Se realizó un estudio prospectivo de resistencias genotípicas mediante secuenciación genética de 125 pacientes (88,0% de los pacientes diagnosticados en el año 2002, 28,9% en 2003-2004 y 87,9% en 2005). Trece de ellos se diagnosticaron de infección primaria reciente. Resultados. En 16 pacientes (12,8%) se detectó la presencia de alguna mutación de resistencia, cuatro con infección reciente (30,8%) y 12 con infección crónica o de duración desconocida (10,7%). Seis pacientes (4,8%) presentaron alguna mutación de resistencia a los inhibidores de la transcriptasa inversa análogos de nucleósido/tido, 9 (7,2%) a los no análogos y 2 pacientes (1,6%) a los inhibidores de la proteasa. Un paciente (0,8%) presentó multirresistencia. Se observó un mayor porcentaje de resistencias en los pacientes con subtipo B (15,5%), la población homosexual/bisexual (17,9%) y los pacientes diagnosticados en el año 2005 (17,9%). En los pacientes con diagnóstico de infección crónica o de duración desconocida, la tasa de resistencia aumentó desde un 9,3% en el año 2002 hasta un 16,3% en 2005. Conclusiones. La tasa global de resistencia a los fármacos antirretrovirales es elevada, tanto en pacientes con infección reciente como crónica, con una tendencia a aumentar en los últimos años. Las pruebas de detección de resistencias se deberían de realizar a todos los pacientes antes de iniciar el tratamiento (AU)

Background. This study examines the prevalence of primary resistance to antiretroviral drugs in patients diagnosed with HIV infection during 2002 to 2005 and determines the clinical and epidemiological characteristics of this population. Methods. A prospective analysis of genotypic resistance was carried out in 125 patients by gene sequencing (88.0% diagnosed in 2002, 28.9% in 2003-2004, and 87.9% in 2005). Thirteen patients had a diagnosis of recent primary infection. Results. Sixteen patients (12.8%) carried viruses with at least one drug-resistance mutation; among them, 4 had recent infection (30.8%) and 12 chronic infection or infection of unknown duration (10.7%). Six patients (4.8%) presented at least one resistance mutation to nucleoside/tide reverse transcriptase inhibitors, 9 patients (7.2%) to non-nucleoside/ tide reverse transcriptase inhibitors inhibitors and 2 patients (1.6%) to protease inhibitors. One patient (0.8%) harbored a multidrug-resistant variant. The frequency of primary resistance was higher in patients with HIV subtype B (15.5%), in the homosexual/bisexual population (17.9%), and in patients diagnosed in 2005 (17.9%). Prevalence increased from 9.3% in 2002 to 16.3% in 2005 in chronically infected patients or those with unknown duration of the infection. Conclusions. Primary resistance to antiretroviral drugs is high in both recent and chronic HIV infection and has increased in recent years. Genotype resistance testing in patients with a diagnosis of HIV infection is recommended before beginning antiretroviral therapy (AU)