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Inicio Enfermedades Infecciosas y Microbiología Clínica (English Edition) Screening for human immunodeficiency virus
Journal Information
Vol. 36. Issue 4.
Pages 256 (April 2018)
Vol. 36. Issue 4.
Pages 256 (April 2018)
Letter to the Editor
DOI: 10.1016/j.eimce.2018.02.015
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Screening for human immunodeficiency virus
Cribado de virus de inmunodeficiencia humana
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Cesar Henriquez Camachoa,
Corresponding author
doctorcesarhenriquez@gmail.com

Corresponding author.
, Juan E. Losaa, José Pérez Molinab, Paola Villafuertec
a Hospital Universitario Fundación Alcorcón, Alcorcón , Madrid, Spain
b Hospital Ramón y Cajal, Madrid, Spain
c Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
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Dear Editor,

We have read with great interest the article by Reyes et al.,1 which lays out a prospective work done in an A&E department applying a rapid HIV diagnosis test with a voluntary exclusion (opt-out) strategy. In this work, a low prevalence of new HIV diagnoses among the participants was found.

We agree with the authors that performing universal opt-out screenings in an A&E department corresponding to a population of low prevalence would have little impact in terms of public health. In a meta-analysis2 that included 28 screening studies (with voluntary inclusion and exclusion) performed in A&E departments, we found that the prevalence detected by an opt-out strategy was 0.40% (373 cases), compared with the voluntary inclusion (opt-in) strategy, which was 0.52% (419 cases).

We agree with the authors with regard to the promotion of voluntary screening, especially in populations with greater risk (targeted voluntary inclusion) and not to perform universal opt-out screening due to the greater occurrence of false positives. Although some recommendations emphasise the opt-out strategy when the prevalence of HIV infection is >0.1%3,4; it has been seen that in our environment, in primary care, there are studies that report prevalence of 0.35%.5

On the other hand, the cost to the national health system of an undiagnosed HIV-infected patient is very high, not only because of the delay in diagnosis and its consequences for the patient's health, but also because it remains a source of infection for others.

Finally, we believe that in the specific case of A&E departments, the strategy that is likely to be most efficient is the targeted opt-in strategy.

References
[1]
J. Reyes, L. Fernandez, L. Force, M. Daza, C. Agusti, J. Casabona.
Estudio del impacto a nivel de salud pública del cribado universal del virus de la inmunodeficiencia humana en un servicio de urgencias.
Enferm Infecc Microbiol Clin, 35 (2017), pp. 434-437
[2]
C. Henriquez, P. Villafuerte, J. Losa, J. Perez-Molina, E. Gotuzzo, N. Cheyne.
Opt-out screening strategy for HIV infection among patients attending emergency departments: systematic review and meta-analysis.
HIV Med, 18 (2017), pp. 419-429
[3]
V.A. Moyer.
U.S. preventive services task force screening for HIV: U.S. preventive services task force recommendation statement.
[4]
Guía de recomendaciones para el diagnóstico precoz del VIH en el ámbito sanitario.
Ministerio de Sanidad, Servicios Sociales e Igualdad, (2014),
[5]
S. Moreno, M. Orodobás, J. Sanz, B. Ramos, J. Astray, M. Ortiz, et al.
Prevalence of undiagnosed HIV infection in the general population having blood tests within primary care in Madrid, Spain.
Sex Transm Infect, 88 (2012), pp. 522-524

Please cite this article as: Henriquez Camacho C, Losa JE, Pérez Molina J, Villafuerte P. Cribado de virus de inmunodeficiencia humana. Enferm Infecc Microbiol Clin. 2018;36:256.

Copyright © 2017. Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica
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