Implementation of an early HIV diagnosis and treatment program in a hospital emergency department

Abstract

Background. To determine the prevalence of undiagnosed HIV infection among individuals presenting to a hospital emergency department with specific clinical conditions, and to describe the characteristics of those diagnosed with HIV.

Material and methods. A cross-sectional study was conducted in the emergency department of the University Hospital of Navarra (Pamplona, Spain) over the first 18 months following the implementation of an early HIV diagnosis program. Adults presenting with herpes zoster, sexually transmitted infections, mononucleosis-like syndrome, community-acquired pneumonia, post-exposure prophylaxis, or chemsex were included. Non-urgent HIV serology tests were requested. In the event of a positive result, patients were informed and referred for consultation to initiate treatment.

Results. Two hundred and fifty-two patients were included (mean age: 37.15 years; 63% male); of these, 37% presented with community-acquired pneumonia, 25% with sexually transmitted infections, and 27% had previous HIV serology. Nine individuals (3.6%) tested positive: six were aged 35 to 55, seven were male, with CD4 counts <500 cells/µL and viral loads <3,400 copies/mL. All accepted antiretroviral treatment and were seen in consultation within ≤6 days.

Conclusions. The early HIV diagnosis program in our emergency department proved effective in identifying HIV infection, particularly among individuals with limited interaction with the healthcare system. These findings support the protocol's utility, its performance, and potential for further optimization.