HIV infection early diagnosis experience in primary care.
BACKGROUND
Traditional screening system focus on classic risk factors "lost" a substantial proportion of HIV-infected patients. Several organizations such as CDC or USPS Task Force favour universal screening for HIV infection for good cost-effectiveness profile. In a previous study prevalence of HIV infection in patients attending our infectious diseases department was high (5.4%).


OBJECTIVE
To determine prevalence of HIV infection in patients aged 20-55 years in primary care (PC).


METHODS
A propsective observational study was undertaken between February and June 2013. We performed a screening of HIV infection type "Opt-out" (offering voluntary rejection) in 4 PC centers (32 Physicians) in San Juan-Alicante. Sample size (n=318) for a prevalence of 1% and a confidence level of 97% was calculated. Nevertheless, other PC physician not recruiting patients performed HIV testing according clinical risk factors.


RESULTS
HIV testing was offered to 508 patients. Mean age 38.9±10 years (58.5% female). Overall, 430 (83.8%) agreed to participate. Finally, 368 patients (71.7% of total) were tested for HIV. No patient had a positive result (100% ELISA HIV negative). However, following clinical practice, 3 patients were diagnosed of HIV in the same period by non-recruiting physicians. In 2 cases, serology was performed at the patient's request and in one case by constitutional syndrome. The 3 patients were MSM.


CONCLUSIONS
1) In our study, we detected no new cases of HIV infection through universal screening. 2) Our screened population could be lower-risk because of high percentage of women included (58.5%). 3) Performing HIV opt-in screening (clinical practice), we detected 3 cases in the same period, all having HIV risk factors (MSM). 4) These results suggest that opt-out screening should be developed in high-risk populations. It is still to be determined what is the best screening strategy in low-risk populations such as ours.
Infectious Diseases, Hospital Clinico San Juan Alicante, Alicante, Spain.
Francisco Jover
FJ
Diaz
Hospital Clinico San Juan Alicante, CSI C/Gerona, Alicante, Spain.
Paz
P
Ortega
Microbiology, Hospital Clinico San Juan Alicante, Alicante, Spain.
Pedro
P
Antequera
Hospital Clinico San Juan Alicante, CS El Cabo, Alicante, Spain.
Blas
B
Cloquell
Hospital Clinico San Juan Alicante, CS Sta Faz, Alicante, Spain.
Marta
M
Alcaraz
Hospital Clinico San Juan Alicante, CS El Cabo, Alicante, Spain.
Mavi
M
Hernandis
Hospital Clinico San Juan Alicante, CS Sta Faz, Alicante, Spain.
Carlos
C
Nuñez
Hospital Clinico San Juan Alicante, CS El Cabo, Alicante, Spain.
Rosario
R
Lloret
Hospital Clinico San Juan Alicante, CS Sta Faz, Alicante, Spain.
Faustino
F
Perez
Hospital Clinico San Juan Alicante, CS Sta Faz, Alicante, Spain.
Sabina Jover
SJ
Perez
Microbiology, Hospital Clinico San Juan Alicante, Alicante, Spain.
Fernando
F
Buñuel
Hospital Clinico San Juan Alicante, CSI C/Gerona, Alicante, Spain.
Francisco
F
Gomez
Hospital Clinico San Juan Alicante, CS Sta Faz, Alicante, Spain.
Marta
M
Sanz
Hospital Clinico San Juan Alicante, CS Sta Faz, Alicante, Spain.
Rafael
R
Ordovas
Hospital Clinico San Juan Alicante, CS El Cabo, Alicante, Spain.
Francisco
F
Torregrosa
Hospital Clinico San Juan Alicante, CS El Cabo, Alicante, Spain.
Angela
A
Barceló
Hospital Clinico San Juan Alicante, CS Juan XXIII, Alicante, Spain.
Consuelo
C
Masegosa
Microbiology, Hospital Clinico San Juan Alicante, Alicante, Spain.
Victoria Ortiz
VO
de la Tabla
Infectious Diseases, Hospital Clinico San Juan Alicante, Alicante, Spain.
Jose María
JM
Cuadrado