Instituto de Investigación Sanitaria, Hospital San Carlos (IdISSC), Madrid, España. Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España.
Servicio de Medicina Preventiva, Unidad de Apoyo Metodológicoa la Investigación (UAMI), Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España.
Emergencias. 2022 Jun;34(3):204-212.
The rates of undiagnosed and late-diagnosed human immunodeficiency virus (HIV) infection are high. Screening for HIV infection in hospital emergency departments (EDs) could offer a way to increase the number of diagnoses. Our aim was to analyze whether universal hospital ED screening for HIV is efficient.
We followed the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, the Cochrane Library, LILACS, Scopus, EMBASE, and the Web of Science were searched using the following terms: "HIV infections/epidemiology," "AIDS serodiagnosis," "emergency service, hospital," "prevalence," and "mass screening/methods." The searches were limited to a 5-year time frame (2016-2020); only publications in English or Spanish were collected. We included studies of universal HIV screening among hospital ED patients and evaluated them using the Quality Assessment Tool for Quantitative Studies.
A total of 273 articles were identified. Twelve met the inclusion criteria. The studies analyzed 103 731 patient samples and yielded 652 new HIV diagnoses. A random effects model estimated an overall new-diagnosis prevalence of 0.60% (95% CI, 0.39%-0.84%). The heterogeneity statistic I2 was high, at 90.02% (P .001). Estimates of prevalence based on studies carried out in Europe, the United States, and Africa were, respectively, 0.48% (95% CI, 0.13%-1.03%), 0.54% (95% CI, 0.33%-0.40%), and 5.6% (95% CI, 3.37%-9.2%). The studies received quality ratings of moderate or strong.
Although the reviewed studies applied various screening strategies to identify new HIV diagnoses, our findings support the conclusion that universal screening is efficient.
人类免疫缺陷病毒（HIV）感染的未确诊和延迟确诊率很高。在医院急诊科（ED）筛查 HIV 感染可能是增加诊断数量的一种方法。我们的目的是分析在医院 ED 进行普遍 HIV 筛查是否有效。
我们遵循系统评价和荟萃分析首选报告项目（PRISMA）的指南。使用以下术语在 PubMed、Cochrane 图书馆、LILACS、Scopus、EMBASE 和 Web of Science 中进行搜索：“HIV 感染/流行病学”、“艾滋病血清学诊断”、“急诊服务，医院”、“患病率”和“大规模筛查/方法”。搜索范围限于 5 年时间框架（2016-2020 年）；仅收集英语或西班牙语的出版物。我们纳入了针对医院 ED 患者普遍进行 HIV 筛查的研究，并使用定量研究质量评估工具对其进行了评估。
共确定了 273 篇文章。符合纳入标准的有 12 项研究。这些研究分析了 103731 个患者样本，发现了 652 例新的 HIV 诊断。随机效应模型估计总体新诊断患病率为 0.60%（95%CI，0.39%-0.84%）。异质性统计量 I2 很高，为 90.02%（P<.001）。基于在欧洲、美国和非洲进行的研究的患病率估计值分别为 0.48%（95%CI，0.13%-1.03%）、0.54%（95%CI，0.33%-0.40%）和 5.6%（95%CI，3.37%-9.2%）。这些研究的质量评分均为中度或强。
尽管审查的研究应用了各种筛查策略来识别新的 HIV 诊断，但我们的研究结果支持普遍筛查有效的结论。
