Recommendations for the early diagnosis of suspected human immunodeficiency virus infection in the emergency department and the referral of patients for follow-up: a consensus statement of the Spanish Society of Emergency Medicine (SEMES).

Almost half of new diagnoses of human immunodeficiency virus (HIV) infection are made late, leading to increased morbidity and mortality, greater spread of infection, and higher public health care costs. Emergency services care for many patients who share behaviors associated with HIV transmission risk who arrive in clinical situations that are associated with HIV infection. A strategy to increase the rates of early diagnosis by promoting serology for HIV when caring for patients with certain clinical profiles might therefore be the key to improvement. This approach is hardly used at present, however, unless the result of serology would change the management of the acute complaint that led to the visit. These recommendations based on evidence from a search and review of recent publications were developed by a group of experts appointed by the Spanish Society of Emergency Medicine (SEMES). The resulting statement aims to support decision-making by emergency physicians and promote HIV screening and referral to appropriate specialists for follow-up in patients with certain conditions (sexually transmitted infections, herpes zoster, community-acquired pneumonia) or reporting certain scenarios (practice of chemsex, need for post-exposure prophylaxis). These 6 settings were selected because they are often seen in emergency departments and are common in patients with HIV-positive tests. The recommendations address when to order serology for HIV and how to manage the referral process. Included are decision-making tools for emergency physicians.