[Emergency medicine and prevention : a contradiction in terms ? Observations based on HIV screening]

In Switzerland, a fifth of people with HIV are unaware of their status and 50 % are diagnosed late (< 350 CD4 / µl). Yet, in the years prior to diagnosis, these patients have often presented to the emergency department (ED) with problems related, or not, to HIV infection, presenting missed opportunities for earlier diagnosis. The current FOPH recommendations assume that doctors can recognise HIV indicator diseases, and patients from high-risk groups, and offer an HIV test (targeted screening). Studies conducted at Lausanne University Hospital ED report that most doctors are unfamiliar with the FOPH recommendations and that HIV screening occurs in only 1 % of patients seen. This review discusses the logic of non-targeted screening in the context of the UNAIDS 2016-2021 strategy to end the AIDS epidemic by 2030.