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Examen de detección de la infección por VIH: Declaración de recomendación del grupo de trabajo de servicios

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Se recomienda la detección de la infección por el virus de la inmunodeficiencia humana (VIH) en todos los adolescentes y adultos de entre 15 y 65 años, incluidas las personas embarazadas. La detección y el tratamiento tempranos ofrecen beneficios sustanciales para reducir las complicaciones y la transmisión relacionadas con el VIH.

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Área de la Ciencia:

  • Salud pública
  • Enfermedades infecciosas
  • La medicina preventiva

Sus antecedentes:

  • El VIH sigue siendo un problema importante de salud pública en los Estados Unidos, con millones de personas que viven con la infección y un aumento notable de los diagnósticos entre los adolescentes.
  • La transmisión perinatal del VIH es un problema crítico, aunque las tasas han disminuido debido al cribado y las intervenciones.
  • El Grupo de Trabajo de Servicios Preventivos de los Estados Unidos (USPSTF) emitió previamente recomendaciones en 2013.

Objetivo del estudio:

  • Actualizar las recomendaciones de 2013 de la USPSTF para el cribado del VIH en adolescentes, adultos y mujeres embarazadas.
  • Evaluar los beneficios y los daños de las estrategias de detección y tratamiento del VIH.

Principales métodos:

  • Revisión sistemática de las pruebas de detección del VIH, incluida la precisión de las pruebas, los intervalos de detección y los umbrales de inicio del tratamiento.
  • Evaluación de los beneficios y daños de la terapia antirretroviral (TAR) tanto para las personas no embarazadas como para las embarazadas.
  • Revisión de la evidencia sobre la prevención de la transmisión del VIH de la madre al niño y la seguridad del TARV durante el embarazo.

Principales resultados:

  • Las pruebas actuales de VIH son muy precisas.
  • La identificación temprana y el tratamiento del VIH reducen significativamente los eventos y la mortalidad relacionados con el SIDA.
  • La terapia antirretroviral (TAR) disminuye sustancialmente la transmisión del VIH a las parejas sexuales y la transmisión de madre a hijo.
  • El TAR está asociado con algunos daños, incluidos efectos neuropsiquiátricos, renales y hepáticos, y un mayor riesgo de parto prematuro.

Conclusiones:

  • El USPSTF recomienda el cribado del VIH para adolescentes y adultos de 15 a 65 años, y para individuos más jóvenes / mayores con mayor riesgo.
  • Todas las mujeres embarazadas deben someterse a pruebas de detección del VIH, incluso aquellas que se presentan en el trabajo de parto con un estado desconocido.
  • El beneficio neto del cribado del VIH en estas poblaciones es sustancial.