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

, Douglas K Owens^1,2, Karina W Davidson³

¹Veterans Affairs Palo Alto Health Care System, Palo Alto, California.

|June 12, 2019

Resumen

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.

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.

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