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La profilaxis previa a la exposición para la prevención de la infección por el VIH: Declaración de recomendación del
, Douglas K Owens1,2, Karina W Davidson3
1Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
JAMA
|June 12, 2019
Resumen
La profilaxis previa a la exposición (PrEP) reduce significativamente el riesgo de VIH en las personas de alto riesgo. La adherencia es clave para la PrEP
Área de la Ciencia:
- Salud pública
- Enfermedades infecciosas
- La medicina preventiva
Sus antecedentes:
- Más de 1.1 millones de personas en los Estados Unidos viven con el VIH, con 38.281 nuevos diagnósticos en 2017.
- La infección por el VIH, aunque tratable, no tiene cura y conlleva importantes consecuencias para la salud.
- El Grupo de Trabajo de Servicios Preventivos de los Estados Unidos (USPSTF) emite recomendaciones sobre servicios de salud preventivos.
Objetivo del estudio:
- Actualizar la recomendación de la USPSTF sobre la profilaxis previa a la exposición (PrEP) para la prevención del VIH.
- Evaluar la eficacia y seguridad de los regímenes de PrEP para reducir el riesgo de contraer el VIH.
Principales métodos:
- Revisión sistemática de la evidencia sobre los beneficios, riesgos y cumplimiento de la PrEP.
- Análisis de la precisión diagnóstica de las herramientas de evaluación de riesgos para identificar a las personas de alto riesgo.
- Evaluación de la eficacia de la PrEP en relación con las tasas de adherencia en la atención primaria.
Principales resultados:
- Hay pruebas convincentes de que la PrEP beneficia sustancialmente a las personas con alto riesgo de contraer el VIH.
- La eficacia de la PrEP está fuertemente vinculada a la adherencia; la adherencia es crucial para obtener beneficios.
- La PrEP está asociada con daños menores, como efectos adversos renales y gastrointestinales.
Conclusiones:
- El USPSTF recomienda ofrecer PrEP con una terapia antirretroviral efectiva a las personas de alto riesgo.
- El beneficio sustancial de la PrEP en la reducción del riesgo de contraer el VIH está respaldado por una gran certeza.
- La adherencia a la PrEP es fundamental para su eficacia en la prevención de la infección por el VIH.
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