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Resident's Forum
Transmission and Diagnosis of Human Immunodeficiency Virus Infection: An Update
FR - Actualización en la transmisión y el diagnóstico de la infección por VIH
E. Ríos Viñuela
Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In recent decades&#44; antiretroviral therapy has seen human immunodeficiency virus &#40;HIV&#41; infection shift from a fatal to a chronic disease&#46; Nonetheless&#44; HIV infection continues to be one of the greatest public health challenges worldwide&#46; During the course of their illness an estimated 80&#8211;95&#37; of HIV-positive patients will develop a skin disease&#44; which in some cases may be the first manifestation of the disease&#46; Therefore&#44; although the general care of HIV patients is beyond the scope of dermatology&#44; it is important that dermatologists have a knowledge of basic aspects of HIV infection&#44; as well as the most notable recent advances&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">According to the latest data published by the United Nations &#40;for 2017&#41;&#44; there are an estimated 36&#46;9 million people infected with HIV worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This represents a 14&#37; increase since 2010&#44; but has been accompanied by decreases in both mortality and the incidence of new infections since access to high activity antiretroviral therapy has become widespread&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The PARTNER and PARTNER 2 studies were carried out to clarify the risk of transmission of HIV between serodiscordant couples &#40;i&#46;e&#46; couples consisting of 1 HIV-positive and 1 HIV-negative individual who did not use barrier protection methods and in which the seropositive patient was receiving antiretroviral treatment and had maintained an undetectable viral load&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Both studies reported a spousal transmission rate of 0&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> These findings prompted the development of the U&#8239;&#61;&#8239;U &#40;Undetectable&#8239;&#61;&#8239;Untransmittable&#41; campaign and underscore the enormous importance of early detection and treatment of infection&#44; not only for individual prognosis but also as a measure to control transmission at the population level&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Diagnosis of HIV infection is established in 2 phases&#58; an initial screening test &#40;generally an enzyme-linked immunosorbent assay &#91;ELISA&#93; test&#41; and a subsequent confirmatory test &#40;Western blot or HIV1&#47;HIV2 differentiation immunoassay&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In Spain&#44; most laboratories use fourth-generation ELISA for screening and Western blot as a confirmatory test&#46; Fourth-generation ELISA has allowed a reduction in the window period to 15&#8211;20 days&#44; as it detects both anti-HIV immunoglobulin &#40;Ig&#41; M and IgG&#44; as well as the viral antigen p24&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Six weeks after the risky sexual contact&#44; a negative fourth-generation ELISA result is considered definitive&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Since 2018&#44; an over-the-counter self-test for early diagnosis of HIV has been available&#46; This test only detects anti-HIV antibodies&#44; and therefore the window period is longer &#40;approximately 3 months&#41;&#44; and despite its high sensitivity and specificity&#44; a positive result must be confirmed using conventional tests&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion&#44; it is important for dermatologists to be up to date with HIV transmission and diagnosis given the cutaneous manifestations that can occur in HIV patients&#46;</p></span>"
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Información del artículo
ISSN: 15782190
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