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Según la Organización Mundial de la Salud (OMS) cada día se infectan en el mundo unas 14.000 personas. Sin embargo, en pocos casos el diagnóstico se realizará durante la fase aguda de la infección por el virus de la inmunodeficiencia humana (VIH). La infección aguda por el VIH es el período comprendido entre la entrada del VIH en el organismo y la seroconversión completa, definida por una prueba de Western blot positiva. Este período dura aproximadamente 30 días y la mayoría de veces (40-90%) se acompaña de manifestaciones clínicas banales (fiebre, exantema, faringitis, úlceras en mucosas entre otras), de 2 semanas de duración, que se pueden confundir con otros procesos infecciosos comunitarios, entre ellos la mononucleosis infecciosa. El diagnóstico microbiológico se realiza por la ausencia de anticuerpos en plasma (prueba de análisis de inmunoabsorción ligado a enzimas [ELISA] negativa) y la presencia de una carga viral (CV) del VIH en plasma positiva (> 10.000 copias/ml). El diagnóstico de la infección aguda por el VIH es muy importante por varias razones: a) epidemiológicas, es el período con las mayores tasas de transmisión de la infección por el VIH y permite conocer el patrón de crecimiento de la epidemia y la tasa de transmisión de cepas resistentes a los antirretrovirales, que en España es del 10%; b) inmunopatológico, ya que es una oportunidad única para estudiar los mecanismos virológicos, inmunológicos, y genéticos implicados en la transmisión y patogenia de esta enfermedad; y c) terapéutico, ya que el inicio del tratamiento antirretroviral en esta fase podría modificar la historia natural de esta infección. Sin embargo, este es un tema controvertido y en la actualidad la mayoría de comités de expertos sólo recomiendan el tratamiento si se pueden incluir los pacientes en ensayos clínicos o si las manifestaciones clínicas son graves o duraderas.
Palabras clave:
Infección aguda
VIH
Tratamiento antirretroviral
According the WHO there are about 14,000 new HIV infections a day. However, in a few cases the diagnosis will be made in the acute phase of the disease. Acute HIV infection is the period between infection with the virus and complete seroconversion, defined by a positive Western blot test. This period lasts approximately 30 days and most patients (40-90%) have mild clinical manifestations (fever, rash, pharyngitis, mucosal ulcers, among others) for 2 weeks which, because they are nonspecific, can be confused with other community-acquired infections. Microbiological diagnosis is based on the absence of serum antibodies (negative ELISA test) together with a positive HIV viral load in plasma (> 10,000 copies/ml). Diagnosis of acute HIV infection is important for several reasons: firstly, from the epidemiological point of view, this is the period with the highest rates of HIV transmission and identification of new HIV infections reveals the growth of the epidemic and the transmission rates of resistant HIV strains, which in Spain is about 10%; secondly, from the immunopathological point of view, this period provides a unique opportunity to study the virological, immunological and genetic mechanisms that play a role in the transmission and pathogenesis of this disease; and thirdly, therapeutically, tarting antiretroviral therapy during this phase could alter the natural history of the disease. However, this is a controversial issue and currently most guidelines recommend treatment only if these patients can be included in clinical trials or if they show lasting or severe clinical manifestations.
Key words:
Acute infection
HIV
Antiretroviral treatment
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