S; paciente masculino 23 años viene a consultorio para control de salud. Su ultimo control fue hace 4 años. En la época diagnosticado con Hipertension arterial que inicia tratamiento con losartan, no adiere a tratamiento. Es usuario de drogas pero refiere que desde la ultima consulta esta consumiendo únicamente marihuana.
O; TA 120X80mmHg.
E; Hipertension por uso de drogas
P; Ecocardio, ECG laboratorio con Prueba de HIV
Mi duda principal fue que la doctora solicito HIV porque dijo que solicita de rutina 1x por año a todo paciente sexualmente activo. Es una recomendación general o personal? Tiene que ver con sus conductas con las drogas? Se es un paciente sano sin pareja estable también se le solicitaría 1x por ano?
Edu la USPSTF recomienda el screening de HIV en personas de entre 15 y 65 años, en lo que respecta a los intervalos dice que si el riesgo es alto (multiples parejas, sexo sin proteccion, uso de drogas, etc) puede hacerse anual y cuando el riesgo es mas bajo puede hacerse cada 3-5 años
ResponderEliminarYo creo que el uso de drogas y que no tenga pareja estable son dos factores de riesgo importantes para solicitar HIV anual siempre que el paciente este de acuerdo.
ResponderEliminarEl hecho que no tenga pareja estable predispone a que tenga relaciones sexuales con múltiples personas, por lo que sería tambien un factor de riesgo por más que sea una persona sana.
Esto es info de la CDC. les paso lo que me parecio interesante:
ResponderEliminarCDC recommendations advocate routine voluntary HIV screening as a normal part of medical practice, similar to screening for other treatable conditions. Screening is a basic public health tool used to identify unrecognized health conditions so treatment can be offered before symptoms develop and, for communicable diseases, so interventions can be implemented to reduce the likelihood of continued transmission
1) HIV infection is a serious health disorder that can be diagnosed before symptoms develop; 2) HIV can be detected by reliable, inexpensive, and noninvasive screening tests; 3) infected patients have years of life to gain if treatment is initiated early, before symptoms develop; and 4) the costs of screening are reasonable in relation to the anticipated benefits.
Among pregnant women, screening has proven substantially more effective than risk-based testing for detecting unsuspected maternal HIV infection and preventing perinatal transmission.
Screening recommendations in adolescents and adults:
• Persons at high risk for HIV infection should be screened for HIV at least annually.
• Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing.
• Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings.
• In all health-care settings, screening for HIV infection should be performed routinely for all patients aged 13--64 years. Health-care providers should initiate screening unless prevalence of undiagnosed HIV infection in their patients has been documented to be <0.1%. In the absence of existing data for HIV prevalence, health-care providers should initiate voluntary HIV screening until they establish that the diagnostic yield is <1 per 1,000 patients screened, at which point such screening is no longer warranted.
• All patients initiating treatment for TB should be screened routinely for HIV infection (108).
• All patients seeking treatment for STDs, including all patients attending STD clinics, should be screened routinely for HIV during each visit for a new complaint, regardless of whether the patient is known or suspected to have specific behavior risks for HIV infection.
• HIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening).