Enfoque diagnóstico del paciente con sospecha de infección por VIH
Paciente femenina de 34 años sin antecedentes patológicos, tóxicos o transfusionales relevantes, quien consulta por aparición de vesículas dolorosas con base eritematosa extensa en dermatomas T8-T11 desde hace 3 días. Primer episodio en su vida. Indica que tuvo primera y única gestación a los 30 año...
- Autores:
-
Zuluaga Gómez, Valentina
Galeano Toro, José Alejandro
- Tipo de recurso:
- Article of journal
- Fecha de publicación:
- 2023
- Institución:
- Universidad de Antioquia
- Repositorio:
- Repositorio UdeA
- Idioma:
- spa
- OAI Identifier:
- oai:bibliotecadigital.udea.edu.co:10495/48404
- Acceso en línea:
- https://hdl.handle.net/10495/48404
- Palabra clave:
- Prueba de VIH
HIV Testing
Infecciones por VIH
HIV Infections
Síndrome de Inmunodeficiencia Adquirida0000
Acquired Immunodeficiency Syndrome
Serodiagnóstico del SIDA
AIDS Serodiagnosis
https://id.nlm.nih.gov/mesh/D000082922
https://id.nlm.nih.gov/mesh/D015658
https://id.nlm.nih.gov/mesh/D000163
https://id.nlm.nih.gov/mesh/D015492
ODS 3: Salud y bienestar. Garantizar una vida sana y promover el bienestar de todos a todas las edades
- Rights
- openAccess
- License
- http://creativecommons.org/licenses/by-nc-sa/4.0/
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Enfoque diagnóstico del paciente con sospecha de infección por VIH |
| dc.title.translated.none.fl_str_mv |
Diagnostic approach to the patient with suspected HIV infection |
| title |
Enfoque diagnóstico del paciente con sospecha de infección por VIH |
| spellingShingle |
Enfoque diagnóstico del paciente con sospecha de infección por VIH Prueba de VIH HIV Testing Infecciones por VIH HIV Infections Síndrome de Inmunodeficiencia Adquirida0000 Acquired Immunodeficiency Syndrome Serodiagnóstico del SIDA AIDS Serodiagnosis https://id.nlm.nih.gov/mesh/D000082922 https://id.nlm.nih.gov/mesh/D015658 https://id.nlm.nih.gov/mesh/D000163 https://id.nlm.nih.gov/mesh/D015492 ODS 3: Salud y bienestar. Garantizar una vida sana y promover el bienestar de todos a todas las edades |
| title_short |
Enfoque diagnóstico del paciente con sospecha de infección por VIH |
| title_full |
Enfoque diagnóstico del paciente con sospecha de infección por VIH |
| title_fullStr |
Enfoque diagnóstico del paciente con sospecha de infección por VIH |
| title_full_unstemmed |
Enfoque diagnóstico del paciente con sospecha de infección por VIH |
| title_sort |
Enfoque diagnóstico del paciente con sospecha de infección por VIH |
| dc.creator.fl_str_mv |
Zuluaga Gómez, Valentina Galeano Toro, José Alejandro |
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Zuluaga Gómez, Valentina Galeano Toro, José Alejandro |
| dc.subject.decs.none.fl_str_mv |
Prueba de VIH HIV Testing Infecciones por VIH HIV Infections Síndrome de Inmunodeficiencia Adquirida0000 Acquired Immunodeficiency Syndrome Serodiagnóstico del SIDA AIDS Serodiagnosis |
| topic |
Prueba de VIH HIV Testing Infecciones por VIH HIV Infections Síndrome de Inmunodeficiencia Adquirida0000 Acquired Immunodeficiency Syndrome Serodiagnóstico del SIDA AIDS Serodiagnosis https://id.nlm.nih.gov/mesh/D000082922 https://id.nlm.nih.gov/mesh/D015658 https://id.nlm.nih.gov/mesh/D000163 https://id.nlm.nih.gov/mesh/D015492 ODS 3: Salud y bienestar. Garantizar una vida sana y promover el bienestar de todos a todas las edades |
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https://id.nlm.nih.gov/mesh/D000082922 https://id.nlm.nih.gov/mesh/D015658 https://id.nlm.nih.gov/mesh/D000163 https://id.nlm.nih.gov/mesh/D015492 |
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ODS 3: Salud y bienestar. Garantizar una vida sana y promover el bienestar de todos a todas las edades |
| description |
Paciente femenina de 34 años sin antecedentes patológicos, tóxicos o transfusionales relevantes, quien consulta por aparición de vesículas dolorosas con base eritematosa extensa en dermatomas T8-T11 desde hace 3 días. Primer episodio en su vida. Indica que tuvo primera y única gestación a los 30 años con controles prenatales completos sin complicaciones, su hijo a la fecha no sufre de ninguna enfermedad. Hace 2 meses presentó cuadro gripal asociado a exantema que resolvió espontáneamente, desde entonces ha percibido pérdida no cuantificada de peso. Al examen físico, además de hallazgos ya mencionados en piel, se detectaron linfadenopatías simétricas, indoloras, cauchosas y móviles en región cervical, inguinal y axilar. El resto del examen físico es normal. |
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2023 |
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2023 |
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2025-11-26T16:42:39Z |
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Artículo de revista |
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Zuluaga V, Galeano JA. Enfoque diagnóstico del paciente con sospecha de infección por VIH. [Internet]. Medellín: Perlas Clínicas, Facultad de Medicina, Universidad de Antioquia; 2023 [acceso día de mes de año]. Disponible en: perlasclinicas.medicinaudea.co. DOI: https://doi.org/10.59473/medudea.pc.2023.03 |
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10.59473/medudea.pc.2023.03 |
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Zuluaga V, Galeano JA. Enfoque diagnóstico del paciente con sospecha de infección por VIH. [Internet]. Medellín: Perlas Clínicas, Facultad de Medicina, Universidad de Antioquia; 2023 [acceso día de mes de año]. Disponible en: perlasclinicas.medicinaudea.co. DOI: https://doi.org/10.59473/medudea.pc.2023.03 10.59473/medudea.pc.2023.03 |
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Perlas Clínicas |
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Fondo Colombiano de Enfermedades de Alto Costo, Cuenta de Alto Costo (CAC). Situación del VIH/SIDA en Colombia 2020; Bogotá D.C. 2021. Alcami J. Advances in the inmunopathogenesis of HIV infection. Enferm Infecc Microbiol Clin 2004;22(8):486-96. Cohen MS, Shaw GM, McMichael AJ, Haynes BF. Acute HIV-1 Infection. N Engl J Med 2011;364:1943-54. Available from: https://pubmed-ncbi-nlm-nihgov.udea.lookproxy.com/21591946/ Wood BR. The natural history and clinical features of HIV infection in adults and adolescents. En: UpToDate [Online]. 2021. Available from: https://www.uptodate.com/contents/the-natural-history-and-clinical-features-of-hivinfection-in-adults-andadolescents?search=HIV&source=search_result&selectedTitle=2~150&usage_type= default&display_rank=2 Deeks SG, Overbaugh J, Phillips A, Buchbinder S. HIV infection. Nat Rev Dis Primers. 2015 Oct 1;1:15035. Available from: https://www-naturecom.udea.lookproxy.com/articles/nrdp201535 Hurt CB, Nelson JAE, Hightow-Weidman LB, Miller WC. Selecting and HIV Test: A Narrative Review for Clinicians and Researchers. Sex Transm Dis. 2017 Dec;44(12):739-746. Available from: https://journals.lww.com/stdjournal/Fulltext/2017/12000/Selecting_an_HIV_Test__A_ Narrative_Review_for.5.aspx Cáceres-Galvis C. Enfoque del paciente con diagnóstico reciente de infección por VIH. En: XIX Curso de Actualización en Medicina Interna: retos clínicos en Medicina Interna, Universidad de Antioquia. 2019. p 331-41. Peters PJ, Westheimer E, Cohen S, Hightow-Weidman LB, Moss N, Tsoi B Et al. Screening Yield of HIV Antigen/Antibody Combination and Pooled HIV RNA Testing for Acute HIV Infection in a High-Prevalence Population. JAMA. 2016;315(7):682–90. Available from: https://jamanetworkcom.udea.lookproxy.com/journals/jama/fullarticle/2491636 Sax PE. Acute and early HIV infection: clinical manifestations and diagnosis. En: UpToDate [Online]. 2021. Available from : https://www.uptodate.com/contents/acute-and-early-hiv-infection-clinical-manifestations-and-diagnosis Robb ML, Ananworanich J. Lessons from acute HIV infection. Curr Opin HIV AIDS 2016, 11:555–560. Available from: https://journals.lww.com/co-hivandaids/Fulltext/2016/11000/Lessons_from_acute_HIV_infection.4.aspx Sullivan AK, Raben D, Reekie J, Rayment M, Mocroft A, Esser S Et al. Feasibility and effectiveness of indicator condition-guided testing for HIV: results from HIDES I (HIV indicator diseases across Europe study). PLoS One. 2013;8(1):e52845. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0052845 Bull L, Rayment M. HIV-indicator-condition-driven HIV testing: clinically effective but still rarely implemented. Clin Med (Lond). 2016 Apr;16(2):175-9. Available from: https://www.rcpjournals.org/content/clinmedicine/16/2/175 HIV in Europe, HIV indicator conditions: Guidance for Implementing HIV testing in Adults in Health care settings, HIV in Europe, Denmark 2012. Available from: https://webgate.ec.europa.eu/chafea_pdb/assets/files/pdb/20114202/20114202_d7_en_ps.pdf Raben D, Sullivan AK, Mocroft A, Kutsyna G, Hadžiosmanović V, Vassilenko A, Et al. Improving the evidence for indicator condition guided HIV testing in Europe: Results from the HIDES II Study – 2012 – 2015. PLoS One. 2019 Aug 13;14(8):e0220108. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220108 Dan Lin Yi, Garner SE, Lau JSY, Korman TM, Woolley IJ. Prevalence of HIV indicator conditions in late presenting patients with HIV: a missed opportunity for diagnosis?. QJM. 2019 Jan 1;112(1):17-21. doi: 10.1093/qjmed/hcy223. CDC. Revised Surveillance Case Definition for HIV Infection-United States. MMWR 2014; 63(RR03);1-10. Ministerio de Salud y Protección Social. Guía de Práctica Clínica basada en la evidencia científica para la atención de la infección por VIH/SIDA en personas adultas, gestantes y adolescentes. Versión completa. Bogotá D.C. Colombia; 2021. Masciotra S, Luo W, Weshteimer E, Cohen SE, Gay CL, Hall L Et al. Performance evaluation of the FDA-approved Determine™ HIV-1/2 Ag/Ab Combo assay using plasma and whole blood specimens. J Clin Virol. 2017 Jun;91:95-100. doi: 10.1016/j.jcv.2017.03.019. Solomon DA. HIV Initial Assessment and Routine Follow-Up. What tests to order and why. Infect Dis Clin N Am 33 (2019) 647–662. Available from: https://pubmed-ncbi-nlm-nih-gov.udea.lookproxy.com/31239091/ Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR Et al. Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2021 Dec 6;73(11):e3572-e3605. Available from: https://academic.oup.com/cid/article/73/11/e3572/5956736?login=true |
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Zuluaga Gómez, ValentinaGaleano Toro, José Alejandro2025-11-26T16:42:39Z2023Zuluaga V, Galeano JA. Enfoque diagnóstico del paciente con sospecha de infección por VIH. [Internet]. Medellín: Perlas Clínicas, Facultad de Medicina, Universidad de Antioquia; 2023 [acceso día de mes de año]. Disponible en: perlasclinicas.medicinaudea.co. DOI: https://doi.org/10.59473/medudea.pc.2023.03https://hdl.handle.net/10495/4840410.59473/medudea.pc.2023.03Paciente femenina de 34 años sin antecedentes patológicos, tóxicos o transfusionales relevantes, quien consulta por aparición de vesículas dolorosas con base eritematosa extensa en dermatomas T8-T11 desde hace 3 días. Primer episodio en su vida. Indica que tuvo primera y única gestación a los 30 años con controles prenatales completos sin complicaciones, su hijo a la fecha no sufre de ninguna enfermedad. Hace 2 meses presentó cuadro gripal asociado a exantema que resolvió espontáneamente, desde entonces ha percibido pérdida no cuantificada de peso. Al examen físico, además de hallazgos ya mencionados en piel, se detectaron linfadenopatías simétricas, indoloras, cauchosas y móviles en región cervical, inguinal y axilar. El resto del examen físico es normal.35 páginasapplication/pdfspaUniversidad de Antioquia, Facultad de MedicinaMedellín, ColombiaPerlas ClínicasFondo Colombiano de Enfermedades de Alto Costo, Cuenta de Alto Costo (CAC). Situación del VIH/SIDA en Colombia 2020; Bogotá D.C. 2021.Alcami J. Advances in the inmunopathogenesis of HIV infection. Enferm Infecc Microbiol Clin 2004;22(8):486-96.Cohen MS, Shaw GM, McMichael AJ, Haynes BF. Acute HIV-1 Infection. N Engl J Med 2011;364:1943-54. Available from: https://pubmed-ncbi-nlm-nihgov.udea.lookproxy.com/21591946/Wood BR. The natural history and clinical features of HIV infection in adults and adolescents. En: UpToDate [Online]. 2021. Available from: https://www.uptodate.com/contents/the-natural-history-and-clinical-features-of-hivinfection-in-adults-andadolescents?search=HIV&source=search_result&selectedTitle=2~150&usage_type= default&display_rank=2Deeks SG, Overbaugh J, Phillips A, Buchbinder S. HIV infection. Nat Rev Dis Primers. 2015 Oct 1;1:15035. Available from: https://www-naturecom.udea.lookproxy.com/articles/nrdp201535Hurt CB, Nelson JAE, Hightow-Weidman LB, Miller WC. Selecting and HIV Test: A Narrative Review for Clinicians and Researchers. Sex Transm Dis. 2017 Dec;44(12):739-746. Available from: https://journals.lww.com/stdjournal/Fulltext/2017/12000/Selecting_an_HIV_Test__A_ Narrative_Review_for.5.aspxCáceres-Galvis C. Enfoque del paciente con diagnóstico reciente de infección por VIH. En: XIX Curso de Actualización en Medicina Interna: retos clínicos en Medicina Interna, Universidad de Antioquia. 2019. p 331-41.Peters PJ, Westheimer E, Cohen S, Hightow-Weidman LB, Moss N, Tsoi B Et al. Screening Yield of HIV Antigen/Antibody Combination and Pooled HIV RNA Testing for Acute HIV Infection in a High-Prevalence Population. JAMA. 2016;315(7):682–90. Available from: https://jamanetworkcom.udea.lookproxy.com/journals/jama/fullarticle/2491636Sax PE. Acute and early HIV infection: clinical manifestations and diagnosis. En: UpToDate [Online]. 2021. Available from : https://www.uptodate.com/contents/acute-and-early-hiv-infection-clinical-manifestations-and-diagnosisRobb ML, Ananworanich J. Lessons from acute HIV infection. Curr Opin HIV AIDS 2016, 11:555–560. Available from: https://journals.lww.com/co-hivandaids/Fulltext/2016/11000/Lessons_from_acute_HIV_infection.4.aspxSullivan AK, Raben D, Reekie J, Rayment M, Mocroft A, Esser S Et al. Feasibility and effectiveness of indicator condition-guided testing for HIV: results from HIDES I (HIV indicator diseases across Europe study). PLoS One. 2013;8(1):e52845. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0052845Bull L, Rayment M. HIV-indicator-condition-driven HIV testing: clinically effective but still rarely implemented. Clin Med (Lond). 2016 Apr;16(2):175-9. Available from: https://www.rcpjournals.org/content/clinmedicine/16/2/175HIV in Europe, HIV indicator conditions: Guidance for Implementing HIV testing in Adults in Health care settings, HIV in Europe, Denmark 2012. Available from: https://webgate.ec.europa.eu/chafea_pdb/assets/files/pdb/20114202/20114202_d7_en_ps.pdfRaben D, Sullivan AK, Mocroft A, Kutsyna G, Hadžiosmanović V, Vassilenko A, Et al. Improving the evidence for indicator condition guided HIV testing in Europe: Results from the HIDES II Study – 2012 – 2015. PLoS One. 2019 Aug 13;14(8):e0220108. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220108Dan Lin Yi, Garner SE, Lau JSY, Korman TM, Woolley IJ. Prevalence of HIV indicator conditions in late presenting patients with HIV: a missed opportunity for diagnosis?. QJM. 2019 Jan 1;112(1):17-21. doi: 10.1093/qjmed/hcy223.CDC. Revised Surveillance Case Definition for HIV Infection-United States. MMWR 2014; 63(RR03);1-10.Ministerio de Salud y Protección Social. Guía de Práctica Clínica basada en la evidencia científica para la atención de la infección por VIH/SIDA en personas adultas, gestantes y adolescentes. Versión completa. Bogotá D.C. Colombia; 2021.Masciotra S, Luo W, Weshteimer E, Cohen SE, Gay CL, Hall L Et al. Performance evaluation of the FDA-approved Determine™ HIV-1/2 Ag/Ab Combo assay using plasma and whole blood specimens. J Clin Virol. 2017 Jun;91:95-100. doi: 10.1016/j.jcv.2017.03.019.Solomon DA. HIV Initial Assessment and Routine Follow-Up. What tests to order and why. Infect Dis Clin N Am 33 (2019) 647–662. Available from: https://pubmed-ncbi-nlm-nih-gov.udea.lookproxy.com/31239091/Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR Et al. Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2021 Dec 6;73(11):e3572-e3605. Available from: https://academic.oup.com/cid/article/73/11/e3572/5956736?login=truehttp://creativecommons.org/licenses/by-nc-sa/4.0/info:eu-repo/semantics/openAccessAttribution-NonCommercial-ShareAlike 4.0 Internationalhttp://purl.org/coar/access_right/c_abf2Enfoque diagnóstico del paciente con sospecha de infección por VIHDiagnostic approach to the patient with suspected HIV infectionArtículo de revistahttp://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1http://purl.org/redcol/resource_type/ARTOTRTexthttp://purl.org/coar/version/c_b1a7d7d4d402bcceinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/draftPrueba de VIHHIV TestingInfecciones por VIHHIV InfectionsSíndrome de Inmunodeficiencia Adquirida0000Acquired Immunodeficiency SyndromeSerodiagnóstico del SIDAAIDS Serodiagnosishttps://id.nlm.nih.gov/mesh/D000082922https://id.nlm.nih.gov/mesh/D015658https://id.nlm.nih.gov/mesh/D000163https://id.nlm.nih.gov/mesh/D015492ODS 3: Salud y bienestar. 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