According to Gesida, one in four people with HIV will be | not diagnosed or not having proper follow up @diariofarma

According to Gesida, one in four people with HIV will be |  not diagnosed or not having proper follow up @diariofarma

DAILY PHARMA | 27.07.2022 – 17:12

Opportunistic infections (OIs) remain an important cause of morbidity and mortality in people living with HIV infection and occur in a context where infected people have very compromised immune systems, particularly due to a delay in diagnosis of the disease and have not yet started antiretroviral treatment (ART).

In order to update the recommendations for the prevention and treatment of various opportunistic infections in patients infected with HIV, GeSIDA – AIDS Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) – has published a new edition of their document in which It summarizes , clear and concise indications for the prophylaxis and treatment of several opportunistic diseases – parasitic, fungal, viral, mycobacterial, bacterial and imported parasites or fungi – as well as a vaccination calendar with the peculiarities of patients along with HIV infection.

It is currently estimated that around 25% of HIV-infected patients in Spain either remain undiagnosed or do not have adequate follow-up regarding their serological status. All this contributes to the existence of an important breeding ground for the occurrence of opportunistic infections. In our setting, the fact of patients who have had no evidence of HIV infection and who are debuting with OI is of particular importance.

“A very important part of the diagnostic delay is in the immigrant population, which may have imported infections for which there is less warning and clinical suspicion in our environment. For these reasons, the treatment of opportunistic infections continues to be a topical issue in the care of HIV-infected patients,” emphasize the coordinators of this new edition of the recommendation document, Doctors María Velasco from the Hospital Universitario Fundación Alcorcon; and Miguel Torralba from the University Hospital of Guadalajara.

Pneumocystis jirovecii pneumonia, tuberculosis and esophageal candidiasis are the three most common infections in Spain, accounting for 50-60% of all infections diagnosed in the country. More specifically, Pneumocystis jirovecii pneumonia was the most common AIDS-defining disease (27.3%) over the period 2012-2020, followed by tuberculosis of any site (16.8%) and esophageal candidiasis (11.4%).

“We have to keep in mind that despite an improvement in CD4+ lymphocyte counts, despite ART, there are infections that continue to occur more frequently in HIV-infected individuals than in the general population, such as B. pneumococcal pneumonia, herpes zoster or tuberculosis. Therefore, correct immunovirological development does not completely prevent OI,” the coordinators of the document emphasize. Therefore, these experts place special emphasis on remembering that after diagnosis of an opportunistic infection, antiretroviral treatment must be started within the first two weeks of diagnosis, with some exceptions such as cryptococcal meningitis due to increased mortality. In addition to treating and preventing this type of infection, the document also insists on the need to promote adherence to the vaccination schedule.

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