• 作者：José ; M. Miró ; ^a ; ^{jmmiro@ub.edu} ; Christian Manzardo^a ; Laura Zamora^a ; Tomas Pumarola^b ; Zoe Herreras^c ; Teresa Gallart^d ; José ; M. Gatell^a
• 关键词：Infecció ; n por el VIH ; Infecció ; n aguda por el VIH ; Infecció ; n cró ; nica por el VIH ; Manejo cl&iacute ; nico del VIH ; Historia cl&iacute ; nica ; Exploració ; n f&iacute ; sica ; Pruebas de laboratorio ; Pruebas complementarias ; Linfocit
• 刊名：Enfermedades Infecciosas y Microbiolog铆a Cl铆nica
• 出版年：2011
• 期刊代码：pca153_0213005X
• 类别：med
• 出版时间：December 2011
• 卷：29
• 期：10
• 页码：759-772
• 文件大小：255 K

The evaluation of new cases of HIV infection is relatively common in Spain, where several thousands of patients with new infections are diagnosed each year. Eighty per cent of them have a chronic HIV infection at the first clinical evaluation, which is symptomatic (late presenters) in up to 30%of patients. The initial evaluation of HIV infection is not only directed at determining the clinical, virological (plasma HIV RNA viral load, resistance test and viral tropism) and immunological (CD4+ T-cell cell count) situation of the patients, but must also address the study of their co-infections (hepatitis, tuberculosis) and comorbidities (cardiovascular, hepatic, renal and bone) and the risk of HIV transmission. This is needed in order to decide, whether or not to start antiretroviral treatment, and with which combined antiretroviral treatment to start with, the prophylaxis of opportunistic infections, and the treatment of coinfections and comorbidities. The past and current medical history, the physical examination and laboratory tests will help us decide if the patient is to receive therapeutic intervention. The level of CD4+ T-cell lymphocytes is the best marker to suggest when to start combined antiretroviral treatment, indicating whether or not to start prophylaxis against opportunistic infections (if patients have a CD4+ T-cell count below 200 cells/mm³), and in advanced patients should make us suspect the presence of active opportunistic diseases in symptomatic cases. The management of patients with HIV infection must also include appropriate health education on the modes of transmission and prevention of HIV infection, and also to explain its natural history and how it can be modified with proper antiretroviral treatment, as well as to promote a healthy life. No less important is the psychological support, as these patients must learn to live with a chronic infection, which managed properly can ensure a very good long-term prognosis and quality of life.