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2003, Número 2

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Rev Inst Nal Enf Resp Mex 2003; 16 (2)


La tuberculosis en el contexto del síndrome de inmunodeficiencia adquirida. Panorámica desde la actual evidencia

Reyes CA, Bouza JY

Idioma: Español
Referencias bibliográficas: 66
Paginas: 108-115
Archivo PDF: 80.61 Kb.


RESUMEN

El presente artículo es una revisión de las principales evidencias disponibles sobre la tuberculosis asociada al virus de la inmunodeficiencia humana/síndrome de inmunodeficiencia adquirida, teniendo en cuenta la seria situación epidemiológica y las devastadoras consecuencias que para estos enfermos produce la coinfección por ambos patógenos. Se revisó la información disponible en MEDLINE, PUBMED, así como numerosas publicaciones disponibles en nuestro Centro Provincial de Información de Ciencias Médicas. El trabajo consta de una introducción que aborda el comportamiento epidemiológico y la situación actual de la pandemia del síndrome de inmunodeficiencia adquirida y la consecuente reemergencia de la tuberculosis como consecuencia del deterioro inmunológico progresivo de estos enfermos. Posteriormente, se desarrolla lo que denominamos: las dianas del binomio tuberculosis/síndrome de inmunodeficiencia adquirida, este acápite consta de tres vertientes esenciales. La primera relacionada con la precipitada progresión de la infección por el virus de la inmunodeficiencia humana durante y con posterioridad al diagnóstico de tuberculosis activa, así como los efectos que sobre la tuberculosis propicia el síndrome de inmunodeficiencia adquirida, se exponen además los fundamentos moleculares y patogénicos de estas observaciones fomentándose una pregunta atrayente: ¿son suficientes las evidencias? Luego revisamos los retos para el diagnóstico de la tuberculosis en estos enfermos con particular interés en la tuberculosis sin comprobación microbiológica, decididamente una realidad incuestionable y en gran medida atribuible a la pandemia del síndrome de inmunodeficiencia adquirida. Finalmente, dedicamos un espacio a las implicaciones que sobre la terapéutica tanto de la tuberculosis como del síndrome de inmunodeficiencia adquirida (terapia antirretroviral altamente activa) representa la coinfección/coenfermedad, cuyo centro cardinal obedece a la multirresistencia de la tuberculosis por algunos llamada la tercera epidemia, hecho que constituye una amenaza en el nosocomio e incluso en poblaciones no afectadas por el virus de la inmunodeficiencia humana/ síndrome de inmunodeficiencia adquirida.


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