Asunción Díaz

Trends in HIV testing, prevalence among first-time testers, and incidence in most-at-risk populations in Spain: the EPI-VIH Study, 2000 to 2009.

During 2000 to 2009, data on people undergoing HIV testing and on those newly diagnosed with HIV were collected in a network of 20 Spanish clinics specialising in sexually transmitted infections and/or HIV testing and counselling. The number of tests performed, overall and disaggregated by different variables, was obtained. HIV prevalence among first-time testers and HIV incidence among repeat testers were calculated. To evaluate trends, joinpoint regression models were fitted. In total, 236,939 HIV tests were performed for 165,745 individuals. Overall HIV prevalence among persons seeking HIV testing was 2.5% (95% CI: 2.4 to 2.6). Prevalence was highest in male sex workers who had sex with other men (19.0% (95% CI: 16.7 to 21.4)) and was lowest in female sex workers (0.8% (95% CI: 0.7 to 0.9)). Significant trends in prevalence were observed in men who have sex with men (MSM) (increasing) and heterosexual individuals (decreasing). The incidence analysis included 30,679 persons, 64,104 person-years (py) of follow-up and 642 seroconversions. The overall incidence rate (IR) was 1.0/100 py (95% CI: 0.9/100 to 1.1/100). Incidence was significantly higher in men and transgender females than in women (1.8/100 py (95% CI: 1.6 to 1.9), 1.2/100 py (95% CI: 0.5 to 2.8) and 0.1/100 py (95% CI: 0.09 to 0.2) respectively) and increased with age until 35–39 years. IRs in MSM and people who inject drugs were significantly greater than in heterosexual individuals (2.5/100 py (95% CI: 2.3 to 2.7), 1.6/100 py (95% CI: 1.1 to 2.2) and 0.1/100 py (95% CI: 0.09 to 0.2) respectively), and an upward trend was observed in MSM. Our results call for HIV prevention to be reinforced in MSM and transgender women in Spain.

Epidemiologic trends of cancer diagnoses among HIV-infected children in Spain from 1997 to 2008.

Background: The introduction of highly active antiretroviral therapy (HAART) has influenced the incidence of cancer in people with human immunodeficiency virus (HIV) infection. The aim of this study was to evaluate changes in the pattern of cancer rates in HIV-infected children on HAART during over a decade of follow-up. Patients and Methods: We carried out a case-control study. Data were obtained from the records of the minimum basic data set of hospitals in Spain from 1999 to 2008. The epidemiologic trends of cancer diagnoses were evaluated through 3 calendar periods: early-period HAART: 1997–1999, midperiod HAART: 2000–2002, and late-period HAART: 2003–2008). Results: HIV-infected children had higher rates of cancer diagnosis than HIV-negative children (P < 0.001) for both acquired immunodeficiency disease syndrome (AIDS)-defining malignancies (ADM) and non-AIDS-defining malignancies (non-ADM). The highest rates of cancer diagnosis in HIV-positive children were for non-Hodgkin lymphoma, malignant neoplasm of bone and articular cartilage, and Hodgkin lymphoma. When we compared the 3 calendar periods, we found that the rate of ADM diagnoses decreased (from 9.1 to 3.6 to 1.0 cancers per 1000 HIV-children/yr; P < 0.05) and that the rate of non-ADM diagnoses increased (from 0.6 to 5.0 to 8.7 cancers per 1000 HIV-children/yr; P < 0.05). Moreover, the overall rate of cancer diagnoses (ADM plus non-ADM) did not change during the study period (9.7, 8.7, and 9.7 cancers per 1000 HIV-children/yr). Conclusions: HIV-infected children had a dramatic decrease in the rate of ADM diagnoses and an increase in the rate of non-ADM diagnoses. The overall cancer diagnosis rate has not decreased during the past decade and the incidence of cancer still remains high in HIV-infected children in Spain.

The Human Immunodeficiency Virus Continuum of Care in European Union Countries in 2013: Data and Challenges

Summary Definitions for a 4-stage continuum of HIV care were standardized and applied to HIV surveillance and national cohort data in 11 European Union countries. These countries are nearing the UNAIDS 90-90-90 target, although reducing the proportion undiagnosed remains challenging.

New HIV diagnoses among adults aged 50 years or older in 31 European countries, 2004–15: an analysis of surveillance data

BACKGROUND The HIV burden is increasing in older adults in the European Union (EU) and European Economic Area (EEA). We investigated factors associated with HIV diagnosis in older adults in the 31 EU/EEA countries during a 12 year period. METHODS In this analysis of surveillance data, we compared data from older people (aged ≥50 years) with those from younger people (aged 15-49 years). We extracted new HIV diagnoses reported to the European Surveillance System between Jan 1, 2004, and Dec 31, 2015, and stratified them by age, sex, migration status, transmission route, and CD4 cell count. We defined late diagnosis as CD4 count of less than 350 cells per μL at diagnosis and diagnosis with advanced HIV disease as less than 200 cells per μL. We compared the two age groups with the χ2 test for difference, and used linear regression analysis to assess temporal trends. FINDINGS During the study period 54 102 new HIV diagnoses were reported in older adults. The average notification rate of new diagnoses was 2·6 per 100 000 population across the whole 12 year period, which significantly increased over time (annual average change [AAC] 2·1%, 95% CI 1·1-3·1; p=0·0009). Notification rates for new HIV diagnoses in older adults increased significantly in 16 countries in 2004-15, clustering in central and eastern EU/EEA countries. In 2015, compared with younger adults, older individuals were more likely to originate from the reporting country, to have acquired HIV via heterosexual contact, and to present late (p<0·0001 for all comparisons). HIV diagnoses increased significantly over time among older men (AAC 2·2%, 95% CI 1·2-3·3; p=0·0006), women (1·3%, 0·2-2·4; p=0·025), men who have sex with men (5·8%, 4·3-7·5; p<0·0001), and injecting drug users (7·4%, 4·8-10·2; p<0·0001). INTERPRETATION Our findings suggest that there is a compelling need to deliver more targeted testing interventions for older adults and the general adult population, such as by increasing awareness among health-care workers and expanding opportunities for provider-initiated and indicator-condition-guided testing programmes. FUNDING European Centre for Disease Prevention and Control.

Reduction in mycobacterial disease among HIV-infected children in the highly active antiretroviral therapy era (1997-2008).

Background: HIV-infected children are at increased risk of developing mycobacterial disease. The aim of this study was to estimate the change in mycobacterial disease rate in HIV-infected children and adolescents in the highly active antiretroviral therapy (HAART) era. Methods: We carried out a retrospective study. Data were obtained from the records of the minimum basic data set of hospitals in Spain from 1997 to 2008. The epidemiologic trends of mycobacterial diseases were evaluated through the following 3 calendar periods: early-period HAART (1997–1999), midperiod HAART (2000–2002), and late-period HAART (2003–2008). Results: We analyzed 1307 HIV-infected children and 5228 HIV-uninfected children. HIV-infected children had similar rate of tuberculosis (TB) and nontuberculous mycobacteria (NTM) disease, and they had an overall rate of mycobacterial disease higher than that of HIV-uninfected children (P < 0.001). In HIV-infected children, the highest rates were for pulmonary TB (15/42 [35.7%]) in the TB category and disseminated mycobacterium (9/42 [21.4%]) in the NTM category. The overall rate of mycobacterial disease (events per 1000 HIV-infected children-year) decreased from 1997–1999 to 2003–2008 (5.88–1.63, P = 0.007) and from 2000–2002 to 2003–2008 (4.20–1.63, P = 0.021). Furthermore, the rate of TB decreased from 1997–1999 to 2000–2002 (3.53–0.84, P = 0.016) and from 1997–1999 to 2003–2008 (3.53–1.31, P = 0.030), and the rate of NTM disease decreased from 2000–2002 to 2003–2008 (3.36–0.32, P = 0.002). Conclusions: The rate of mycobacterial disease decreased among HIV-infected children in the HAART era, but the incidence of mycobacterial disease still remains higher than in the general population.

Eligibility for and outcome of treatment of latent tuberculosis infection in a cohort of HIV-infected people in Spain

BackgroundPrevious studies have demonstrated the efficacy of treatment for latent tuberculosis infection (TLTBI) in persons infected with the human immunodeficiency virus, but few studies have investigated the operational aspects of implementing TLTBI in the co-infected population.The study objectives were to describe eligibility for TLTBI as well as treatment prescription, initiation and completion in an HIV-infected Spanish cohort and to investigate factors associated with treatment completion.MethodsSubjects were prospectively identified between 2000 and 2003 at ten HIV hospital-based clinics in Spain. Data were obtained from clinical records. Associations were measured using the odds ratio (OR) and its 95% confidence interval (95% CI).ResultsA total of 1242 subjects were recruited and 846 (68.1%) were evaluated for TLTBI. Of these, 181 (21.4%) were eligible for TLTBI either because they were tuberculin skin test (TST) positive (121) or because their TST was negative/unknown but they were known contacts of a TB case or had impaired immunity (60). Of the patients eligible for TLTBI, 122 (67.4%) initiated TLTBI: 99 (81.1%) were treated with isoniazid for 6, 9 or 12 months; and 23 (18.9%) with short-course regimens including rifampin plus isoniazid and/or pyrazinamide. In total, 70 patients (57.4%) completed treatment, 39 (32.0%) defaulted, 7 (5.7%) interrupted treatment due to adverse effects, 2 developed TB, 2 died, and 2 moved away. Treatment completion was associated with having acquired HIV infection through heterosexual sex as compared to intravenous drug use (OR:4.6; 95% CI:1.4-14.7) and with having taken rifampin and pyrazinamide for 2 months as compared to isoniazid for 9 months (OR:8.3; 95% CI:2.7-24.9).ConclusionsA minority of HIV-infected patients eligible for TLTBI actually starts and completes a course of treatment. Obstacles to successful implementation of this intervention need to be addressed.

Incidence and mortality of tuberculosis disease in Spain between 1997 and 2010: Impact of human immunodeficiency virus (HIV) status

OBJECTIVE To estimate incidence and mortality of TB disease in Spain, as well as TB recurrence and its mortality, and to analyse its trend from 1997 to 2010 in human immunodeficiency virus (HIV)-infected patients (HIV(+) group), compared to HIV-uninfected subjects (HIV(-) group). METHODS We performed a retrospective study using data from Minimum Basic Data Set. The outcome variables were new TB diagnosis, TB recurrences, and mortality; which were analysed through three calendar periods related to widespread use of combination antiretroviral therapy (cART): a) From 1997 to 1999 for early-period cART; b) from 2000 to 2003 for mid-period cART; and c) from 2004 to 2008 for late-period cART. RESULTS We studied 86,093 HIV-uninfected patients and 17,031 HIV infected patients. TB diagnosis in HIV(-) group (events per 100,000 patients-yr) decreased from 20.16 (1997-1999) to 16.31 (2000-2003; p < 0.001), and later to 13.48 (2004-2010; p < 0.001); and among HIV(+) group (events per 1000 patients-yr) it decreased from 19.23 (1997-1999) to 10.93 (2000-2003; p < 0.001), and later to 6.35 (2004-2010; p < 0.001). For the mortality, HIV(-) group (events per 1,000,000 patients-yr) decreased from 11.5 (1997-1999) to 9.8 (2000-2003; p < 0.001), and later to 7.2 (2004-2010; p < 0.001); and HIV(+) group (events per 10,000 patients-yr) decreased from 20.69 (1997-1999) to 13.20 (2000-2003; p < 0.001), and later to 6.83 (2004-2010; p < 0.001). During the whole period, the diagnostic rate and mortality of TB remained 100-fold higher in HIV(+) group than HIV(-) group (p < 0.001). Moreover, HIV (+) group had higher percentage of patients with TB recurrence than HIV(-) group (p < 0.001). CONCLUSION TB diagnosis and mortality decreased in Spain between 1997 and 2010, in both HIV infected patients and people without HIV infection; but these rates remained higher in HIV infected patients.

Epidemiological surveillance of congenital syphilis in Spain, 2000-2010.

The characteristics of 67 confirmed congenital syphilis cases reported to the surveillance system in Spain (2000–2010) were analyzed. The incidence rates ranged from 0.00 to 2.23 per 100,000 live births. Median age at diagnosis was 4 days. Hepatosplenomegaly was the most common clinical finding, although almost 60% of the cases were asymptomatic. Missed opportunities for congenital syphilis prevention through antenatal care were identified.

Evolución de la seroprevalencia de infección por el virus de la inmunodeficiencia humana en madres de recién nacidos vivos en 8 comunidades autónomas (1996-2005)

Fundamento y objetivo El objetivo del trabajo ha sido estudiar la evolucion de la seroprevalencia del virus de la inmunodeficiencia humana (VIH) en madres de recien nacidos vivos. Poblacion y metodo Se ha realizado un estudio anonimo y no relacionado de anticuerpos anti-VIH en muestras recogidas para la deteccion de metabolopatias congenitas durante el periodo 1996- 2005 en las comunidades autonomas de Baleares, Canarias, Castilla-La Mancha, Castilla y Leon, Galicia, Melilla y Murcia, y en la Comunidad Valenciana desde 2003. Los resultados se obtuvieron mediante enzimoinmunoanalisis y se confirmaron por inmunotransferencia. Resultados La prevalencia global se mantuvo estable en torno al 1‰ en el periodo 1996-2005, pero aumento en el primer quinquenio y descendio en el ultimo, ambas tendencias con significacion estadistica. Valencia y Baleares presentaron las mayores prevalencias, aunque Baleares con tendencia descendente. Canarias fue la unica comunidad cuya prevalencia aumento significativamente. Conclusiones La prevalencia de infeccion por el VIH en madres de recien nacidos se mantuvo estable entre 1996 y 2005, pero despues de un incremento significativo se observa que la tendencia se revierte. Los datos presentados muestran la importancia de mantener y mejorar este sistema de informacion, y subrayan la necesidad de mejorar la aplicacion de los programas preventivos de la transmision perinatal del VIH.

Pneumocystis pneumonia in HIV-positive patients in Spain: epidemiology and environmental risk factors.

Specific environmental factors may play a role in the development of Pneumocystis pneumonia (PCP) in HIV‐positive patients. The aim of this study was to estimate the PCP incidence and mortality in hospitalized HIV‐positive patients in Spain during the combination antiretroviral therapy (cART) era (1997 to 2011), as well as to analyze the climatological factors and air pollution levels in relation to hospital admissions and deaths.