Search

Objective: To assess the effect of an HIV counseling and testing program targeting steady heterosexual serodiscordant couples. Methods: We studied 564 couples who attended a sexually transmitted infections/HIV clinic in Madrid in the period 1989 to 2007 and participated in couples counseling and testing. Sociodemographic, epidemiologic, clinical, and behavioral information of both partners was obtained before testing the nonindex partner. Sexual practices reported in the first (preintervention) and second visit were compared, as well those reported in 4 additional visits. Results: Among the 399 couples who returned for a second visit (71%), the median number of sexual risk practices in the previous 6 months decreased (26.9-0; P Conclusion: The diagnosis of HIV-infection and counseling appears to provide complementary reductions in sexual risk behaviors among serodiscordant steady heterosexual couples at follow-up, but the risk of transmission was not totally eliminated.

PurposeThe European Men who have sex with men Internet Survey looked over the characteristics and needs of men who have sex with men (MSM) across Europe. Our objective was to estimate the prevalence of HIV testing and its associated factors among MSM younger than 25 years old participating in the EMIS-2017 in Spain.MethodsMultivariable regression model was used to compare those who had been tested for HIV within the last 12 months and those that had not.ResultsOf 2313 participants, 1070 (46.3%) had been tested for HIV in the past 12 months. Increased age (age 19–21 years, aOR=3.38 (95% CI 2.57 to 4.44); age 22–24 years, aOR=5.26 (4.06 to 6.92) compared with age 16–18 years); being migrant (Latin America: aOR=1.34 (0.98 to 1.84); Europe, North America and Mediterranean countries (aOR=1.56 (0.98 to 2.51) compared with those from Spain); living more openly with one’s sexuality (out to some people (aOR=1.53 (1.19 to 1.96)); out to all or almost all people (aOR=2.24 (1.75 to 2.87) compared with those out to none or a few people); having had one condomless steady partners in the las year ((aOR=1.59 (1.26 to 2.02)); having had condomless non-steady partners in the last year (one: aOR=1.76 (1.35 to 2.29)); two or more partners: aOR=2.37 (1.84 to 3.04)); and having practised sex work in the past year (aOR=1.52 (1.07 to 2.13)) were associated with increased odds of HIV testing. Living in a smaller city was associated with less likelihood of HIV testing (<1 00 000 inhabitants: aOR=0.51 (95% CI 0.41 to 0.64); 100 000–500 000: aOR=0.68 (95% CI 0.54 to 0.86) compared with more than 500 000).ConclusionYoung MSM showed low HIV testing rate. Future programming specifically targeting this population, especially those middle adolescents, living in a medium-small city and having less ‘outness’, can help increase HIV testing and prevent access barriers.

Background To compare effectiveness and safety of initial antiretroviral therapy (ART) among premenopausal and postmenopausal women living with HIV aged 45–60 years from the cohort of the Spanish HIV/AIDS Research Network (CoRIS) who initiated ART between 2004 and 2015.Methods Multivariable regression models were used to compare post- versus premenopausal women regarding viral suppression (≤50 copies/ml), change in CD4+T-cell count and time to treatment change (TC) at 48 and 96 weeks after ART initiation.Results Among 230 women, 154 (67%) were premeno-pausal at ART initiation. The most frequent initial regimen was tenofovir disoproxil fumarate/emtricitabine/efavirenz prescribed in 49 (32%) premenopausal and 22 (29%) postmenopausal women. The proportion of TC was 35.7% and 30.3% at 48 weeks and 51.3% and 47.4% at 96 weeks, for pre- and postmenopausal women, respectively. There were no significant differences in CD4+T-cell count changes from ART initiation, viral load suppression, time to TC or reason for TC between both groups. The main reason for TC was occurrence of an adverse event, followed by simplification, in both groups.Conclusions ART effectiveness and safety did not differ significantly between pre- and postmenopausal women.

El linfogranuloma venéreo (LGV) era infrecuente en Europa hasta 2003, cuando surgieron brotes en hombres que tenían relaciones sexuales con hombres (HSH). Esta enfermedad es de declaración obligatoria nacional a partir de 2015. El objetivo es describir los casos de LGV publicados entre 2005 y 2015 en España. Se identificaron 14 publicaciones con casos en 7 comunidades autónomas. La mayoría fueron HSH, españoles, entre 30 y 45 años y con sintomatología rectal. El serovar más frecuente fue el L2. Más del 60% de los casos en HSH estaban coinfectados con el VIH y casi la mitad presentaba otras infecciones concurrentes. Tras la descripción del primer caso publicada en 2005, el LGV se ha distribuido ampliamente en España, con características similares a las de los casos descritos en Europa. La puesta en marcha de la vigilancia estatal del LGV permitirá conocer su magnitud y tendencia y caracterizar los casos, lo que es clave para su control.

Supplemental Digital Content is available in the text

Background Gender-specific data on the management of HIV infection are scarce. Further, an increase in the proportion of new HIV diagnoses in older persons has been observed. Using data from the CoRIS cohort, we compared immunovirological responses and survival in HIV-infected men and women who started their first combination anti-retroviral therapy (cART) when aged

Evaluar la tendencia en la vacunación de hepatitis A, hepatitis B, neumococo, tétanos y gripe estacional en personas con infección por VIH, y analizar sus factores asociados.

Background The possible differences in the disease spectrum and prognosis of HIV infection in women and men is a major point of concern. Women are under-represented in randomized clinical trials and in some cohorts. Discordant results have often been obtained depending on the setting.Methods We assessed gender differences in clinical and epidemiological features, antiretroviral treatment (ART) exposure and survival in two multicentre cohorts of HIV-positive subjects in Spain: CoRIS-MD and CoRIS. Competing risk regression models were used to assess gender effect on time to start ART and time to first ART change, and a Cox regression model to estimate gender effect on time to death.Results Between January 1996 and December 2008, 1,953 women and 6,072 men naive to ART at study entry were included. The trend analysis over time showed the percentage of women in the younger (<20 years) and older (>50 years) strata increased significantly (P<0.001) from 0.5% and 1.8% in 1996 to 4.9% and 4.2% in 2008, respectively. By competing risk analysis women started ART earlier than men (adjusted subhazard ratio [ASHR] 1.21, 95% CI 1.11, 1.31) in CoRIS cohort, while in CoRIS-MD none of these differences were observed. In both cohorts women showed a shorter time to the first ART change (ASHR 1.10, 95% CI 1.01, 1.19). Pregnancy and patient's/physician's decisions as reasons for changing were more frequent in women than in men in CoRIS. In the Cox regression model, gender was not associated with differences in survival.Conclusions In two large cohorts in Spain, we observed relevant gender differences in epidemiological characteristics and antiretroviral exposure outcomes, while survival differences were not attributable to gender.

Supplemental Digital Content is available in the text

Supplemental Digital Content is available in the text

OBJECTIVE: To estimate the risk and probability of heterosexual transmission of HIV-1 from infected people taking combined antiretroviral treatment. Design Cross sectional and prospective cohort studies. Setting HIV clinic in Madrid, Spain. Participants Stable heterosexual couples with one partner with HIV-1 infection (index partner) and the other reporting this sexual relationship as the only risk exposure. MAIN OUTCOME MEASURES: HIV seroprevalence in non-index partners at enrolment and seroconversions in follow-up according to antiretroviral treatment taken by the index partner. RESULTS: In 476 couples in which the index partner was not taking antiretroviral treatment, HIV seroprevalence at enrolment in non-index partners was 9.2% (n=44), whereas in 149 couples in which the index partner was taking combined antiretroviral therapy no partner was infected (P<0.001). During follow-up, the 341 serodiscordant couples in which the index partner was not taking antiretroviral treatment had about 11 000 acts of intercourse without condoms, 50 natural pregnancies, and five HIV seroconversions (0.0004 per unprotected intercourse; 95% confidence interval 0.0001 to 0.0010); 294 of these couples always used condoms, accounting for about 42 000 acts of intercourse, 136 risk exposures from condom failure, and one HIV seroconversion. The relative risk associated with condom use was 0.07 (0.01 to 0.58). In 144 couples the index partner was taking combined antiretroviral treatment; they accounted for over 7000 unprotected acts of intercourse and 47 natural pregnancies but no HIV seroconversion (0 to 0.0005 per unprotected intercourse). CONCLUSIONS: The heterosexual infectivity of HIV-1 in individuals taking effective antiretroviral treatment is low. Avoidance of unprotected intercourse and receipt of antiretroviral treatment by the infected partner in accordance with protocols are complementary measures to prevent HIV transmission.