Highly active antiretroviral therapy (HAART) has been shown to be highly effective in reducing plasma levels of HIV RNA; therefore, these treatments could diminish the risk of transmission. We ...analyzed 393 steady heterosexual couples, of which one partner had been previously diagnosed with HIV infection (index case) and where the nonindex partner reported his or her sexual relationship with the index case as the unique risk exposure. These couples were consecutively enrolled in the period 1991 through 2003 when the nonindex partners took their first HIV test. HIV prevalence among partners of index cases who had not received antiretroviral therapy was 8.6%, whereas no partner was infected in couples in which the index case had been treated with HAART (P = 0.0123). HIV prevalence among nonindex partners declined from 10.3% during the pre-HAART period (1991-1995) to 1.9% during the late HAART period (1999-2003; P = 0.0061). In the multivariate analysis, this decline held (odds ratio = 0.14, 95% confidence interval0.03-0.66) after adjusting for length of partnership, unprotected coitus, and pregnancies as well as gender, CD4 lymphocyte count, AIDS-defining diseases, and sexually transmitted infections in the index case. When HAART became widely available, a reduction of approximately 80% in heterosexual transmission of HIV was observed, irrespective of changes in other factors that affect transmission.
The aim of this study was to analyse the impact of the introduction of universal adolescent HBV vaccination on the incidence of acute hepatitis B virus (HBV) infections. Acute HBV cases reported to ...the Spanish National Epidemiological Surveillance Network between 2005 and 2021 were included. For regions starting adolescent vaccination in 1991-1993 and in 1994-1996, HBV incidence rates were compared by calculating the incidence rate ratio (IRR) and 95% confidence interval (CI). We also analysed the 2017 Spanish national seroprevalence survey data. The overall acute HBV incidence per 100,000 persons was 1.54 in 2005 and 0.64 in 2021 (
< 0.001). The incidence in 2014-2021 was lower for regions that started adolescent vaccination in 1991-1993 rather than in 1994-1996 (IRR 0.76; 95% CI 0.72-0.83;
< 0.001). In the 20-29 age group, incidence in regions that started adolescent vaccination in 1991-1993 was also lower (IRR 0.87; 95% CI 0.77-0.98;
= 0.02 in 2005-2013 and IRR 0.71; 95% CI 0.56-0·90;
< 0.001 in 2014-2021). Anti-HBc prevalence in the 35-39 age group was lower in the regions that started vaccination earlier, although the difference was not statistically significant (
= 0.09). Acute HBV incidence decreased more in the young adult population in regions that began adolescent vaccination earlier. Maintaining high universal vaccination coverage in the first year of life and in at-risk groups is necessary to achieve HBV elimination by 2030.
Over 79,000 confirmed cases of mpox were notified worldwide between May and November 2022, most of them in men who have sex with men. Cases in women, for whom mpox might pose different risks, are ...rare, and Spain has reported more than one third of those in Europe. Using surveillance data, our study found similar time trends, but differences in delay of diagnosis, sexual transmission and signs and symptoms between men and women.
The purpose of this study was to describe temporal trends in the use of antiretroviral therapy (ART) among people living with HIV (PLWHIV) from the cohort of the Spanish HIV/AIDS research network ...(CoRIS), 2004-2020.
We described the yearly evolution of the proportion of patients receiving ART and the most frequently prescribed antiretroviral drugs among newly recruited treatment-naïve patients and among all patients with active follow-up.
Of 15,539 patients included, 14,618 (94.1%) started ART during their follow-up. Regarding initial regimens, the use of 2NRTI plus 1NNRTI (which were the most frequently prescribed until 2014) and 2NRTI plus 1bPI decreased after 2014, being gradually replaced by INI-based triple therapies. Since 2019, other regimens started to be prescribed, mainly dual therapies. TDF/FTC/EFV was the single-tablet regimen (STR) most frequently prescribed as initial ART until 2012, decreasing thereafter as TDF/FTC/RPV, TDF/FTC/EVG/COBI, and ABC/3TC/DTG became available. TAF/FTC/BIC accounted for 53.6% of initial prescriptions in 2020, followed by DTG/3TC (24%). The percentage of patients on ART increased from 45.7% in 2004 to 98.2% in 2020. Among all patients receiving ART, regimens based on 2NRTI plus 1INI increased from 0.1% in 2007 to 53.3% in 2020. During 2007-2015, most patients were receiving TDF/FTC/EFV, which was replaced after 2017 by ABC/3TC/DTG. In 2020, 13.0% of patients were receiving dual therapies.
Robust real-world data on ART use in PLWHIV over more than 15 years show historical trends in prescriptions with an unprecedented visualization of the contemporary treatment patterns.
Objetivo: La muerte es un tema tabú en la sociedad actual, y por ello es común que los padres tengan dudas acerca de cómo abordar este tema con los menores. Los objetivos de este trabajo son: 1) ...describir el concepto evolutivo de muerte y la forma de afrontamiento de niños y adolescentes ante una pérdida y 2) hacer una revisión bibliográfica de las principales recomendaciones y pautas para abordar el proceso de comunicación y preparación de los niños ante esta situación. Método: Se ha hecho una búsqueda bibliográfica sistemática en bases de datos primarias y secundarias (TripDatbase, PsycInfo, PubMed, Cochrane Library, Psicodoc) combinando diferentes términos clave. Resultados: La mayor parte del material revisado procede del ámbito anglosajón. En nuestro país la mayoría tiene un formato divulgativo, y no consta a los autores de este trabajo la publicación de investigaciones regladas. Sin embargo sí es posible extraer de todo el material revisado una serie de pautas generales que facilitan la comunicación con los menores en esas situaciones. Conclusiones: La comunicación adecuada y en base a unas pautas establecidas contribuye a facilitar el proceso de elaboración del duelo en los niños y adolescentes. Palabras clave: muerte parental, comunicación, duelo, infancia. Aims: Death is a taboo in our society, and it is common that parents have questions about how to cope with children this issue. The aims of this paper are: 1) to describe the developmental concept of death and the ways of coping in children and adolescents in case of loss 2) to make a literature review of the main recommendations and guidelines to address the communication process and preparation children in this situation. Method: A systematic literature search has been made in primary and secondary databases (TripDatbase, PsycInfo, PubMed, Cochrane Library, Psicodoc), by combining different keywords. Results: Most of the reviewed material comes from England and USA. In our country the majority has an informative format, and we have no evidence of published regulated research. However it is possible to remove from all the material reviewed a number of general guidelines to facilitate communication with children in case of loss of a loved one. Conclusions: The correct and based on established guidelines communication makes easier the process of grief in children and adolescents. Keywords: Parental dead, communication, grief, childhood.
OBJECTIVE:We aim to estimate the number of people living with HIV and the undiagnosed fraction in Spain, where coverage of the HIV surveillance system has only recently become complete.
METHODS:The ...reconstruction of all HIV diagnoses and infections was obtained by combining HIV and AIDS surveillance data. The imputation of the diagnoses and back-calculation of the infection incidence are integrated in a Bayesian framework to take into account the uncertainty associated with unavailable data.
RESULTS:An estimated 141 000 95% credible interval (CI) 128 000–155 000 persons were living with HIV by the end of 2013, in Spain and 18% (95% CI 14.3–22.1%) were unaware of it. A similar fraction of undiagnosed infections was obtained in men who have sex with men and heterosexuals (18.8 and 20.1%, respectively), but for injection drug users, this fraction was 3.5%.
CONCLUSION:This study provides the first estimates of the number of people living with HIV and the undiagnosed fraction in Spain, using routine surveillance data. The proposed method could be useful for countries where the geographical coverage of the HIV surveillance system is partial or was completed only recently.
Introducción: Entre la población de mayor edad con infección por el virus de la inmunodeficiencia humana (VIH) se encuentran aquellos que adquirieron la infección en décadas anteriores como los que ...se diagnostican con 50 años o más. El objetivo es describir las características de los nuevos diagnósticos de VIH de 50 años o más identificados en España en 2022 y analizar la tendencia en 2013-2022.
Método: Estudio descriptivo de los nuevos diagnósticos de 50 años o más notificados al Sistema de Vigilancia de Nuevos Diagnósticos de VIH (2013-2022) y su comparación con los de 15-49 años. Las tendencias se estudiaron mediante variación de tasas.
Resultados: En 2022 se produjeron 2.952 nuevos diagnósticos de VIH en mayores de 14 años, de los que el 18,3% (540) tenían 50 o más años. La mayoría fueron hombres (84,3%), nacidos en España (68,7%) y el modo de transmisión más frecuente fueron las relaciones sexuales no protegidas entre hombres (40,7%). El 64,4% presentó diagnóstico tardío. Comparados con los casos entre 15 y 49 años, se observó mayor proporción de españoles, transmisión en hombres heterosexuales y de casos con retraso diagnóstico. Entre aquellos de 50 o más años la tendencia en las tasas totales, por sexo y modo de transmisión fue descendente con importante disminución entre 2019 y 2020. El porcentaje de casos con diagnóstico tardío no varió en el periodo.
Conclusiones: La elevada proporción de diagnóstico tardío en los nuevos diagnósticos de mayor edad hace necesario reforzar la prevención primaria y secundaria en esta población.
Seasonal flu epidemics in the European region cause high numbers of cases and deaths. Flu-associated mortality has been estimated but morbidity studies are necessary to understand the burden of ...disease in the population. Our objective was to estimate the excess hospital admissions in Spain of diseases associated with influenza during four epidemic influenza periods (2000-2004).
Hospital discharge registers containing pneumonia, chronic bronchitis, heart failure and flu from all public hospitals in Spain were reviewed for the years 2000 to 2004. Epidemic periods were defined by data from the Sentinel Surveillance System. Excess hospitalisations were calculated as the difference between the average number of weekly hospitalisations/100,000 in epidemic and non-epidemic periods. Flu epidemics were defined for seasons 2001/2002, 2002/2003, 2003/2004.
A(H3N2) was the dominant circulating serotype in 2001/2002 and 2003/2004. Negligible excess hospitalisations were observed during the 2002/2003 epidemic where A(H1N1) was circulating. During 2000/2001, flu activity remained below threshold levels and therefore no epidemic period was defined. In two epidemic periods studied a delay between the peak of the influenza epidemic and the peak of hospitalisations was observed. During flu epidemics with A(H3N2), excess hospitalisations were higher in men and in persons <5 and >64 years higher than 10 per 100,000. Pneumonia accounted for 70% of all flu associated hospitalisations followed by chronic bronchitis. No excess flu-specific hospitalisations were recorded during all seasons.
Flu epidemics have an impact on hospital morbidity in Spain. Further studies that include other variables, such as temperature and humidity, are necessary and will deepen our understanding of the role of each factor during flu epidemics and their relation with morbidity.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The barriers to HIV testing and counselling that migrants encounter can jeopardize proactive HIV testing that relies on the fact that HIV testing must be linked to care. We analyse available evidence ...on HIV testing and counselling strategies targeting migrants and ethnic minorities in high-income countries.
Systematic literature review of the five main databases of articles in English from Europe, North America and Australia between 2005 and 2009.
Of 1034 abstracts, 37 articles were selected. Migrants, mainly from HIV-endemic countries, are at risk of HIV infection and its consequences. The HIV prevalence among migrants is higher than the general population's, and migrants have higher frequency of delayed HIV diagnosis. For migrants from countries with low HIV prevalence and for ethnic minorities, socio-economic vulnerability puts them at risk of acquiring HIV. Migrants have specific legal and administrative impediments to accessing HIV testing-in some countries, undocumented migrants are not entitled to health care-as well as cultural and linguistic barriers, racism and xenophobia. Migrants and ethnic minorities fear stigma from their communities, yet community acceptance is key for well-being.
Migrants and ethnic minorities should be offered HIV testing, but the barriers highlighted in this review may deter programs from achieving the final goal, which is linking migrants and ethnic minorities to HIV clinical care under the public health perspective.
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