¿Por qué están aumentando las infecciones de transmisión sexual entre jóvenes y adolescentes?

Noticia publicada en The Conversation España, el 05/07/2023.Nos pueden sonar a enfermedades del pasado, pero la sífilis y la infección gonocócica (gonorrea) están muy de actualidad. Forman parte de las denominadas infecciones de transmisión sexual (ITS), y se han descrito más de veinte microorganismos, entre virus, bacterias y parásitos, que pueden producirlas. Las cifras son preocupantes. Según la Organización Mundial de la Salud, en 2020 se produjeron un total de 374 millones de nuevos casos de las llamadas ITS curables (sífilis, gonorrea, infección por Chlamydia trachomatis y tricomoniasis) entre la población mundial de 15 a 49 años.N

A case-based tool to assess college students’ perceptions about ethical competence

[EN] The main objective of this study was to design a new tool to explore the perception of professionally-related ethical values in Health Sciences undergraduate students. For this purpose, 24 conversational interviews, as well as an extensive literature review, were initially employed. Then, five ethical values were selected: respect for the patient, altruism, empathy, responsibility for my actions, and lifelong learning. Next, twenty cases with ethical dilemmas were created with protagonists pertaining to four degrees in the Health Sciences: Nursing, Dentistry, Physical Therapy, and Medicine. These cases were examined by professionals from these fields and presented to a sample of students to analyze their functioning. Our results indicate that the cases are easy to understand as most cases were identified correctly. Interestingly, students reported “respect for the patient” as the most important ethical value. The least important value was “altruism.” This new tool adds a practical perspective based on clinical cases with real-life dilemmas. Further studies are needed to continue exploring this topic.Gonzalez-Cuevas, G.; Lopez Del Hierro, M.; Martinez, N.; Hernando, MA. (2017). A case-based tool to assess college students’ perceptions about ethical competence. En Proceedings of the 3rd International Conference on Higher Education Advances. Editorial Universitat Politècnica de València. 1271-1277. https://doi.org/10.4995/HEAD17.2017.55811271127

Vigilancia epidemiológica de la infección por el VIH: Situación en la Unión Europea y en España, 2018

[ES] A continuación se presentan los principales resultados de la vigilancia de la infección por el virus de la inmunodeficiencia humana (VIH) en los países de la Unión Europa/Área Económica Europa (UE/ AEE) y España correspondientes al año 2018, así como las tendencias en España en el periodo 2009- 2018. La tasa de nuevos diagnósticos de VIH en España en 2018 fue superior a la media de la UE/ AEE (8,6/100.000 habitantes en España y 5,8 en la UE/AEE, corregidas por retraso en la notificación), aunque es similar a la de otros países del entorno. La vía de transmisión más importante sigue siendo la sexual, ocupando el primer lugar las relaciones sexuales no protegidas entre hombres. Los datos muestran, tanto en España como en la UE/AEE, que casi la mitad de los nuevos diagnósticos en 2018 fueron tardíos y la tendencia se mantiene estable en los últimos años. El grupo de edad más afectado son los adultos entre 25 y 39 años. La tendencia de las tasas entre 2009 y 2018 es ligeramente descendente, variando según la categoría de transmisión. Entre personas que se inyectan drogas y los casos heterosexuales es decreciente. Por grupos de edad, la tendencia es descendente en todos ellos, excepto entre 25 y 29 años que se mantiene estable.[EN] This report shows the main results about HIV surveillance in European Union/European Economic Area (EU/EEA) and Spain in 2018, and the trends in Spain in the period 2009-2018. The rate of new HIV diagnoses in Spain was higher than the average in UE/EEA (8.6/100.000 population in Spain and 5.8 in EU/EEA, adjusting for report delay), although is similar to other neighbor countries. Sexual transmission is still the most important route of transmission, and the unprotected sexual relationships between men were the highest proportion of cases. In Spain, as well as EU/EEA countries, nearly half of new HIV diagnosed in 2018 were late presenters and the trend remains stable. Adults aged between 25 and 39 years were the largest age group. The rate trend is slightly decreased during the period 2009-2018, changing by category of transmission. Among persons who injecting drugs and heterosexuals, the trend is descending. By age group, the trend is descending, except between 25 and 29 that remains stable.N

Impact of the COVID-19 pandemic on the epidemiological surveillance systems of HIV infection in Spain

[ES] Fundamentos: La pandemia de la COVID-19 afectó de forma indirecta a otras enfermedades transmisibles, como la infección por el virus de la inmunodeficiencia humana (VIH). El objetivo de este estudio fue evaluar el impacto de la pandemia de la COVID-19 en la vigilancia epidemiológica del VIH a través de indicadores epidemiológicos. Métodos: Se analizaron los datos recogidos en el Sistema de Información de Nuevos Diagnósticos de VIH (SINIVIH) en el periodo 2013-2021. Los indicadores epidemiológicos analizados fueron: 1) Retraso en la notificación de nuevos diagnósticos; 2) Infradiagnóstico de caso, calculado por mes y por cada año de diagnóstico; 3) Diagnóstico tardío, casos diagnosticados con menos de 350 células CD4/mm3. Resultados: Respecto al retraso en la notificación de nuevos diagnósticos, en 2022 se notificaron 2.770 casos diagnosticados en 2020, un 43,8% más respecto a los notificados en 2021 para ese año. Los casos diagnosticados por mes entre 2016 y 2019 seguían una tendencia constante. En 2020 se observó un descenso importante de diagnósticos entre marzo y mayo que no se recuperó al corregir por retraso en la notificación. Al comparar las tasas de casos diagnosticados en 2013 con los años sucesivos, se observó un descenso continuo que se interrumpía en el último año del periodo de estudio. El porcentaje de casos con diagnóstico tardío se mantuvo estable en el periodo de estudio (entre el 46% y el 50%), observándose un descenso al corregir por retraso en la notificación. Conclusiones: La vigilancia epidemiológica del VIH sufrió un importante retraso en la notificación. Se constata un descenso en los casos diagnosticados, en parte debido al confinamiento y la falta de acceso a pruebas diagnósticas. No se observan cambios en el diagnóstico tardío. [EN] Objective: The COVID-19 pandemic indirectly affected other communicable diseases, such as human immunodeficiency virus (HIV) infection. The aim of this paper was to evaluate the impact of the COVID-19 pandemic on the epidemiological surveillance of HIV through epidemiological indicators. Methods: Data collected in the New HIV Diagnosis Information System (SINIVIH, acronym in Spanish) in the period 2013-2021 was analyzed. The epidemiological indicators analyzed were: 1) Reporting delay of new diagnoses; 2) Under diagnosis of cases, calculated per month of diagnosis and for each year of diagnosis; 3) Late diagnosis, cases diagnosed with less than 350 CD4 cell/mm3. Results: Regarding the reporting delay of new diagnoses, in 2022 2,770 diagnoses were reported in 2020, 43.8% more than those reported in 2021 for that year. The cases diagnosed per month between 2016 and 2019 followed a constant trend. In 2020, a significant decrease in diagnoses was observed between March and May that was not recovered after correcting for reporting delay. When comparing the rates of cases diagnosed in 2013 with the successive years, a continuous decrease was interrupted in the last year of the study period. The percentage of cases with late diagnosis had remained stable in the study period (between 46% and 50%), and a decrease in this percentage was observed after correcting for reporting delay. Conclusions: The epidemiological surveillance of HIV suffered a significant reporting delay. A decrease in cases diagnosed is confirmed, partly due to lockdown and lack of access to the health system. Changes on late diagnosis is not observed.S

Overall and cause-specific excess mortality in HIV-positive persons compared with the general population: Role of HCV coinfection

We aimed to estimate overall and cause-specific excess mortality of HIV-positive patients compared with the general population, and to assess the effect of risk factors.We included patients aged >19 years, recruited from January 1, 2004 to May 31, 2014 in Cohort of the Spanish Network on HIV/AIDS Research. We used generalized linear models with Poisson error structure to model excess mortality rates.In 10,340 patients, 368 deaths occurred. Excess mortality was 0.82 deaths per 100 person-years for all-cause mortality, 0.11 for liver, 0.08 for non-AIDS-defining malignancies (NADMs), 0.08 for non-AIDS infections, and 0.02 for cardiovascular-related causes. Lower CD4 count and higher HIV viral load, lower education, being male, and over 50 years were predictors of overall excess mortality. Short-term (first year follow-up) overall excess hazard ratio (eHR) for subjects with AIDS at entry was 3.71 (95% confidence interval [CI] 2.66, 5.19) and 1.37 (95% CI 0.87, 2.15) for hepatitis C virus (HCV)-coinfected; medium/long-term eHR for AIDS at entry was 0.90 (95% CI 0.58, 1.39) and 3.83 (95% CI 2.37, 6.19) for HCV coinfection. Liver excess mortality was associated with low CD4 counts and HCV coinfection. Patients aged ≥50 years and HCV-coinfected showed higher NADM excess mortality, and HCV-coinfected patients showed increased non-AIDS infections excess mortality.Overall, liver, NADM, non-AIDS infections, and cardiovascular excesses of mortality associated with being HIV-positive were found, and HCV coinfection and immunodeficiency played significant roles. Differential short and medium/long-term effects of AIDS at entry and HCV coinfection were found for overall excess mortality.The RIS cohort (CoRIS) is supported by the Instituto de Salud Carlos III through the Red Temática de Investigación Cooperativa en Sida (RD06/006 and RD12/0017/0018) as part of the Plan Nacional R+D+I and cofinanced by ISCIII-Subdirección General de Evaluación y el Fondo Europeo de Desarrollo Regional (FEDER)S

Estimates of mpox effective reproduction number in Spain, April-August 2022

We analysed the transmission of the human mpox virus in Spain by estimating the effective reproduction number of the disease from official surveillance data. Our computations show that this decreased steadily after an initial burst phase, dropping below 1 on July 12, and thus the outbreak was expected to reduce in the following weeks. Differences in trends were found across geographical regions of the country and across MSM and heterosexual populations.This research was partially supported by CIBER (Strategic Action for Monkeypox) – Consorcio Centro de Investigación Biomédica en Red – (CB 2021), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea – NextGenerationEU.S

Vigilancia Epidemiológica del VIH/SIDA: situación en europa y en España, 2015

[ES] En este boletín se presentan los principales resultados de la vigilancia de la infección por VIH/sida en los países de la Unión Europea/Área Económica Europea (UE/AEE) y España correspondientes al año 2015. La tasa de nuevos diagnósticos de VIH en España fue superior a la media de la UE/AEE (7,4/100.000 habitantes en España y 5,8 en la UE/AEE, sin corregir por retraso en la notificación), aunque es similar a la de otros países del entorno. La vía de transmisión más importante sigue siendo la sexual, ocupando el primer lugar las relaciones sexuales no protegidas entre hombres. Los datos muestran, tanto en España como en la UE/AEE, que casi la mitad de los nuevos diagnósticos en 2015 fueron tardíos y la tendencia se mantiene estable en los últimos años. [EN] This report shows the main findings about HIV/AIDS surveillance in European Union/European Economic Area countries (EU/EEA) and Spain in 2015. The rate of new HIV diagnoses was 7.4 per 100,000 population in Spain and 5.8 in EU/EEA, without adjusting by reporting delay. Sexual transmission is the most important transmission route and the highest proportion of HIV diagnoses was reported in men who have sex with men. In Spain, as well as in EU/EEA countries, nearly half (47%) of new HIV diagnoses in 2015 were late presenters and the trend remains stable.N

Effectiveness and tolerability of dolutegravir/lamivudine for the treatment of HIV-1 infection in clinical practice

Objectives: To assess the effectiveness and tolerability of dolutegravir (DTG)/lamivudine (3TC) among treatment-naive and virologically suppressed treatment-experienced individuals in the multicentre cohort of the Spanish HIV/AIDS Research Network (CoRIS) during the years 2018-2021. Methods: We used multivariable regression models to compare viral suppression (VS) [HIV RNA viral load (VL) <50 copies/mL] and the change in CD4 cell counts at 24 and 48 (±12) weeks after initiation with dolutegravir/lamivudine or other first-line ART regimens. Results: We included 2160 treatment-naive subjects, among whom 401 (18.6%) started with dolutegravir/lamivudine. The remaining subjects started bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide (TAF) (n = 949, 43.9%), DTG + FTC/tenofovir disoproxil fumarate (TDF) (n = 282, 13.1%), DTG/3TC/abacavir (ABC) (n = 255, 11.8%), darunavir (DRV)/cobicistat(COBI)/FTC/TAF (n = 147, 6.8%) and elvitegravir (EVG)/COBI/FTC/TAF (n = 126, 5.8%). At 24 and 48 weeks after starting dolutegravir/lamivudine, 91.4% and 93.8% of the subjects, respectively, achieved VS. The probability of achieving VS with dolutegravir/lamivudine was not significantly different compared with any other regimen at 24 or 48 weeks, with the exception of a lower chance of achieving VS at 24 weeks for DRV/COBI/FTC/TAF (adjusted OR: 0.47; 95% CI: 0.30-0.74) compared with dolutegravir/lamivudine.For the analysis of treatment-experienced virally suppressed subjects we included 1456 individuals who switched to dolutegravir/lamivudine, among whom 97.4% and 95.5% maintained VS at 24 and 48 weeks, respectively. During the first 48 weeks after dolutegravir/lamivudine initiation, 1.0% of treatment-naive and 1.5% of treatment-experienced subjects discontinued dolutegravir/lamivudine due to an adverse event. Conclusions: In this large multicentre cohort, effectiveness and tolerability of dolutegravir/lamivudine were high among treatment-naive and treatment-experienced subjects.This work was supported by (i) the Instituto de Salud Carlos III through the Red Temática de Investigación Cooperativa en Sida (RD06/006, RD12/0017/0018 and RD16/0002/0006) as part of the Plan Nacional I + D + i and co-financed by Instituto de Salud Carlos III-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), and (ii) ViiV Healthcare. The funders did not play any decision making role in the design, execution, analysis or reporting of the research.S

Safety and efficacy of ribociclib plus letrozole in patients with HR+, HER2– advanced breast cancer: Results from the Spanish sub-population of the phase 3b CompLEEment-1 trial

Background: Breast cancer is the most common malignancy and the second leading cause of cancer-related mortality in Spanish women. Ribociclib in combination with endocrine therapy (ET) has shown superiority in prolonging survival in patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC) vs. ET alone.Methods: CompLEEment-1 is a single-arm, open-label phase 3b trial evaluating ribociclib plus letrozole in a broad population of patients with HR+, HER2- ABC. The primary endpoints were safety and tolerability. Here we report data for Spanish patients enrolled in CompLEEment-1.Results: A total of 526 patients were evaluated (median follow-up: 26.97 months). Baseline characteristics showed a diverse population with a median age of 54 years. At study entry, 56.5% of patients had visceral metastases and 8.7% had received prior chemotherapy for advanced disease. Rates of all-grade and Grade >= 3 adverse events (AEs) were 99.0% and 76.2%, respectively; 21.3% of patients experienced a serious AE, and 15.8% of AEs led to treatment discontinuation. AEs of special interest of neutropenia, increased alanine aminotransferase, increased aspartate aminotransferase and QTcF prolongation occurred in 77.8%, 14.8%, 11.4% and 4.0% of patients, respectively. Patients aged >70 years experienced increased rates of all-grade and Grade >= 3 neutropenia and anemia. Efficacy results were consistent with the global study.Conclusions: Results from Spanish patients enrolled in CompLEEment-1 are consistent with global data showing efficacy and a manageable safety profile for ribociclib plus letrozole treatment in patients with HR+, HER2-ABC, including populations of interest (NCT02941926).Trial registration: ClinicalTrials.gov NCT0294192

Effectiveness of Modified Vaccinia Ankara-Bavaria Nordic Vaccination in a Population at High Risk of Mpox: A Spanish Cohort Study

Background: With over 7,500 cases notified since April 2022, Spain has experienced the highest incidence of mpox in Europe. From July 12th onwards, the Modified Vaccinia Ankara-Bavaria Nordic (MVA-BN) smallpox vaccine was offered as pre-exposure prophylaxis for individuals at high-risk of mpox, including those receiving pre-exposure prophylaxis for HIV (HIV-PrEP). Our aim was to assess the effectiveness of one dose of MVA-BN vaccine as pre-exposure against mpox virus (MPXV) infection in persons on HIV-PrEP. Methods: We conducted a national retrospective cohort study between July 12 and December 12, 2022. Individuals ≥18 years, receiving HIV-PrEP as of July 12 and with no previous MPXV infection or vaccination were eligible. Each day, we matched individuals receiving a first dose of MVA-BN vaccine and unvaccinated controls of the same age group and region. We used a Kaplan-Meier estimator and calculate risk ratios (RR) and vaccine effectiveness (VE = 1-RR). Results: We included 5,660 matched pairs, with a median follow-up of 62 days (interquartile range 24-97). Mpox cumulative incidence was 5.6 per 1,000 (25 cases) in unvaccinated and 3.5 per 1,000 (18 cases) in vaccinated. No effect was found during days 0-6 post-vaccination (VE -38.3; 95% confidence interval (95%CI): -332.7; 46.4), but VE was 65% in ≥7 days (95%CI 22.9; 88.0) and 79% in ≥14 days (95%CI 33.3; 100.0) post-vaccination. Conclusions: One dose of MVA-BN vaccine offered protection against mpox in a most-at-risk population shortly after the vaccination. Further studies need to assess the VE of a second dose and the duration of protection over time.S