4 research outputs found
STI epidemic re-emergence, socio-epidemiological clusters characterisation and HIV coinfection in Catalonia, Spain, during 2017-2019 : A retrospective population-based cohort study
Objectives To describe the epidemiology of sexually transmitted infections (STIs), identify and characterise socio-epidemiological clusters and determine factors associated with HIV coinfection. Design Retrospective population-based cohort. Setting Catalonia, Spain. Participants 42 283 confirmed syphilis, gonorrhoea, chlamydia and lymphogranuloma venereum cases, among 34 600 individuals, reported to the Catalan HIV/STI Registry in 2017-2019. Primary and secondary outcomes Descriptive analysis of confirmed STI cases and incidence rates. Factors associated with HIV coinfection were determined using logistic regression. We identified and characterized socio-epidemiological STI clusters by Basic Health Area (BHA) using K-means clustering. Results The incidence rate of STIs increased by 91.3% from 128.2 to 248.9 cases per 100 000 population between 2017 and 2019 (p<0.001), primarily driven by increase among women (132%) and individuals below 30 years old (125%). During 2017-2019, 50.1% of STIs were chlamydia and 31.6% gonorrhoea. Reinfections accounted for 10.8% of all cases and 6% of cases affected HIV-positive individuals. Factors associated with the greatest likelihood of HIV coinfection were male sex (adjusted OR (aOR) 23.69; 95% CI 16.67 to 35.13), age 30-39 years (versus <20 years, aOR 18.58; 95% CI 8.56 to 52.13), having 5-7 STI episodes (vs 1 episode, aOR 5.96; 95% CI 4.26 to 8.24) and living in urban areas (aOR 1.32; 95% CI 1.04 to 1.69). Living in the most deprived BHAs (aOR 0.60; 95% CI 0.50 to 0.72) was associated with the least likelihood of HIV coinfection. K-means clustering identified three distinct clusters, showing that young women in rural and more deprived areas were more affected by chlamydia, while men who have sex with men in urban and less deprived areas showed higher rates of STI incidence, multiple STI episodes and HIV coinfection. Conclusions We recommend socio-epidemiological identification and characterisation of STI clusters and factors associated with HIV coinfection to identify at-risk populations at a small health area level to design effective interventions
Monitorización y evaluación del vih en Cataluña, cada vez más cerca de los objetivos 90-90-90
Background: Epidemiological surveillance of HIV infection
allows monitoring its incidence as well as possible epidemiological
changes, allowing specific interventions to be planned and
their impact monitored. The objective of this article is to describe
the results of the monitoring and evaluation of the response
to the HIV epidemic in Catalonia, based on data included in the
Integrated System of Epidemiological Surveillance of AIDS/HIV
and Sexually Transmitted Infections of Catalonia (SIVES).
Methods: A descriptive analysis of the data from the different
sources of information of the SIVES was performed. The
time period was defined based on the availability of data from
each of the sources of information included in the analysis. The
information was structured according to the conceptual representation
of the cascade of HIV care, as described in the World
Health Organization consolidated strategic information guidelines
for HIV.
Results: Of the total of 4,849 new diagnoses notified (2012-
2018), 86% were men, of these; the most frequently reported
transmission group was men having sex with men with 65%. The
trend in the number of new diagnoses decreased in all transmission
groups. It is estimated that in 2018 there were 32,429 people
living with HIV in Catalonia, of which 89% were diagnosed, of
these, 83% were under follow-up in a specialized unit and 78% of
them were under treatment. 73% of people in treatment had suppressed
the viral load.
Conclusions: SIVES as an integrated system of different
sources of strategic information allows monitoring the HIV epidemic
in Catalonia and evaluating the response to it, identifying
key populations and determinants to acquire HIV, as well as the
barriers to which people living with HIV they face to achieve viral
suppression.Fundamentos: La vigilancia epidemiológica de la infección
por el VIH permite monitorizar su incidencia así como eventuales
cambios epidemiológicos, permitiendo planificar intervenciones específicas
y monitorizar su impacto. El objetivo de este artículo fue
describir los resultados de la monitorización y evaluación de la respuesta
a la epidemia del VIH en Cataluña, a partir de los datos incluidos
en el Sistema Integrado de Vigilancia Epidemiológica del
Sida/VIH e Infecciones de transmisión sexual de Cataluña (SIVES).
Métodos: Se realizó un análisis descriptivo de los datos de
las diferentes fuentes de información del SIVES. El periodo de
tiempo se definió a partir de la disponibilidad de los datos de cada
una de las fuentes de información incluidas en el análisis. La información
se estructuró de acuerdo a la representación conceptual
de la cascada de diagnóstico y tratamiento de VIH, tal y como se
describe en las directrices de información estratégica consolidada
de la Organización Mundial de la Salud para el VIH.
Resultados: Del total de 4.849 nuevos diagnósticos notificados
(2012-2018), el 86% eran hombres. De estos, el grupo de
transmisión informado más frecuente fueron los hombres que tiene
sexo con hombres con un 65%. La tendencia del número de
nuevos diagnósticos descendió en todos los grupos de transmisión.
Se estima que en 2018 había 32.429 personas viviendo con el VIH
en Cataluña, de las cuales el 89% estaban diagnosticadas. De estas,
el 83% estaban en seguimiento en una unidad especializada, y
el 78% de ellas estaban en tratamiento. El 73% de las personas en
tratamiento tenían la carga viral suprimida.
Conclusiones: El SIVES, como sistema integrado de diferentes
fuentes de información estratégica, permite monitorizar la
epidemia del VIH en Cataluña y evaluar la respuesta a la misma,
identificando poblaciones claves y determinantes para adquirir el
VIH, así como las barreras a las que se enfrentan las personas que
viven con VIH para lograr a supresión viral
Genome-wide Association Study Meta-analysis Identifies Five New Loci For Systemic Lupus Erythematosus
Background: Systemic lupus erythematosus (SLE) is a common systemic autoimmune disease with a complex genetic inheritance. Genome-wide association studies (GWAS) have significantly increased the number of significant loci associated with SLE risk. To date, however, established loci account for less than 30% of the disease heritability and additional risk variants have yet to be identified. Here we performed a GWAS followed by a meta-analysis to identify new genome-wide significant loci for SLE. Methods: We genotyped a cohort of 907 patients with SLE (cases) and 1524 healthy controls from Spain and performed imputation using the 1000 Genomes reference data. We tested for association using logistic regression with correction for the principal components of variation. Meta-analysis of the association results was subsequently performed on 7,110,321 variants using genetic data from a large cohort of 4036 patients with SLE and 6959 controls of Northern European ancestry. Genetic association was also tested at the pathway level after removing the effect of known risk loci using PASCAL software. Results: We identified five new loci associated with SLE at the genome-wide level of significance (p < 5 x 10(-8)): GRB2, SMYD3, ST8SIA4, LAT2 and ARHGAP27. Pathway analysis revealed several biological processes significantly associated with SLE risk: B cell receptor signaling (p = 5.28 x 10(-6)), CTLA4 co-stimulation during T cell activation (p = 3.06 x 10(-5)), interleukin-4 signaling (p = 3.97 x 10(-5)) and cell surface interactions at the vascular wall (p = 4.63 x 10(-5)). Conclusions: Our results identify five novel loci for SLE susceptibility, and biologic pathways associated via multiple low-effect-size loci
ABATACEPT in rheumatoid arthritis with interstitial lung disease. A multicenter study of 181 patients
Background Interstitial Lung Disease (ILD) is a severe extraarticular manifestation of rheumatoid arthritis (RA).
Objectives Our aim was to assess the efficacy of abatacept (ABA) in RA patients with ILD.
Methods Retrospective multicenter study of RA patients with ILD treated with ABA. ILD was diagnosed by HRCT. We have analyzed the following variables: a) 1-point change the Modified Medical Research Council (MMRC); b) FVC improvement ≥10%; and improvement ≥10% in DLCO; c) radiological improvement in HRCT scan, d) changes in DAS28 score. Values were compared with baseline e) prednisone doses
Results We studied 181 patients (94women/87 men) with ILD associated to RA. The follow-up was 12.1[6.2-24.1] months. The mean age was 64.54 ± 9.7 years. The median to progression of ILD was 12 [3-43.75] months. 81 patients were treated in monotherapy, 100 patients in combination therapy. The most frequent pattern was UIP 45,3%.
The most of patients who did not have dyspnea remained asymptomatic.
See results in Figure1. DAS28 also improved. We appreciate a decrease in the dose of prednisone compared to the initial dose.
Conclusion ABA seems to be effective. However, should be verified in prospective and randomized studies