Cambios epidemiológicos entre los nuevos diagnósticos de infección por el VIH : impacto de la profilaxis pre-exposición

Para evitar la transmisión del VIH, se han utilizado varias medidas preventivas: uso sistemático del preservativo, educación sexual, cribado de VIH/ITS, profilaxis postexposición, diagnóstico precoz del VIH, tratamiento antirretroviral inmediato y, más recientemente, profilaxis pre-exposición (PrEP). Esta última consiste en la administración de fármacos antirretrovirales a personas seronegativas con prácticas de alto riesgo para evitar contraer el VIH. Desde su implementación, se ha descrito un aumento de las prácticas sexuales de riesgo, favorecidas por el uso de la PrEP, denominado “risk compensation”. Esta tesis basada en artículos tiene tres objetivos principales: [1] describir las características sociodemográficas, clínicas y conductuales de los hombres que tienen sexo con hombres (HSH) con nuevo diagnóstico de infección por el VIH y estudiar su evolución entre 2014-2019; [2] estimar el efecto preventivo que supondría haber incluido la PrEP, en los pacientes con seroconversión documentada al VIH entre 2014-2016, y [3] medir los cambios clínicos y conductuales asociados a la PrEP, “risk compensation”, mediante el análisis del uso del preservativo en el coito anal, número de parejas sexuales, consumo de drogas para el sexo y frecuencia de ITS. Este trabajo se ha realizado en una Clínica de referencia en VIH/ITS..

Risk factors associated with sexually transmitted infections and HIV among adolescents in a reference clinic in Madrid.

INTRODUCTION:Adolescents have a higher incidence of sexually transmitted infections (STIs) than persons of older age groups. The WHO emphasises the need to adopt specific and comprehensive prevention programmes aimed at this age group. The objective of this work was to analyse the prevalence of HIV/STIs among adolescents and to identify the sociodemographic, clinical and behavioural markers associated with these infections, in order to promote specific preventive strategies. METHODOLOGY:Retrospective descriptive study of adolescents, aged 10-19 years, who were attended to for the first consultation between 2016 and 2018 in a reference STI clinic in Madrid. All adolescents were given a structured epidemiological questionnaire where information on sociodemographic, clinical and behavioural characteristics was collected. They were screened for human inmmunodeficiency virus (HIV) and other sexually transmitted infections (STIs). The processing and analysis of the data was done using the STATA 15.0 statistical package. RESULTS:The frequency of HIV/STIs detected among all adolescents was: gonorrhoea 21.7%, chlamydia 17.1%, syphilis 4.8% and HIV 2.4%. After conducting a multivariate analysis, the independent and statistically significant variables related to the presence of an STI were having first sexual relations at a young age and having a history of STIs. Latin American origin was just below the level of statistical significance (p = 0.066). DISCUSSION/CONCLUSIONS:Adolescents who begin sexual relations at an early age or those who have a history of HIV/STIs are at higher risk of acquiring STIs. Comprehensive prevention programmes aimed specifically at adolescents should be implemented, especially before the age of 13 years

Low use of condom and high STI incidence among men who have sex with men in PrEP programs.

ObjectiveSince the recent introduction of preexposure prophylaxis (PrEP), several studies have reported a decrease in the use of condoms and a rise in STIs among users. This rise in risk behavior associated with the advent of PrEP is known as "risk compensation." The aim of this study is to measure clinical and behavioral changes associated with the introduction of PrEP by analyzing condom use for anal intercourse, number of sexual partners, sexualized drug use and STI incidence.MethodsWe performed a retrospective descriptive study of PrEP users followed every 3months over a 2-year period spanning 2017-2019 in a referral clinic specializing in STI/HIV in Madrid, Spain. One hundred ten men who have sex with men and transgender women underwent regular screening for STIs and hepatitis C virus (HCV) infection. Sociodemographic, clinical, and behavioral data were gathered for all subjects studied.ResultsThe risk compensation observed in this study consisted primarily of a lower rate of condom use, while the number of sexual partners and recreational drug consumption remained stable. We observed a very high incidence of STIs in this sample, particularly rectal gonorrhea and chlamydia. The factors shown to be independently associated with the presence of an STI on multivariate analysis were age below 30 years and over 10 sexual partners/month.ConclusionThe incidence of STI acquisition was higher than expected, indicating a need for strategies to minimize this impact, particularly among younger individuals with a higher number of sexual partners