Sexually transmitted infections in young people and factors associated with HIV coinfection : An observational study in a large city

Altres ajuts: We thank all the reporting physicians who have contributed to the collection and quality of the information in the surveys. The Spanish Society of Epidemiology (SEE) for rewarding with 'VII Premio Emilio Perea' the work that gave rise to this article as the second best oral senior communication in the SEE Congress held in Barcelona in September 2017.Objectives Young people are a critical target group for sexually transmitted infections (STI) surveillance due to their particular behavioural and social related vulnerability. The aim of this study was to describe the epidemiological characteristics and trends in the incidence of gonorrhoea, syphilis, HIV and venereal lymphogranuloma (LGV) among 15-24-year-olds in Barcelona, and to determine factors associated with HIV coinfection. Design We performed a population-based incidence study covering the 2007-2015 period. Participants All new cases of STI - HIV, gonorrhoea, infectious syphilis and LGV - notified to the epidemiological surveillance system in Barcelona between 2007 and 2015. 1218 cases were studied: 84.6% were men, 19.3% were 15-19 years old and 50.6% were born in Spain. Among men, 73.7% were men who have sex with men (MSM); among women, 85.6% were women that have sex with men. Primary and secondary outcomes Incidence of HIV, gonorrhoea, infectious syphilis and LGV. HIV coinfection. Results There was an increase in the incidence of gonorrhoea, from 1.9 cases per 10 000 people in 2007 to 7.6/10 000 in 2015 (p10 sexual partners (ORa=4.11, 95% CI 1.53 to 11.01) or STI diagnosis during the previous 12 months (ORa=2.06; 95% CI 1.13 to 3.77). Conclusions The incidence of gonorrhoea and syphilis among 15-24-year-olds increased, while HIV infection remained stable but with a high incidence among MSM. Being MSM, having sex with multiple partners and having a diagnosis of an STI in the previous 12 months were factors associated with HIV coinfection

Meeting Report. Infectious Diseases and Social Determinants Stockholm, 26-27 April, 2007

Report di Meeting Internazionale svoltosi presso la sede Europea dell'"European Center for Disease Control and Prevention" (ECDC) di Stoccolma (Svezia), al fine di esaminare le connessioni tra malattie infettive e determinanti sociali, e di tracciare eventuali linee di intervento su base continentale (Europea

Long-term mortality in HIV-positive Individuals virally suppressed for >3 years with incomplete CD4 recovery

Background.\u2003Some human immunodeficiency virus (HIV)-infected individuals initiating combination antiretroviral therapy (cART) with low CD4 counts achieve viral suppression but not CD4 cell recovery. We aimed to identify (1) risk factors for failure to achieve CD4 count >200 cells/\ub5L after 3 years of sustained viral suppression and (2) the association of the achieved CD4 count with subsequent mortality. Methods.\u2003We included treated HIV-infected adults from 2 large international HIV cohorts, who had viral suppression ( 64500 HIV type 1 RNA copies/mL) for >3 years with CD4 count 64200 cells/\ub5L at start of the suppressed period. Logistic regression was used to identify risk factors for incomplete CD4 recovery ( 64200 cells/\ub5L) and Cox regression to identify associations with mortality. Results.\u2003Of 5550 eligible individuals, 835 (15%) did not reach a CD4 count >200 cells/\ub5L after 3 years of suppression. Increasing age, lower initial CD4 count, male heterosexual and injection drug use transmission, cART initiation after 1998, and longer time from initiation of cART to start of the virally suppressed period were risk factors for not achieving a CD4 count >200 cells/\ub5L. Individuals with CD4 64200 cells/\ub5L after 3 years of viral suppression had substantially increased mortality (adjusted hazard ratio, 2.60; 95% confidence interval, 1.86-3.61) compared with those who achieved CD4 count >200 cells/\ub5L. The increased mortality was seen across different patient groups and for all causes of death. Conclusions.\u2003Virally suppressed HIV-positive individuals on cART who do not achieve a CD4 count >200 cells/\ub5L have substantially increased long-term mortality

Does rapid HIV disease progression prior to combination antiretroviral therapy hinder optimal CD4 + T-cell recovery once HIV-1 suppression is achieved?

Objective: This article compares trends in CD4 + T-cell recovery and proportions achieving optimal restoration (≥500cells/μl) after viral suppression following combination antiretroviral therapy (cART) initiation between rapid and nonrapid progressors. Methods: We included HIV-1 seroconverters achieving viral suppression within 6 months of cART. Rapid progressors were individuals experiencing at least one CD4 + less than 200cells/μl within 12 months of seroconverters before cART. We used piecewise linear mixed models and logistic regression for optimal restoration. Results: Of 4024 individuals, 294 (7.3%) were classified as rapid progressors. At the same CD4 + T-cell count at cART start (baseline), rapid progressors experienced faster CD4 + T-cell increases than nonrapid progressors in first month [difference (95% confidence interval) in mean increase/month (square root scale): 1.82 (1.61; 2.04)], which reversed to slightly slower increases in months 1-18 [-0.05 (-0.06; -0.03)] and no significant differences in 18-60 months [-0.003 (-0.01; 0.01)]. Percentage achieving optimal restoration was significantly lower for rapid progressors than nonrapid progressors at months 12 (29.2 vs. 62.5%) and 36 (47.1 vs. 72.4%) but not at month 60 (70.4 vs. 71.8%). These differences disappeared after adjusting for baseline CD4 + T-cell count: odds ratio (95% confidence interval) 0.86 (0.61; 1.20), 0.90 (0.38; 2.17) and 1.56 (0.55; 4.46) at months 12, 36 and 60, respectively. Conclusion: Among people on suppressive antiretroviral therapy, rapid progressors experience faster initial increases of CD4 + T-cell counts than nonrapid progressors, but are less likely to achieve optimal restoration during the first 36 months after cART, mainly because of lower CD4 + T-cell counts at cART initiation. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved