Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p < 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Mechanisms in the privatization process of public education

The situation in the district of Puente de Vallecas (Madrid, Spani) can be taken as an example of the progressive development of private schools held by public funds at the expense of the public schools network. This situation is the result of different mechanisms: first, the lost perception of education as a common good; second, the neglect of the right to free compulsory education in all schools supported by public funds; and third, the unfair distribution of students from economic and cultural disadvantaged backgrounds

Mecanismos en el proceso de privatización de la enseñanza pública

En el ejemplo del distrito de Puente de Vallecas, se observa cómo el progresivo desarrollo de la red de enseñanza concertada en detrimento de la red pública se apoya en distintos mecanismos, entre los que destaca la pérdida de percepción de la educación como un bien público, el desconocimiento del derecho de a la gratuidad de la enseñanza en todos los centros de educación obligatoria sostenidos con fondos públicos, así como el desigual reparto del alumnado procedente de los grupos sociales económica y culturalmente más desfavorecidos.The situation in the district of Puente de Vallecas (Madrid, Spani) can be taken as an example of the progressive development of private schools held by public funds at the expense of the public schools network. This situation is the result of different mechanisms: first, the lost perception of education as a common good; second, the neglect of the right to free compulsory education in all schools supported by public funds; and third, the unfair distribution of students from economic and cultural disadvantaged backgrounds

Revista electrónica interuniversitaria de formación del profesorado

Monográfico con el título: 'Mercantilización de la educación'. Resumen basado en el de la publicaciónSe muestran los efectos del desarrollo de la red de enseñanza concertada en detrimento de la red pública en el distrito de Puente de Vallecas. Entre las consecuencias que subyacen de este reemplazo de centros escolares se señalan: la pérdida de percepción de la educación como un bien público; el desconocimiento del derecho a la gratuidad de la enseñanza en todos los centros de educación obligatoria sostenidos con fondos públicos; y el desigual reparto del alumnado procedente de los grupos sociales económica y culturalmente más desfavorecidos. Los datos de los que se extraen estas afirmaciones se derivan del trabajo de la Federación de la Comunidad de Madrid de Asociaciones de Padres y Madres del Alumnado Francisco Giner de los Ríos.AragónES

Impact of late presentation of HIV infection on short-, mid- and long-term mortality and causes of death in a multicenter national cohort : 2004-2013

To analyze the impact of late presentation (LP) on overall mortality and causes of death and describe LP trends and risk factors (2004-2013). Cox models and logistic regression were used to analyze data from a nation-wide cohort in Spain. LP is defined as being diagnosed when CD4 < 350 cells/ml or AIDS. Of 7165 new HIV diagnoses, 46.9% (CI:45.7-48.0) were LP, 240 patients died.First-year mortality was the highest (aHR = 10.3[CI:5.5-19.3]); between 1 and 4 years post-diagnosis, aHR = 1.9(1.2-3.0); an

Prediction of long-term outcomes of HIV-infected patients developing non-AIDS events using a multistate approach

Outcomes of people living with HIV (PLWH) developing non-AIDS events (NAEs) remain poorly defined. We aimed to classify NAEs according to severity, and to describe clinical outcomes and prognostic factors after NAE occurrence using data from CoRIS, a large Spanish HIV cohort from 2004 to 2013. Prospective multicenter cohort study. Using a multistate approach we estimated 3 transition probabilities: from alive and NAE-free to alive and NAE-experienced ("NAE development"); from alive and NAE-experienced to death ("Death after NAE"); and from alive and NAE-free to death ("Death without NAE"). We analyzed the effect of different covariates, including demographic, immunologic and virologic data, on death or NAE development, based on estimates of hazard ratios (HR). We focused on the transition "Death after NAE". 8,789 PLWH were followed-up until death, cohort censoring or loss to follow-up. 792 first incident NAEs occurred in 9.01% PLWH (incidence rate 28.76; 95% confidence interval [CI], 26.80-30.84, per 1000 patient-years). 112 (14.14%) NAE-experienced PLWH and 240 (2.73%) NAE-free PLWH died. Adjusted HR for the transition "Death after NAE" was 12.1 (95%CI, 4.90-29.89). There was a graded increase in the adjusted HRs for mortality according to NAE severity category: HR (95%CI), 4.02 (2.45-6.57) for intermediate-severity; and 9.85 (5.45-17.81) for serious NAEs compared to low-severity NAEs. Male sex (HR 2.04; 95% CI, 1.11-3.84), ag