RESUMO
OBJECTIVE: To describe the epidemiology of acute/recent human immunodeficiency virus (HIV) infection over two decades in Barcelona (Spain). METHODS: Prospective, single-centre cohort including all patients with an acute/recent HIV infection (<180 days) since 1997. Patients were stratified into four periods. Phylogenetic analysis was performed to determine clusters of transmission. RESULTS: A total of 346 consecutive acute/recently infected patients were included. The annual proportion of recent infections among total new HIV diagnoses increased over time from 1% (29 out of 1964) to 8% (112 out of 1474) (p <0.001). Proportion of men who have sex with men (MSM) in the cohort increased from 62% (18 out of 29) to 89% (100 out of 112) (p <0.001). The proportion of migrants showed a non-significant increasing trend (24% (7 of 29) to 40% (45 of 112)) likewise the non-B subtype (0% to 22% (22 of 112)). The mean time from infection to diagnosis was 53.6 days (interquartile range (IQR) 50-57), comparable among all periods. Mean time from infection to treatment decreased over the years from 575 (IQR 467-683) to 471 (IQR 394-549) days (p <0.001) without significant differences between migrants and non-migrants (133 (IQR 71-411) versus 208 (IQR 90-523) days p 0.089). Almost 50% (152 of 311) of recently infected individuals were included in a cluster of transmission, and 92% (137 of 149) of them were MSM. CONCLUSION: The MSM population has progressively grown within acutely/recently infected patients in Barcelona, and is frequently involved in transmission clusters. Although the time between diagnosis and treatment has been reduced, the time between infection and diagnosis still needs to be shortened.
Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Homossexualidade Masculina , Doença Aguda , Adulto , Feminino , HIV-1/isolamento & purificação , Humanos , Masculino , Filogenia , Estudos Prospectivos , Minorias Sexuais e de Gênero , Espanha/epidemiologia , MigrantesRESUMO
BACKGROUND: Health resources needed by immigrants have increased steadily in the last few years. Studying health problems and social vulnerability in immigrants would help to improve the health care quality. PATIENTS AND METHODS: A case-control study performed in the Hospital Clinic of Barcelona. Immigrant patients admitted with infectious diseases from October 2002 to September 2003 were included. Controls were paired by age, gender and HIV infection. Clinical (emergency room attendance, days and number of admission to hospital, amount of clinical procedures and drugs used during the admission, etiological and microbiological diagnosis and post-admission control) and social vulnerability variables (social worker consultation, health care card, relatives or friends caregiver, drug use, language barrier and discharge document of the nurse) were analyzed. RESULTS: One hundred and two patients (51 cases and 51 controls, all of them males) were studied. A total of 56% were HIV-1 infected in both groups. The number of diagnostic or therapeutic procedures was higher in the immigrant group (p = 0.02), a lower proportion of patients had a final etiologic diagnosis (82% vs 98%, p = 0.021) and the number of post-discharge controls was lower (55% vs 77%, p = 0.04). Immigrants had a higher social vulnerability index than the Spanish population and 35% could not speak Spanish, French or English. The number of immigrants with health care card was lower (63% vs 94%, p < 0,0001) and a higher number needed to be admitted to a social-health care center after discharge (16% vs 2%, p = 0.01). DISCUSSION: Social vulnerability influences the etiological diagnosis, the number of diagnostic and therapeutic procedures during the admission to the hospital and post-discharge control of immigrant population.