Changes in the profile of newly HIV-diagnosed men who have sex with men, Madrid, 2014 to 2019.

IntroductionKnowing the factors associated with HIV transmission is necessary in order to design preventive programmes tailored to the epidemiological situation in each region and population.AimOur objective was to study the sociodemographic, clinical and behavioural characteristics of men who have sex with men (MSM) who were newly diagnosed with HIV infection.MethodsWe carried out an observational, descriptive, study on all MSM newly diagnosed with HIV infection in one clinic for sexually transmitted infections (STI) and HIV clinic in Madrid between 2014 and 2019. Information on sociodemographic, clinical, and behavioural characteristics of participants per year of diagnosis was collected.ResultsWe detected a total of 1,398 people with HIV infection, 253 of whom were recent seroconverters (rSCV) with a median duration of documented seroconversion of 6 months. From the total, 97.9% infections were sexually transmitted and 2.1% involved injected drugs, i.e. slam practices. The average age was 32.9 years (range: 15.6-74.9), 51.8% were Spanish and 40% Latin American. These diagnoses decreased in Spanish people and increased in Latin Americans during the study period. Of the rSCV, 73.9% had condomless sex under the influence of drugs and 28.9% participated in chemsex sessions. Apps were used by 92.6% rSCV for sexual encounters and 70.4% of them attributed HIV transmission to their use.ConclusionsCombination of HIV prevention strategies, as pre-exposure prophylaxis, should be reinforced among young MSM, especially those born in Latin America, those who use drugs for sex, and those who use apps in search of sexual contacts.

Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study.

BACKGROUND: The level of evidence for HIV transmission risk through condomless sex in serodifferent gay couples with the HIV-positive partner taking virally suppressive antiretroviral therapy (ART) is limited compared with the evidence available for transmission risk in heterosexual couples. The aim of the second phase of the PARTNER study (PARTNER2) was to provide precise estimates of transmission risk in gay serodifferent partnerships. METHODS: The PARTNER study was a prospective observational study done at 75 sites in 14 European countries. The first phase of the study (PARTNER1; Sept 15, 2010, to May 31, 2014) recruited and followed up both heterosexual and gay serodifferent couples (HIV-positive partner taking suppressive ART) who reported condomless sex, whereas the PARTNER2 extension (to April 30, 2018) recruited and followed up gay couples only. At study visits, data collection included sexual behaviour questionnaires, HIV testing (HIV-negative partner), and HIV-1 viral load testing (HIV-positive partner). If a seroconversion occurred in the HIV-negative partner, anonymised phylogenetic analysis was done to compare HIV-1 pol and env sequences in both partners to identify linked transmissions. Couple-years of follow-up were eligible for inclusion if condomless sex was reported, use of pre-exposure prophylaxis or post-exposure prophylaxis was not reported by the HIV-negative partner, and the HIV-positive partner was virally suppressed (plasma HIV-1 RNA <200 copies per mL) at the most recent visit (within the past year). Incidence rate of HIV transmission was calculated as the number of phylogenetically linked HIV infections that occurred during eligible couple-years of follow-up divided by eligible couple-years of follow-up. Two-sided 95% CIs for the incidence rate of transmission were calculated using exact Poisson methods. FINDINGS: Between Sept 15, 2010, and July 31, 2017, 972 gay couples were enrolled, of which 782 provided 1593 eligible couple-years of follow-up with a median follow-up of 2·0 years (IQR 1·1-3·5). At baseline, median age for HIV-positive partners was 40 years (IQR 33-46) and couples reported condomless sex for a median of 1·0 years (IQR 0·4-2·9). During eligible couple-years of follow-up, couples reported condomless anal sex a total of 76 088 times. 288 (37%) of 777 HIV-negative men reported condomless sex with other partners. 15 new HIV infections occurred during eligible couple-years of follow-up, but none were phylogenetically linked within-couple transmissions, resulting in an HIV transmission rate of zero (upper 95% CI 0·23 per 100 couple-years of follow-up). INTERPRETATION: Our results provide a similar level of evidence on viral suppression and HIV transmission risk for gay men to that previously generated for heterosexual couples and suggest that the risk of HIV transmission in gay couples through condomless sex when HIV viral load is suppressed is effectively zero. Our findings support the message of the U=U (undetectable equals untransmittable) campaign, and the benefits of early testing and treatment for HIV. FUNDING: National Institute for Health Research.

To whom is HIV pre-exposure prophylaxis proposed? / ¿A quién proponer la profilaxis preexposición al virus de la inmunodeficiencia humana?

INTRODUCTION: HIV Pre-Exposure Prophylaxis (PrEP) consists of administering antiretroviral drugs to seronegative individuals with high risk practices. The aim of the study was to describe the characteristics of recent seroconverted HIV patients in order to determine the profile of the appropriate candidates for PrEP. METHODS: A descriptive study of all patients diagnosed with HIV infection in 2014, and who had achieved a documented negative serology over the previous 12 months. A specific form was completed to determine the sociodemographic, behavioural, and clinical features, with complementary tests being performed for other sexually transmitted infections. RESULTS: Almost all (98.4%) of the 61 recent seroconverted were men who have sex with men, and aged between 20 to 39 years (88.5%). They also had a background of sexually transmitted infections (80.3%), performed multiple and unprotected sexual practices (82.7%), and under the effect of recreational drugs (87%). CONCLUSIONS: The evaluation of the risk factors for HIV infection in seronegative patients should enable the appropriate candidates for PrEP to be identified.

Life expectancy of people with HIV on antiretroviral therapy in Spain.

OBJECTIVE: To estimate life expectancy of people with HIV (PWH) and describe causes of death. DESIGN: Antiretroviral therapy (ART)-naive adults from the CoRIS cohort starting ART in 2004-2019. METHODS: We calculated life expectancy at age 40 for men and women according to their ART initiation period, and stratified by transmission category, CD4 + cell count and AIDS diagnosis. We estimated life expectancy in 10-year age bands using life tables constructed from mortality rates, estimated through Poisson models. RESULTS: Life expectancy increased from 65.8 [95% confidence interval (CI) 65.0-66.6] in 2004-2008 to 72.9 (72.2-73.7) in 2014-2019 in men [general population comparators (GPC): 79.1 and 81.2 years, respectively] and from 65.8 (65.0-66.6) to 72.5 (71.8-73.3) in women (GPC: 84.9 and 86.4, respectively). Non-AIDS-related deaths accounted for 68% of deaths among men and 78% among women. Life expectancy was longer when starting ART with higher CD4 + cell counts and without AIDS. For men acquiring HIV through sex with men, starting ART in 2014-2019 without AIDS, life expectancy was 75.0 (74.2-75.7) with CD4 + cell count less than 200 cells/µl, rising to 78.1 (77.5-78.8) with CD4 + cell count at least 350 cells/µl. Corresponding figures were 70.1 (69.4-70.9) and 76.0 (75.3-76.7) for men acquiring HIV heterosexually (HTX) and 61.5 (60.7-62.3) and 69.0 (68.2-69.8) for those acquiring HIV through injection drug use (IDU). For women starting ART from 2014 without AIDS, life expectancy increased from 71.7 (71.0-72.4) to 77.3 (76.7-77.9) among HTX and from 63.7 (62.9-64.5) to 70.7 (70.0-71.5) among IDU. CONCLUSION: Our findings confirm the progressive improvement of life expectancy in PWH in Spain over the last decades, supporting the insurability of PWH on suppressive ART in our current setting and time.

Incidence of sexually transmitted infections and screening models among pre-exposure prophylaxis users.

INTRODUCTION: There is discussion about the frequency of STI screening among pre-exposure prophylaxis (PrEP) users. The aim of this study was to analyse the incidence of STIs and to evaluate different screening models in order to optimise the follow-up. METHODOLOGY: A prospective study was conducted between 2017 and 2023, including 138 PrEP users in a STI clinic. Participants were tested for STIs every three months. Unscheduled visits were performed for those with STI-related symptoms or for people who were notified for an STI by a sexual partner. We performed a survival analysis of repeated events, estimating the cumulative incidence (CI) and incidence rate (IR). RESULTS: The overall CI by quarterly screening was 8.3 (95% CI: 7.6-9.1) infections per person over six years, with a decreasing trend. The most frequently diagnosed pathogen was Neisseria gonorrhoeae, with a IR of 0.76 (95% CI: 0.68-0.84). If the frequency of screening is reduced to every six months, the IR of STIs is reduced by (95% CI: 0.5-0.66) infections per user per year, and at 12 months by 0.82 (95% CI: 0.73-0.89). In the case of no pharyngeal or urethral screening, IR is reduced by 0.37 (95% CI: 0.32-0.42) infections per person per year and in those over 35 years of age by 0.33 (95% CI: 0.25-0.4). Eliminating unscheduled visits, the reduction in IR is 0.33 (95% CI: 0.24-0.42). CONCLUSIONS: The incidence of STIs among PrEP users is high, especially in the rectum, but it does not increase over time. STI screening could be optimised reducing the frequency of pharyngeal and urethral testing, particularly in those over 35 years of age. It is essential to redistribute health resources for unscheduled visits, which have been shown to be the most cost-effective screening.

Is dark-field microscopy still useful for the primary syphilis diagnosis in the 21ST century?

INTRODUCTION: Serological test for primary syphilis could be negative the first 5-15 days. The aim of this study was to evaluate the benefit of including dark field microscopy (DFM) in the diagnosis algorythm for primary syphilis. MATERIALS/METHODS: Patients attended to a sexual transmission diseases clinic of Madrid, from 2015 to 2019, for a genital ulcer with clinical suspicion of primary syphilis. They were tested for DMF and serological test (EIA/TPPA/RPR). RESULTS: Over the total amount of samples (806), 53.2% (429) were positive for DFM. Thus, the 48% of the 429 patients had negative serological test (EIA/RPR) of which the 77.6% were positive at TPPA. CONCLUSIONS: DFM allows primary syphilis early diagnosis, even without serological test. If no direct detection methods are available, for patients without history of syphilis, TPPA could help to diagnose primary syphilis.

Survey of diagnostic resources for STI in Spain.

BACKGROUND: Scarce information is available on the resources to deal with the Sexually Transmitted Infections (STIs), both in the clinic and in the laboratory. The objective is to describe and know the reality of the clinics and laboratories that treat these infections in Spain. METHODS: Cross-sectional observational study with data collection through a survey aimed at the members of the GEITS Group. RESULTS: Responses were obtained from 24 centers (response rate 38.1%) belonging to 10 Autonomous Communities. Regarding STI consultations, 38% require that the patient present a health card to provide assistance, and 31.8% only provide it by referral from another doctor. The 52.4% perform diagnostic methods in the care center. Regarding laboratories, 18.2% do not offer immediate response diagnostic tests, although 100% have PCR against Neisseria gonorrhoeae and Chlamydia trachomatis, 47.8% against Mycoplasma genitalium and 65% detect lymphogranuloma venereum genotypes. All laboratories continue to perform culture and gonococcal sensitivity techniques, and 20% perform molecular methods for detection of MG antimicrobial resistance. CONCLUSION: There is great variability in the provision of human and material resources both in the clinics and in the laboratories that attend STIs. In a significant number of centers there are limitations for patient access. Although laboratories have molecular biology technologies, not all of them offer immediate response tests. All laboratories detect N. gonorrhoeae infection by PCR and also by culture, which allows sensitivity testing in all centers.

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

OBJECTIVE: Since 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. METHODS: We 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. RESULTS: The 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. CONCLUSION: The 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.

Survey of diagnostic resources for STI in Spain. / Encuesta de recursos diagnósticos de las ITS en España.

BACKGROUND: Scarce information is available on the resources to deal with the Sexually Transmitted Infections (STIs), both in the clinic and in the laboratory. The objective is to describe and know the reality of the clinics and laboratories that treat these infections in Spain. METHODS: Cross-sectional observational study with data collection through a survey aimed at the members of the GEITS Group. RESULTS: Responses were obtained from 24 centers (response rate 38.1%) belonging to 10Autonomous Communities. Regarding STI consultations, 38% require that the patient present a health card to provide assistance, and 31.8% only provide it by referral from another doctor. The 52.4% perform diagnostic methods in the care center. Regarding laboratories, 18.2% do not offer immediate response diagnostic tests, although 100% have PCR against Neisseria gonorrhoeae and Chlamydia trachomatis, 47.8% against Mycoplasma genitalium and 65% detect lymphogranuloma venereum genotypes. All laboratories continue to perform culture and gonococcal sensitivity techniques, and 20% perform molecular methods for detection of MG antimicrobial resistance. CONCLUSION: There is great variability in the provision of human and material resources both in the clinics and in the laboratories that attend STIs. In a significant number of centers there are limitations for patient access. Although laboratories have molecular biology technologies, not all of them offer immediate response tests. All laboratories detect N.gonorrhoeae infection by PCR and also by culture, which allows sensitivity testing in all centers.

Is dark-field microscopy still useful for the primary syphilis diagnosis in the 21ST century? / ¿Sigue siendo útil la microscopia de campo oscuro en el diagnóstico de la sífilis primaria en el siglo XXI?

INTRODUCTION: Serological test for primary syphilis could be negative the first 5-15 days. The aim of this study was to evaluate the benefit of including dark field microscopy (DFM) in the diagnosis algorythm for primary syphilis. MATERIALS/METHODS: Patients attended to a sexual transmission diseases clinic of Madrid, from 2015 to 2019, for a genital ulcer with clinical suspicion of primary syphilis. They were tested for DMF and serological test (EIA/TPPA/RPR). RESULTS: Over the total amount of samples (806), 53.2% (429) were positive for DFM. Thus, the 48% of the 429 patients had negative serological test (EIA/RPR) of which the 77.6% were positive at TPPA. CONCLUSIONS: DFM allows primary syphilis early diagnosis, even without serological test. If no direct detection methods are available, for patients without history of syphilis, TPPA could help to diagnose primary syphilis.

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.

Relationship between oral Kaposi 's sarcoma and HAART: contribution of two case reports.

Two HIV infected patients not receiving Highly Active Antiretroviral Treatment (HAART) presented with epidemic Kaposi's sarcoma of the oral cavity. One patient initially refused HAART, but when the lesion became large enough to be noticeable he agreed to HAART associated with excision of the intraoral lesion by CO2 laser. The other patient developed KS and progressed to AIDS at two years after ceasing HAART due to adverse effects; he was referred to hospital for renewed administration of HAART. In both cases, the lesions observed in the oral cavity were the first clinical manifestation of AIDS. These reports underline the close relationship between the use of HAART and the control of KS lesions, highlighting the important role of the dentist in the identification and early diagnosis of these oral lesions.

¿Sigue siendo útil la microscopia de campo oscuro en el diagnóstico de la sífilis primaria en el siglo XXI? / Is dark-field microscopy still useful for the primary syphilis diagnosis in the 21ST century?

IntroducciónLa serología luética en la sífilis primaria puede ser negativa los primeros 5-15 días. El objetivo de este trabajo fue evaluar los beneficios de incluir la microscopia de campo oscuro (MCO) en el algoritmo diagnóstico de la sífilis primaria.MetodologíaSe incluyó a todos los pacientes que acudieron a una clínica de infecciones de transmisión sexual de la Comunidad de Madrid entre 2015 y 2019 que presentaban una úlcera genital sospechosa de sífilis primaria. Se les realizó MCO y serología (EIA/TPPA/RPR).ResultadosDe las 806 muestras, el 53,2% (429) fueron positivas para MCO. De los 429, el 48% presentaba screening serológico negativo (EIA/RPR) y de ellos en el 77,6% el TPPA fue positivo.ConclusionesLa MCO permite un diagnóstico de sífilis primaria precoz, incluso sin confirmación serológica. Si no se dispone de técnicas directas, en primoinfección, la TPPA es de gran ayuda en el diagnóstico.

IntroductionSerological test for primary syphilis could be negative the first 5-15 days. The aim of this study was to evaluate the benefit of including dark field microscopy (DFM) in the diagnosis algorythm for primary syphilis.Materials/methodsPatients attended to a sexual transmission diseases clinic of Madrid, from 2015 to 2019, for a genital ulcer with clinical suspicion of primary syphilis. They were tested for DMF and serological test (EIA/TPPA/RPR).ResultsOver the total amount of samples (806), 53.2% (429) were positive for DFM. Thus, the 48% of the 429 patients had negative serological test (EIA/RPR) of which the 77.6% were positive at TPPA.ConclusionsDFM allows primary syphilis early diagnosis, even without serological test. If no direct detection methods are available, for patients without history of syphilis, TPPA could help to diagnose primary syphilis.

Dental management of patients with human immunodeficiency virus.

The demand for dental treatment by human immunodeficiency virus (HIV)-infected individuals is rising. Some professionals are still reluctant to treat these patients, despite the extremely low likelihood of professional transmission, which increases only in patients with a very elevated viral load. The complications rate after dental intervention is very low, even in patients with considerable immunologic deterioration. The dentist should pay special attention to the general clinical situation and immunologic and HIV virologic status of the seropositive patient, and to the presence of hemostasis alterations or of other concomitant diseases. Antiretroviral or any other drug treatments must also be recorded, in order to avoid possible interactions with clinician-prescribed drugs. Tooth extraction is the most common dental treatment and requires no antibiotic therapy except in cases of neutropenia or severe immunosuppression. Other dental treatments do not require special precautions, and the complications index among these patients is similar to that among the uninfected patient population. With this background, there is a need to make the clinician-in-training aware of the importance of regular dental health checkups as part of the health care routine of HIV-infected patients and to familiarize the clinician with their management, while not disregarding the unquestionable requirement to carry out the general and specific prevention measures to be adopted in all cases.

Relationship between oral Kaposi ’s sarcoma and HAART: Contribution of two case reports

Two HIV infected patients not receiving Highly Active Antiretroviral Treatment (HAART) presented with epidemicKaposi’s sarcoma of the oral cavity. One patient initially refused HAART, but when the lesion became large enoughto be noticeable he agreed to HAART associated with excision of the intraoral lesion by CO2 laser. The other patientdeveloped KS and progressed to AIDS at two years after ceasing HAART due to adverse effects; he was referred tohospital for renewed administration of HAART. In both cases, the lesions observed in the oral cavity were the firstclinical manifestation of AIDS. These reports underline the close relationship between the use of HAART and thecontrol of KS lesions, highlighting the important role of the dentist in the identification and early diagnosis of these oral lesions (AU)