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

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 (p<0.01), in MSM from 27.1 to 228.8/10 000 (p<0.01). The incidence of syphilis increased from 0.4/10 000 in 2007 to 3.1/10 000 in 2015 (significant in men only, p<0.01), in MSM from 18.1 to 116.9/10 000 (p<0.01). The incidence of HIV showed a non-significant increase in men (p=0.27), and that of LGV remained stable (p=0.59). Factors associated with increased risk of HIV coinfection included being MSM (adjusted OR[ORa]=14.14, 95% CI 3.34 to 59.91) and having >10 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.

Estimating the HIV undiagnosed population in Catalonia, Spain: descriptive and comparative data analysis to identify differences in MSM stratified by migrant and Spanish-born population.

OBJECTIVE: Undiagnosed HIV continues to be a hindrance to efforts aimed at reducing incidence of HIV. The objective of this study was to provide an estimate of the HIV undiagnosed population in Catalonia and compare the HIV care cascade with this step included between high-risk populations. METHODS: To estimate HIV incidence, time between infection and diagnosis and the undiagnosed population stratified by CD4 count, we used the ECDC HIV Modelling Tool V.1.2.2. This model uses data on new HIV and AIDS diagnoses from the Catalan HIV/AIDS surveillance system from 2001 to 2013. Data used to estimate the proportion of people enrolled, on ART and virally suppressed in the HIV care cascade were derived from the PISCIS cohort. RESULTS: The total number of people living with HIV (PLHIV) in Catalonia in 2013 was 34 729 (32 740 to 36 827), with 12.3% (11.8 to 18.1) of whom were undiagnosed. By 2013, there were 8458 (8101 to 9079) Spanish-born men who have sex with men (MSM) and 2538 (2334 to 2918) migrant MSM living with HIV in Catalonia. A greater proportion of migrant MSM than local MSM was undiagnosed (32% vs 22%). In the subsequent steps of the HIV care cascade, migrants MSM experience greater losses than the Spanish-born MSM: in retention in care (74% vs 55%), in the proportion on combination antiretroviral treatment (70% vs 50%) and virally suppressed (65% vs 46%). CONCLUSIONS: By the end of 2013, there were an estimated 34 729 PLHIV in Catalonia, of whom 4271 were still undiagnosed. This study shows that the Catalan epidemic of HIV has continued to expand with the key group sustaining HIV transmission being MSM living with undiagnosed HIV.

[Descriptive study of hepatitis outbreaks occurring in Catalonia (1999-2003)]. / Estudio descriptivo de los brotes de hepatitis A investigados en Cataluña (1999-2003).

BACKGROUND AND OBJECTIVE: The currently low endemic level of hepatitis A in Spain favors manifestation of the disease as outbreaks among specific risk groups. The aim of this study is to analyze the hepatitis A outbreaks investigated in Catalonia (Spain) during the period of 1999 to 2003. METHODS: The criteria for including an outbreak were defined and outbreaks were classified according to the type of transmission. The variables analyzed were space, time, socio-demographic parameters, setting, risk factors, and preventive measures adopted. The incidence rate and rate ratio were calculated according to age and sex. RESULTS: Among 74 outbreaks, 73 fulfilled the inclusion criteria. Most outbreaks involved person-to-person transmission (83.8%) and the rest had a common source of infection (14.9%). In total, 334 cases were included (cumulative incidence 1999-2003: 5.27 per 100,000 inhabitants), with an average age of 24.5 years. The settings yielding the most cases were family (143), community (97) and schools/preschools (87). The number of cases per outbreak ranged from 2 to 11, except one outbreak that occurred in 83 young homosexual men with high-risk sexual practices. The main factors related to the case index or to coprimary cases included belonging to age groups with low immunity (children and young adults) and travelling to or from endemic areas. CONCLUSION: Hepatitis A outbreaks in Catalonia are still frequent. They mainly occur in the family environment, by person-to-person transmission and in the most vulnerable groups (preschool or school employees, travelers, and men who perform high-risk sexual practices with other men).

Estudio descriptivo de los brotes de hepatitis A investigados en Cataluña (1999-2003) / Descriptive study of hepatitis outbreaks occurring in Catalonia (1999-2003)

Antecedentes y objetivo. Actualmente España presenta un patrón de baja endemicidad de hepatitis A que favorece que la enfermedad se manifieste en forma de brotes en colectivos susceptibles. El objetivo de este estudio es analizar los brotes de hepatitis A investigados en Cataluña durante el período 1999-2003. Métodos. Se definieron criterios para la inclusión de los brotes y posteriormente se clasificaron según el mecanismo de transmisión. Se analizaron variables de espacio, tiempo, sociodemográficas, ámbito, factores de riesgo y medidas preventivas. Se calcularon las tasas de incidencia y la razón de tasas según edad y sexo. Resultados. De 74 brotes, 73 cumplieron los criterios de inclusión: la mayoría con transmisión persona-persona (83,8%) y el resto con fuente de infección común (14,9%). En total, se incluyeron 334 casos (incidencia acumulada 1999-2003:5,27 por 100.000 habitantes), con una mediana de edad de 24,5 años. Los ámbitos con más casos fueron el familiar (143), el comunitario (97) y el escolar/guardería (87). El número de casos por brote osciló entre 2 y 11, excepto un brote que afectó a 83 varones con prácticas homosexuales de riesgo. Pertenecer a los grupos de edad de baja inmunidad (niños y adultos jóvenes) y viajar o proceder de zonas endémicas fueron las características más importantes relacionadas con el caso índice y/o con los casos coprimarios. Conclusión. Los brotes de hepatitis A en Cataluña todavía son frecuentes. La mayoría se producen en el ámbito familiar, por transmisión persona-persona, y en los subgrupos de población más susceptibles a la infección (trabajadores de guarderías o escuelas, viajeros y varones con prácticas homosexuales de riesgo) (AU)

Background and objective. The currently low endemic level of hepatitis A in Spain favors manifestation of the disease as outbreaks among specific risk groups. The aim of this study is to analyze the hepatitis A outbreaks investigated in Catalonia (Spain) during the period of 1999 to 2003. Methods. The criteria for including an outbreak were defined and outbreaks were classified according to the type of transmission. The variables analyzed were space, time, socio-demographic parameters, setting, risk factors, and preventive measures adopted. The incidence rate and rate ratio were calculated according to age and sex. Results. Among 74 outbreaks, 73 fulfilled the inclusion criteria. Most outbreaks involved person-to-person transmission (83.8%) and the rest had a common source of infection (14.9%). In total, 334 cases were included (cumulative incidence 1999-2003: 5.27 per 100,000 inhabitants), with an average age of 24.5 years. The settings yielding the most cases were family (143), community (97) and schools/preschools (87). The number of cases per outbreak ranged from 2 to 11, except one outbreak that occurred in 83 young homosexual men with high-risk sexual practices. The main factors related to the case index or to coprimary cases included belonging to age groups with low immunity (children and young adults) and travelling to or from endemic areas. Conclusion. Hepatitis A outbreaks in Catalonia are still frequent. They mainly occur in the family environment, by person-to-person transmission and in the most vulnerable groups (preschool or school employees, travelers, and men who perform high-risk sexual practices with other men) (AU)