Human Immunodeficiency Virus/Hepatits C Virus Coinfection in Spain: Elimination Is Feasible, but the Burden of Residual Cirrhosis Will Be Significant.

BACKGROUND: We assessed the prevalence of antibodies against hepatitis C virus (HCV-Abs) and active HCV infection in patients infected with human immunodeficiency virus (HIV) in Spain in 2016 and compared the results with those of similar studies performed in 2002, 2009, and 2015. METHODS: The study was performed in 43 centers during October-November 2016. The sample was estimated for an accuracy of 2% and selected by proportional allocation and simple random sampling. During 2016, criteria for therapy based on direct-acting antiviral agents (DAA) were at least significant liver fibrosis, severe extrahepatic manifestations of HCV, and high risk of HCV transmissibility. RESULTS: The reference population and the sample size were 38904 and 1588 patients, respectively. The prevalence of HCV-Abs in 2002, 2009, 2015, and 2016 was 60.8%, 50.2%, 37.7%, and 34.6%, respectively (P trend <.001, from 2002 to 2015). The prevalence of active HCV in 2002, 2009, 2015, and 2016 was 54.0%, 34.0%, 22.1%, and 11.7%, respectively (P trend <.001). The anti-HCV treatment uptake in 2002, 2009, 2015, and 2016 was 23.0%, 48.0%, 59.3%, and 74.7%, respectively (P trend <.001). In 2016, HCV-related cirrhosis was present in 7.6% of all HIV-infected individuals, 15.0% of patients with active HCV, and 31.5% of patients who cleared HCV after anti-HCV therapy. CONCLUSIONS: Our findings suggest that with universal access to DAA-based therapy and continued efforts in prevention and screening, it will be possible to eliminate active HCV among HIV-infected individuals in Spain in the short term. However, the burden of HCV-related cirrhosis will continue to be significant among HIV-infected individuals.

[Changes in knowledge, attitudes, and habits of the general population with regard to HIV infection]. / Evolución de los conocimientos, actitudes y hábitos de la población general sobre la infección por el VIH.

INTRODUCTION: Knowledge of the social changes related to HIV infection can be helpful in the attempts to design more effecting preventive strategies for this disease. The aim of this study was assess the progress that has occurred in the knowledge, attitudes and habits of the general population in relation to HIV infection between 1997 and 2005. METHODS: With this objective, a multidisciplinary team designed a questionnaire survey containing 64 items, which was validated through a pilot study performed with 100 subjects. The target population included all residents of the city of Zamora aged 18 to 70 years old. The population was stratified by district (five), sex, and age (younger or older than 40 years old) into 20 groups. The sample size was calculated and a randomly selected list of participants was obtained for each group. The questionnaire was filled out at the homes of the selected population with the help of trained personal in 1997, and was repeated in 2005. Results from the two time points were compared. RESULTS: In 2005, a larger number of people were interested in gaining more information about the disease and showed concern about the risk of infection. However, there were no significant changes in the related knowledge or habits, and frequent errors persisted regarding prevention of sexual transmission. Nonetheless, the attitude toward infected patients had improved. CONCLUSIONS: Over the 8 years of the study, knowledge about HIV infection has not changed, and errors regarding sexual prevention remain, although there is a more positive attitude toward patients with this disease. Modifying this deficit in the understanding of HIV may contribute to preventing this disease.

Evolución de los conocimientos, actitudes y hábitos de la población general sobre la infección por el VIH / Changes in knowledge, attitudes, and habits of the general population with regard to HIV infection

INTRODUCCIÓN. El conocimiento de la evolución de la sociedad respecto a la infección por el virus de la inmunodeficiencia humana (VIH) puede ayudar al diseño de estrategias preventivas más eficaces frente a esta epidemia. El objetivo de este trabajo fue evaluar los cambios de los conocimientos, actitudes y hábitos conductuales de la población general frente al VIH entre1997 y 2005.MÉTODOS. Con este propósito, un equipo multidisciplinario elaboró una encuesta de 64 preguntas, y con ella se realizó una prueba piloto en 100 personas, corrigiéndose las deficiencias detectadas. La población diana la formaban los censados en la ciudad de Zamora con edades comprendidas entre 18 y 70 años, y fue estratificada según distrito (cinco en total), sexo y edad (mayor o menor de 40 años), con un resultado de 20 grupos. Se calculó el tamaño muestral y se obtuvo una muestra aleatoria para cada uno de los 20 grupos, así como tres listas de reservas para cada uno de ellos. La encuesta fue cumplimentada en el domicilio de los seleccionados en 1997, y con la misma metodología el estudio se repitió en 2005, pudiéndose de esta forma comparar los resultados. RESULTADOS. En 2005, un porcentaje mayor se mostraba interesado en mejorar la información sobre esta enfermedad, y percibía mayor riesgo de infectarse. No se observaron cambios destacables en los conocimientos ni en los hábitos de conducta, pero han mejorado los porcentajes de encuestados con actitudes positivas frente a los enfermos. Persisten errores frecuentes en los conocimientos sobre la prevención sexual. CONCLUSIONES. En los últimos años se ha avanzado en la aceptación de los pacientes, pero, a pesar de los esfuerzos realizados, no se objetivan progresos en los conocimientos de la población general sobre esta enfermedad. Son especialmente significativos los errores en la prevención sexual. La corrección de estas carencias podría contribuir al control de esta epidemia (AU)

INTRODUCTION. Knowledge of the social changes related toHIV infection can be helpful in the attempts to design more effecting preventive strategies for this disease. The aim of this study was assess the progress that has occurred in the knowledge, attitudes and habits of the general population in relation to HIV infection between 1997 and 2005.METHODS. With this objective, a multidisciplinary team designed a questionnaire survey containing 64 items, which was validated through a pilot study performed with100 subjects. The target population included all residents of the city of Zamora aged 18 to 70 years old. The population was stratified by district (five), sex, and age (younger or older than 40 years old) into 20 groups. The sample size was calculated and a randomly selected list of participants was obtained for each group. The questionnaire was filled out at the homes of the selected population with the help of trained personal in 1997, and was repeated in 2005. Results from the two time points were compared. RESULTS. In 2005, a larger number of people were interested in gaining more information about the disease and showed concern about the risk of infection. However, there were no significant changes in the related knowledge or habits, and frequent errors persisted regarding prevention of sexual transmission. Nonetheless, the attitude toward infected patients had improved. CONCLUSIONS. Over the 8 years of the study, knowledge about HIV infection has not changed, and errors regarding sexual prevention remain, although there is a more positive attitude toward patients with this disease. Modifying this deficit in the understanding of HIV may contribute to preventing this disease (AU)

Effectiveness and safety of simplification therapy with once-daily tenofovir, lamivudine, and efavirenz in HIV-1-infected patients with undetectable plasma viral load on HAART.

OBJECTIVE: To evaluate the effectiveness and tolerability of a simplification regimen with tenofovir DF (TDF), lamivudine (3TC), and efavirenz (EFV) in HAART-experienced HIV-1-infected subjects with sustained viral suppression. METHOD: Patients with HIV-1 RNA <200 copies/mL during the previous 6 months and who switched their current twice-daily or three-times-daily HAART to a simplified once-daily regimen of TDF (300 mg), 3TC (300 mg), and EFV (600 mg) were included. RESULTS: 154 patients (70% males, mean age 42 years) were included. Previous HAART included a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen in 55% of the patients and a thymidine analog in 87%. The percentage of patients with viral load <200 copies/mL in the intent-to-treat (ITT) data set was 83% at 6 months and 75% at 12 months (98% and 96%, respectively, in the on-treatment [OT] analysis). Five patients (3%) were identified as virologic failures according to the study protocol. The mean CD4 T-cell count increased significantly 12 months after simplification (from 570 to 632 cells/mm3; p < .01). At 12 months, mean triglyceride levels decreased from 233 to 170 mg/dL (p < .01) and mean cholesterol levels decreased from 205 to 189 mg/dL (p < .01). Thirty-three patients (21%) discontinued the study treatment prior to completing the 12-month follow-up. CONCLUSION: Simplification to a once-daily regimen containing TDF, 3TC, and EFV is virologically and immunologically effective, well-tolerated, and safe with benefits in the lipid profile in the majority of patients.

Seroprevalencia de hepatitis A / Seroprevalence of hepatitis A

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[Seroprevalence of hepatitis C virus in the general population]. / Seroprevalencia del virus de la hepatitis C en la población general.

AIM: To determine the prevalence of hepatitis C virus (HCV) infection and to study associated risk factors in the general population of the province of Zamora. PATIENTS AND METHODS: For this transversal, observational, descriptive, population study, we randomly selected 1973 individuals over 14 years old and grouped them according to age and sex. The study included completion of a questionnaire containing socio-demographic information and data on risk factors. Serum samples were collected for analysis of antibodies to HCV by means of a third-generation ELISA, and were confirmed by an immunoblot technique. Viral load and genotype analyses were carried out in positive cases by polymerase chain reaction technique. RESULTS: Among the total, 600 complete studies (questionnaires and serum samples) 657 questionnaires and 675 samples were obtained. Eleven serum samples tested positive for HCV and among these, 5 were confirmed by immunoblot. The positive samples corresponded to 3 men and 2 women; 4 lived in urban settings and all 5 had one or more known risk factors for acquiring the infection. CONCLUSIONS: The prevalence of HCV infection in our geographical area was 0.74% (95% CI, 0.27-1.82). The seropositive individuals detected in this population screening study had a history of parenteral risk activities and most lived in urban areas.

Seroprevalencia del virus de la hepatitis C en la población general / Seroprevalence of hepatitis C virus in the general population

INTRODUCCIÓN. Determinar la prevalencia de infección por el virus de la hepatitis C (VHC) en la población general de la provincia de Zamora y analizar los factores de riesgo asociados. PACIENTES Y MÉTODO. Se diseñó un estudio transversal, observacional, descriptivo de ámbito poblacional. Se seleccionaron de forma aleatoria 1.973 individuos mayores de 14 años, estratificados por edad y sexo. El estudio comprendía la realización de una encuesta con datos sociodemográficos y factores de riesgo, y extracción de sangre para determinación de anticuerpos frente al VHC por técnica de ELISA de tercera generación. La confirmación se realizó con técnica de inmunoblot. Asimismo, se determinaron los genotipos de los anticuerpos frente al VHC.RESULTADOS. Se obtuvieron 600 estudios completos (encuesta y extracción de sangre), 657 encuestas y 675 sueros. Un total de once fueron positivos para el VHC y cinco fueron confirmados por inmunoblot. Éstos correspondían a 3 varones y 2 mujeres; cuatro tenían domicilio urbano y todos presentaban alguno/s de los factores de riesgo conocidos para la adquisición de la infección. CONCLUSIONES. La prevalencia de infección por VHC obtenida en nuestro medio fue del 0,74 por ciento (IC del 95 por ciento, 0,27-1,82); los sujetos seropositivos detectados en nuestro cribado poblacional tenían antecedentes de prácticas de riesgo parenterales y residían predominantemente en áreas urbanas (AU)