Incidence of Diabetes Mellitus and Associated Factors in the Era of Antiretroviral Drugs With a Low Metabolic Toxicity Profile.

Objective: The incidence of type 2 diabetes mellitus (T2DM) has risen dramatically. Among people living with HIV (PLHIV), chronic disease (now >15 cases/1000 in the general population worldwide) and long-term exposure to antiretroviral therapy (ART) can alter metabolic processes early, favoring insulin resistance and T2DM. We retrospectively studied the incidence of T2DM and associated factors in the Cohort of the Spanish AIDS Research Network, a prospective cohort of PLHIV enrolled at diagnosis and before initiation of ART. Methods: PLHIV were aged >18 years and ART naive at inclusion. The incidence of new diagnoses of T2DM after initiation of ART (per 1000 person-years) was calculated. Predictors of a diagnosis of T2DM were identified by a Cox proportional hazards model adjusted for statistically significant and clinically relevant variables. Results: Cumulative incidence was 5.9 (95% CI, 5.1-6.7) per 1000 person-years, increasing significantly in persons aged >50 years to 14.4 (95% CI, 10.4-19.3). Median time to diagnosis of T2DM was 27 months. Only age and higher education were significant. Interestingly, higher education was associated with a 33% reduction in the incidence of T2DM. Having received tenofovir disoproxil fumarate + (lamivudine or emtricitabine) + rilpivirine was almost significant as a protective factor (hazard ratio, 0.49; 95% CI, .24-1.01; P = .05). Conclusions: The incidence of T2DM in PLHIV in Spain was high, especially in persons aged >50 years. Age was the factor most closely associated with onset, and educational level was the factor most associated with reduced risk. We highlight the lack of association between HIV-related factors and T2DM and show that, within nonnucleoside reverse transcriptase inhibitors, rilpivirine could prove more benign for metabolic comorbidities.

Chlamydia trachomatis re-infection in Spain: A STI clinic-based cohort study / Reinfección por Chlamydia trachomatis en España: un estudio de cohorte en una Unidad de ITS

BACKGROUND: Chlamydia trachomatis (C. trachomatis) is the most frequently reported sexually transmitted infection (STI) in developed countries, but there is a lack data on its incidence and population dynamics in Spain. The objectives of this study were to estimate the incidence of C. trachomatis in patients seeking medical attention in an STI clinic with a defined population catchment area, to identify factors associated with this infection, and to explore differences between factors associated with new infections and re-infections. METHODS: A retrospective study was conducted on a cohort of patients from a STI clinic who underwent chlamydia testing at least twice between 2007 and 2015. RESULTS: Of the 2633 patients who met study selection criteria, 795 (30.2%) tested positive for C. trachomatis at baseline (baseline Chlamydia). The overall incidence was 7.97/100 person-years (95% CI: 7.2-8.8): 5.9/100 person-years (95% CI: 5.2-6.7) among patients testing negative for C. trachomatis at baseline, and 18.3 person-years (95% CI: 15.6-21.5) among those testing positive at baseline. In multivariate analysis, the factors independently associated with overall incidence were a history of infection with C. trachomatis in the previous 6 months (hazard ratio=3.6; 95% CI: 2.3-5.4), younger age (HR <20 vs ≥35 years=5.5; 95% CI: 3.2-9.5), male sex, 2 or more sexual partners in the previous month and year, and inconsistent condom use. CONCLUSIONS: Guidelines should be established for C. trachomatis in Spain, including recommendations on the need for follow-up and re-testing, independently of age. Though data concerning the optimal timing of re-testing are inconclusive, our findings support the establishment of a 3-6 month interval

INTRODUCCIÓN: Chlamydia trachomatis es la infección de transmisión sexual (ITS) más frecuentemente notificada en los países desarrollados, pero en España carecemos de información sobre su incidencia y su dinámica poblacional. Nuestros objetivos han sido estimar la incidencia de C.trachomatis en los pacientes de una clínica de ITS con una población de referencia definida, identificar factores asociados con ella y evaluar diferencias entre los factores asociados con las nuevas infecciones y las reinfecciones. MÉTODOS: Cohorte retrospectiva de pacientes de una Unidad de ITS con pruebas diagnósticas para Chlamydia en más de una ocasión entre 2007 y 2015. RESULTADOS: De los 2.633 pacientes que cumplieron los criterios de inclusión en el estudio, 795 (30,2%) tuvieron un resultado positivo de C.trachomatis en el episodio basal (Chlamydia basal). La incidencia global fue de 7,97/100 años-persona (IC 95%: 7,2-8,8): 5,9/100 años-persona (IC 95%: 5,2-6,7) entre los pacientes con chlamydia basal negativa y 18,3 años-persona (IC 95%: 15,6-21,5) entre aquellos con chlamydia basal positiva. En los análisis multivariantes, los factores asociados independientemente con la incidencia global fueron haber padecido otra infección por C.trachomatis en los últimos 6meses (hazard ratio [HR] = 3,6; IC95%: 2,3-5,4), menor edad (HR < 20 vs ≥ 35 = 5,5; IC95%: 3,2-9,5), ser hombre, 2 o más parejas en el último mes o en el último año y la utilización inconsistente del preservativo. CONCLUSIÓN: Son necesarias guías de práctica clínica para C.trachomatis en España que incluyan recomendaciones sobre la necesidad de seguimiento y re-cribado, independientemente de la edad. El periodo óptimo para repetir las pruebas no está establecido, nuestros resultados apoyan la implantación de un intervalo de 3-6 meses

Chlamydia trachomatis re-infection in Spain: A STI clinic-based cohort study.

BACKGROUND: Chlamydia trachomatis (C. trachomatis) is the most frequently reported sexually transmitted infection (STI) in developed countries, but there is a lack data on its incidence and population dynamics in Spain. The objectives of this study were to estimate the incidence of C. trachomatis in patients seeking medical attention in an STI clinic with a defined population catchment area, to identify factors associated with this infection, and to explore differences between factors associated with new infections and re-infections. METHODS: A retrospective study was conducted on a cohort of patients from a STI clinic who underwent chlamydia testing at least twice between 2007 and 2015. RESULTS: Of the 2633 patients who met study selection criteria, 795 (30.2%) tested positive for C. trachomatis at baseline (baseline Chlamydia). The overall incidence was 7.97/100 person-years (95% CI: 7.2-8.8): 5.9/100 person-years (95% CI: 5.2-6.7) among patients testing negative for C. trachomatis at baseline, and 18.3 person-years (95% CI: 15.6-21.5) among those testing positive at baseline. In multivariate analysis, the factors independently associated with overall incidence were a history of infection with C. trachomatis in the previous 6 months (hazard ratio=3.6; 95% CI: 2.3-5.4), younger age (HR <20 vs ≥35 years=5.5; 95% CI: 3.2-9.5), male sex, 2 or more sexual partners in the previous month and year, and inconsistent condom use. CONCLUSIONS: Guidelines should be established for C. trachomatis in Spain, including recommendations on the need for follow-up and re-testing, independently of age. Though data concerning the optimal timing of re-testing are inconclusive, our findings support the establishment of a 3-6 month interval.