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.

Hepatitis C antibody prevalence and active hepatitis C infection in HIV-negative gay, bisexual, and other men who have sex with men in Barcelona and Madrid, Spain (March 2018-March 2021).

Objectives: Hepatitis C virus (HCV) has been recognized as a sexually transmitted infection (STI) in HIV-positive men who have sex with men (MSM), with an increased notification in HIV-negative MSM. The aim of this study was to determine the prevalence of HCV antibody and active HCV infection in HIV-negative gay, bisexual, and other MSM (GBMSM), and their characteristics, in Barcelona and Madrid, from March 2018 to March 2021. Methods: Cross-sectional study conducted on 3548 HIV-undiagnosed GBMSM, across four HIV/STI testing centers. Respondents submitted an online, self-administered questionnaire after consultation, which collected information on sociodemographics, sexual health history, HCV knowledge, and substance consumption. Prevalence of HCV antibodies was determined by a reactive result in a rapid anti-HCV test or enzyme-linked immunosorbent assay (ELISA), while active HCV infection was determined by participants who were also positive on an HCV-RNA test. Crude and adjusted Poisson analyses with robust variance are presented for both prevalence and active infection. Results: In total, 97.6% of participants (n = 3463) were HIV-negative. Of those, 18 were found to have HCV antibodies (0.52%), of which nine (0.26%) were also HCV-RNA positive. Those with HCV antibodies were associated to have lived with an HCV (+) person (adjusted prevalence ratio [APR]: 7.84, [95% confidence interval: 2.50-24.53]), using injectable drugs for sex (APR: 6.92, [1.20-39.79]) and testing positive for an STI in the previous year (APR: 4.06, [1.09-15.12]). Presenting an active infection was strongly associated with a previous HCV diagnosis (APR: 100.82 [22.16-458.76]), sexualized injectable drug use (APR: 17.53 [2.70-113.76]), and sharing douching material (APR: 7.45, [2.12-25.95]). Conclusion: Sexual practices with a higher risk of bleeding and sexualized drug use, particularly sexualized injectable drug use, were associated with higher rates of HCV diagnosis in GBMSM. Identifying these practices during consultation, contact tracing new cases and regularly testing those with a previous history of HCV, will facilitate HCV eradication.

Effectiveness and tolerability of dolutegravir/lamivudine for the treatment of HIV-1 infection in clinical practice.

OBJECTIVES: To assess the effectiveness and tolerability of dolutegravir (DTG)/lamivudine (3TC) among treatment-naive and virologically suppressed treatment-experienced individuals in the multicentre cohort of the Spanish HIV/AIDS Research Network (CoRIS) during the years 2018-2021. METHODS: We used multivariable regression models to compare viral suppression (VS) [HIV RNA viral load (VL) <50 copies/mL] and the change in CD4 cell counts at 24 and 48 (±12) weeks after initiation with dolutegravir/lamivudine or other first-line ART regimens. RESULTS: We included 2160 treatment-naive subjects, among whom 401 (18.6%) started with dolutegravir/lamivudine. The remaining subjects started bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide (TAF) (n = 949, 43.9%), DTG + FTC/tenofovir disoproxil fumarate (TDF) (n = 282, 13.1%), DTG/3TC/abacavir (ABC) (n = 255, 11.8%), darunavir (DRV)/cobicistat(COBI)/FTC/TAF (n = 147, 6.8%) and elvitegravir (EVG)/COBI/FTC/TAF (n = 126, 5.8%). At 24 and 48 weeks after starting dolutegravir/lamivudine, 91.4% and 93.8% of the subjects, respectively, achieved VS. The probability of achieving VS with dolutegravir/lamivudine was not significantly different compared with any other regimen at 24 or 48 weeks, with the exception of a lower chance of achieving VS at 24 weeks for DRV/COBI/FTC/TAF (adjusted OR: 0.47; 95% CI: 0.30-0.74) compared with dolutegravir/lamivudine.For the analysis of treatment-experienced virally suppressed subjects we included 1456 individuals who switched to dolutegravir/lamivudine, among whom 97.4% and 95.5% maintained VS at 24 and 48 weeks, respectively. During the first 48 weeks after dolutegravir/lamivudine initiation, 1.0% of treatment-naive and 1.5% of treatment-experienced subjects discontinued dolutegravir/lamivudine due to an adverse event. CONCLUSIONS: In this large multicentre cohort, effectiveness and tolerability of dolutegravir/lamivudine were high among treatment-naive and treatment-experienced subjects.

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.

Rapid antigen tests for the detection of SARS-CoV-2: A narrative review / Test rápidos de antígenos para la detección del SARS-CoV-2: Revisión narrativa

The rapid identificationand isolation of COVID-19 patients has become the cornerstone for the control of the recent outbreak. Real-time quantitative polymerase chain reaction is routinely used to confirm COVID-19 diagnosis and is considered the gold standard due to high sensitivity and specificity. Nevertheless, it usually takes several days and a relatively higher cost. Antigen tests based have emerged to cope with such disadvantages, by offering rapid results, an easy-to-use procedure, and low costs. The objective of the narrative review was to provide up-to-date data about CE-marked rapid antigen tests (RATs) for COVID-19. Given their large number, the study only focused on representative and widely used in Spain (Standard Q, Nadal, Panbio, CerTest, and Wondfo). RATs have become a very useful and validated tool for controlling the spread of COVID-19 allowing the rapid identification of active infection and isolation of positive patients. The present revision of the literature has demonstrated that sensitivity and specificity of all available RATs in Spain are high and accomplish European regulations and WHO recommendations.(AU)

La rápida identificación y aislamiento de los pacientes por COVID-19 se ha convertido en un reto para el control de la pandemia. La reacción en cadena de la polimerasa cuantitativa a tiempo real se utiliza de manera rutinaria para confirmar el diagnóstico de COVID-19 y se considera el estándar de referencia por su alta sensibilidad y especificidad. Sin embargo, normalmente lleva varios días y los costes son relativamente altos. Los test de antígeno son una herramienta rápida, fácil de realizar y de bajo coste. El objetivo de la revisión narrativa es proporcionar información actualizada sobre los test rápidos de antígenos (TRA) para COVID-19 con marcado europeo. Dado su gran número, el estudio solo se enfoca en aquellos representativos y ampliamente empleados en España (Standard Q, Nadal, Panbio, CerTest y Wondfo). Los TRA se han convertido en una herramienta validada muy útil para controlar la diseminación de la COVID-19, al permitir la identificación rápida de la infección activa y el aislamiento de pacientes positivos. La presente revisión de la literatura ha demostrado que la sensibilidad y especificidad de los TRA disponibles en España son altas y cumplen con la regulación europea y las recomendaciones de la OMS.(AU)

Rapid antigen tests for the detection of SARS-CoV-2: A narrative review.

The rapid identificationand isolation of COVID-19 patients has become the cornerstone for the control of the recent outbreak. Real-time quantitative polymerase chain reaction is routinely used to confirm COVID-19 diagnosis and is considered the gold standard due to high sensitivity and specificity. Nevertheless, it usually takes several days and a relatively higher cost. Antigen tests based have emerged to cope with such disadvantages, by offering rapid results, an easy-to-use procedure, and low costs. The objective of the narrative review was to provide up-to-date data about CE-marked rapid antigen tests (RATs) for COVID-19. Given their large number, the study only focused on representative and widely used in Spain (Standard Q, Nadal, Panbio, CerTest, and Wondfo). RATs have become a very useful and validated tool for controlling the spread of COVID-19 allowing the rapid identification of active infection and isolation of positive patients. The present revision of the literature has demonstrated that sensitivity and specificity of all available RATs in Spain are high and accomplish European regulations and WHO recommendations.

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.

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.

Hepatitis C: nuevos diagnósticos y seroconversiones en una clínica de infecciones de transmisión sexual en Madrid / Hepatitis C: New diagnosis and seroconversions in a Madrid sexually transmitted diseases clinic

OBJETIVO: El objetivo es evaluar las nuevas infecciones por el virus de la hepatitis C (VHC) en función de su orientación sexual, situación serológica respecto al virus de la inmunodeficiencia humana (VIH), región geográfica de origen y la coinfección con otras infecciones de transmisión sexual (ITS). MATERIAL Y MÉTODOS: Estudio realizado en el Centro Sanitario Sandoval clínica de referencia de ITS en Madrid. Se incluyeron todas las personas seronegativas al VHC que fueron reanalizadas para este virus, entre enero de 2010 y diciembre de 2016. RESULTADOS: Se diagnosticaron 59 nuevos diagnósticos de infección por el VHC. La proporción de hombres que tienen sexo con hombres (HSH) dentro de los nuevos diagnósticos fue del 37% en 2010 y del 75% en 2016 y, fue aún mayor, en el grupo de coinfectados por el VIH/VHC (94%). Se detectaron 67 seroconvertores al VHC (1,2%). El 100% eran HSH. El 89% de los seroconvertores al VHC eran seropositivos para el VIH. CONCLUSIONES: La infección por el VHC sigue siendo un problema de salud vigente, especialmente en colectivos de riesgo, como los HSH seropositivos para el VIH

INTRODUCTION: The aim of this study was to evaluate the incidence of new hepatitis C virus (HCV) infections, based on their sexual orientation, human immunodeficiency virus (HIV) status, geographical regions and coinfection with other sexually transmitted diseases (STDs). MATERIAL AND METHODS: This study was carried out at the Sandoval Health Center, reference clinic of Sexually Transmitted Diseases (STDs) in Madrid. All HCV seronegative individuals who were reanalyzed for this virus were included, between January 2010 and December 2016. RESULTS: A total of 59 new diagnoses of HCV were diagnosed. The proportion of men who have sex with men (MSM) diagnosed with HCV was 37% in 2010 and 75% in 2016 and was even higher in the group of coinfected with HIV/HCV (94%). A total of 67 seroconverters for HCV were detected (1.2%) of which 100% were MSM. The proportion of HCV seroconverters with HIV was 89%. CONCLUSIONS: HCV infection continues to be a current health problem, especially in HIV-positive MSM

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

INTRODUCCIÓN: La profilaxis preexposición (PrEP) al VIH consiste en administrar fármacos antirretrovirales a personas negativas para el VIH con prácticas de riesgo. El objetivo del estudio fue describir las características de los serconvertores recientes al VIH para conocer el perfil de los candidatos a quienes proponer PrEP. MÉTODOS: Estudio descriptivo de todos los pacientes diagnosticados de VIH durante 2014, con serología negativa documentada en los 12 meses previos. Se pasó un cuestionario estructurado para conocer características sociodemográficas, conductuales y clínicas, y se realizó despistaje de otras ITS. RESULTADOS: El 98,4% de los 61 seroconvertores recientes eran hombres que tenían sexo con hombres, de 20 a 39 años (88,5%), con antecedentes de ITS (80,3%) y múltiples parejas con las que mantenían sexo sin preservativo (82,7%), bajo el efecto de drogas recreativas (87%). CONCLUSIONES: Evaluar el riesgo para el VIH de los pacientes seronegativos permite identificar a los candidatos idóneos a quienes proponer la PrEP

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

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.

La salud de los médicos de familia: ¿practicamos lo que predicamos? / Health of family physicians: do we practice what we preach?

ObjetivosDescribir los estilos de vida de los médicos de Atención Primaria, detallar su adherencia a pruebas de cribado de cáncer y describir aspectos básicos de su salud laboral, mental y sexual.DiseñoEstudio descriptivo transversal.EmplazamientoAtención Primaria. Servicio Madrileño de Salud, Área 7.ParticipantesMédicos de familia.MétodoEstudio realizado mediante encuesta anónima y autorreferida que fue enviada a través del correo interno institucional. El cuestionario fue elaborado siguiendo en las recomendaciones de la Guía Europea de Prevención Cardiovascular, el Programa de Actividades Preventivas y de Promoción de la Salud y el documento de actividad física y salud de la Organización Mundial de la Salud. La escala de Hamilton se utilizó para medir la ansiedad.ResultadosParticiparon 114 médicos de familia en los que la media de años ejercidos fue de 18,29 años (DE: 8,2). La adherencia al cribado de enfermedad cardiovascular fue del 70%. La adherencia al cribado de cáncer cérvix, de mama y colorrectal fue del 73, 86 y 24% respectivamente. El calendario vacunal estuvo actualizado en el 51,8%. El 81,6% respondió tener pareja sexual estable y el 75,2% está satisfecho con sus relaciones sexuales. El método de barrera lo utiliza siempre el 21,1%. La escala de Hamilton fue patológica en el 74,3% de los participantes, aunque el 90,4% refiere sentirse bien o muy bien.ConclusionesLa adherencia al cribado cardiovascular y de cáncer femenino es adecuado, pero deficiente en el cáncer colorrectal. La vacunación entre los participantes se realiza de forma deficiente(AU)

AimsTo describe the lifestyle of primary care physicians, their adherence to cancer screening tests and to describe basic aspects of occupational, mental and sexual health.DesignCross-sectional study.SettingPrimary Care. Health Area 7, Madrid.ParticipantsFamily Physicians.MethodsAn anonymous survey sent through the internal mail was completed by the participants. The questionnaire was based on the Cardiovascular Disease Prevention European Guidelines, Health Prevention and Promotion Activities Program (Programa de Actividades Preventivas y de Promoción de la Salud) and the World Health Organisation document on physical activity and health. The Hamilton Anxiety Scale was used to measure anxiety.ResultsA total of 114 primary care physicians participated in the study. The average years of medical practice was 18.29 years (SD: 8.2). Adherence to cardiovascular screening was 70%. Adherence to cervix, breast and colorectal cancer screening was of 73%, 86% and 24%, respectively. Vaccination records were up to date in 51.8% of the participants. A total of 81.6% had a stable sexual partner and 75.2% were satisfied with their sexual relationships. The condom was always used by just 21.1% of the participants. Hamilton¿s anxiety scale was abnormal in 74.3% of the physicians, but 90.4% reported to feel good or very good.ConclusionsAdherence to cardiovascular and female cancer screening is adequate, but insufficient in colorectal cancer. Vaccination among the participants was adequate(AU)

[Health of family physicians: do we practice what we preach?]. / La salud de los médicos de familia: ¿practicamos lo que predicamos?

AIMS: To describe the lifestyle of primary care physicians, their adherence to cancer screening tests and to describe basic aspects of occupational, mental and sexual health. DESIGN: Cross-sectional study. SETTING: Primary Care. Health Area 7, Madrid. PARTICIPANTS: Family Physicians. METHODS: An anonymous survey sent through the internal mail was completed by the participants. The questionnaire was based on the Cardiovascular Disease Prevention European Guidelines, Health Prevention and Promotion Activities Program (Programa de Actividades Preventivas y de Promoción de la Salud) and the World Health Organisation document on physical activity and health. The Hamilton Anxiety Scale was used to measure anxiety. RESULTS: A total of 114 primary care physicians participated in the study. The average years of medical practice was 18.29 years (SD: 8.2). Adherence to cardiovascular screening was 70%. Adherence to cervix, breast and colorectal cancer screening was of 73%, 86% and 24%, respectively. Vaccination records were up to date in 51.8% of the participants. A total of 81.6% had a stable sexual partner and 75.2% were satisfied with their sexual relationships. The condom was always used by just 21.1% of the participants. Hamiltons anxiety scale was abnormal in 74.3% of the physicians, but 90.4% reported to feel good or very good. CONCLUSIONS: Adherence to cardiovascular and female cancer screening is adequate, but insufficient in colorectal cancer. Vaccination among the participants was adequate.