Prevalencia de diagnóstico tardío en infección por VIH / Prevalence of late diagnosis of HIV infection

OBJETIVO: Prevalencia de diagnóstico tardío (DT) e identificar oportunidades perdidas. MÉTODOS: Estudio observacional retrospectivo de nuevos diagnósticos de VIH entre el 2013 y el 2018 en nuestra área de referencia. Se analizan variables sociodemográficas y clínico-analíticas en el momento del diagnóstico. Se revisa la atención sanitaria prestada en los 5 años previos para identificar oportunidades perdidas de diagnóstico precoz. RESULTADOS: Setenta y cuatro pacientes. Edad media 35,3 años, 83,8% hombres. Prevalencia de DT del 44,6% y de enfermedad avanzada del 23,0%. Tendencia aumentada de DT en los pacientes mayores de 40 años, en especial entre los españoles. Ser testado de VIH protege de presentar un DT. Todos los pacientes con contacto previo con el sistema sanitario presentaban indicadores o factores de riesgo asociados al VIH, pero tan solo el 50% había sido testado del VIH. CONCLUSIONES: A pesar del contacto repetido de nuestros pacientes con el sistema sanitario, casi la mitad de nuevos diagnósticos se realizan de forma tardía. Es importante implementar estrategias que permitan identificar mejor a aquellos pacientes con factores de riesgo o indicadores clínicos para una detección más precoz del VIH

BACKGROUND: Prevalence of late diagnosis (LD) and identifying missed opportunities. METHODS: Retrospective observational study of new HIV diagnoses between 2013 and 2018 in our referral area. Sociodemographic and clinical-analytical variables were analysed at the time of diagnosis. The patient's clinical history in the last 5 years before the HIV diagnoses was reviewed to identify missed opportunities for early diagnosis. RESULTS: Seventy-four patients were included. The prevalence of LD was 44.6%, and 23% as an advanced disease. A tendency for LD was observed in patients older than 40 years, especially among Spaniards. Being tested 11for HIV protected against LD. All patients who had previous contact with the health system had clinical indicators or risk factors associated with HIV, but only 50% had ever been tested in their lifetime of HIV. CONCLUSIONS: In spite of multiple contacts with our health system, almost half of the new cases of HIV infection are diagnosticated late. Different strategies should be implemented to improve the identification of the risk factors and clinical indicators of possible HIV infection

Prevalence of late diagnosis of HIV infection. / Prevalencia de diagnóstico tardío en infección por VIH.

BACKGROUND: Prevalence of late diagnosis (LD) and identifying missed opportunities. METHODS: Retrospective observational study of new HIV diagnoses between 2013 and 2018 in our referral area. Sociodemographic and clinical-analytical variables were analysed at the time of diagnosis. The patient's clinical history in the last 5 years before the HIV diagnoses was reviewed to identify missed opportunities for early diagnosis. RESULTS: Seventy-four patients were included. The prevalence of LD was 44.6%, and 23% as an advanced disease. A tendency for LD was observed in patients older than 40 years, especially among Spaniards. Being tested 11for HIV protected against LD. All patients who had previous contact with the health system had clinical indicators or risk factors associated with HIV, but only 50% had ever been tested in their lifetime of HIV. CONCLUSIONS: In spite of multiple contacts with our health system, almost half of the new cases of HIV infection are diagnosticated late. Different strategies should be implemented to improve the identification of the risk factors and clinical indicators of possible HIV infection.

Tratamiento de la hepatitis por virus C en pacientes coinfectados por el virus de la inmunodeficiencia humana / Treatment of hepatitis C virus in HIV-positive patients

La coinfección por VIH-VHC ocurre actualmente en más del 30% de los pacientes infectados por VIH en nuestro país. En la actualidad, interferón pegilado más ribavirina constituye el tratamiento de elección para la hepatitis crónica por VHC en pacientes VIH. Con ello se obtienen unas tasas de curación global algo inferiores a las obtenidas en los monoinfectados por el VHC y cercanas al 50% de los pacientes. El desarrollo de efectos adversos relacionados con la medicación es muy frecuente y en un 10-20% de los casos conduce al abandono del tratamiento. Son de destacar 3 nuevos aspectos de la hepatitis C en pacientes VIH: 1) aparición en los últimos años de brotes epidémicos de hepatitis aguda por VHC en pacientes VIH varones a partir de relaciones homosexuales; 2) marcadores farmacogenéticos en forma de polimorfismos genéticos cercanos al gen de IL28B relacionados con la respuesta al tratamiento del VHC así como con la erradicación espontánea del VHC tras la infección aguda, y 3) nuevas moléculas antivirales cuyos resultados preliminares en ensayos clínicos son muy esperanzadores por cuanto permiten diseñar tratamientos combinados triples que alcanzan altas tasas de respuesta (AU)

Hepatitis C virus (HCV)-HIV coinfection currently occurs in more than 30% of HIV-positive patients in Spain. Nowadays, the treatment of choice for chronic hepatitis due to HCV infection in HIV-positive patients is pegylated interferon plus ribavirin. This combination achieves an overall cure rate of 50%, which is somewhat lower than those obtained in patients with HCV monoinfection. Adverse effects are frequent, leading to treatment withdrawal in 10-20% of patients.Importantly, there are three new features of hepatitis C in patients with HIV: (1) the recent development of epidemic outbreaks of acute hepatitis due to HCV infection in HIV-positive men caused by homosexual activity, (2) pharmacogenetic markers in the form of genetic polymorphisms near the IL28B gene related to response to HCV treatment as well as spontaneous eradication of HCV after acute infection, and (3) new antiviral molecules have allowed triple combination treatments to be designed and the preliminary results of clinical trials reporting high response rates are highly promising (AU)

[Treatment of hepatitis C virus in HIV-positive patients]. / Tratamiento de la hepatitis por virus C en pacientes coinfectados por el virus de la inmunodeficiencia humana.

Hepatitis C virus (HCV)-HIV coinfection currently occurs in more than 30% of HIV-positive patients in Spain. Nowadays, the treatment of choice for chronic hepatitis due to HCV infection in HIV-positive patients is pegylated interferon plus ribavirin. This combination achieves an overall cure rate of 50%, which is somewhat lower than those obtained in patients with HCV monoinfection. Adverse effects are frequent, leading to treatment withdrawal in 10-20% of patients. Importantly, there are three new features of hepatitis C in patients with HIV: (1) the recent development of epidemic outbreaks of acute hepatitis due to HCV infection in HIV-positive men caused by homosexual activity, (2) pharmacogenetic markers in the form of genetic polymorphisms near the IL28B gene related to response to HCV treatment as well as spontaneous eradication of HCV after acute infection, and (3) new antiviral molecules have allowed triple combination treatments to be designed and the preliminary results of clinical trials reporting high response rates are highly promising.