Cronicidad, envejecimiento y multimorbilidad / Chronicity, ageing and multimorbidity

Gracias al tratamiento antirretroviral de gran actividad (TAR) se ha reducido drásticamente la mortalidad y la infección por VIH se ha convertido en una enfermedad crónica. La población con VIH está envejeciendo. Lo hace de forma prematura. A pesar de un buen control inmunovirológico, el VIH provoca un estado de inflamación crónica e inmunosenescencia acelerada. Clínicamente se manifiesta como un aumento de la comorbilidad relacionada con la edad y de la fragilidad que aparece a edades más tempranas que en la población general. Dada la heterogeneidad de la población mayor con VIH, es importante identificar a aquellas personas que corren el riesgo de tener peor estado de salud y detectar la fragilidad puede ser una buena manera. La relación entre envejecimiento, infección por VIH, tratamiento antirretroviral, comorbilidades y fragilidad todavía necesita ser aclarada. Los pacientes mayores con infección por VIH son pacientes complejos que requieren un abordaje global, específico y multidisciplinario

Thanks to highly active antiretroviral therapy (HAART), HIV-related mortality has been drastically reduced and HIV infection has become a chronic disease. The HIV-infected population is ageing prematurely. Despite good immunovirological control, HIV causes chronic inflammation and accelerated immunosenes-cence. This clinically manifests as an increased prevalence of age-related comorbidity and frailty occurring earlier than in the general population. The heterogeneity of older HIV-infected adults highlights the rele-vance of identifying those who are at risk of poor health, and frailty may be an effective indicator. The rela-tionship between ageing, HIV infection, antiretroviral treatment, comorbidities and frailty still needs to be clarified. Elderly HIV-infected adults are complex patients who require a specific, global and multidisci-plinary approach

Prevención primaria / Primary prevention

La infección por VIH no está controlada en España. Se requieren nuevas estrategias para prevenir la transmisión, especialmente en los colectivos en que tiene mayor incidencia, mediante intervenciones combinadas. El diagnóstico precoz de la infección y el inicio de tratamiento es la estrategia más eficiente, que deben estar acompañados por intervenciones que promuevan cambios de conductas. Este tipo de campañas no solo se deben dirigir a la población general, sino que también es necesario llegar a grupos poblacionales clave de forma más específica. Las intervenciones biomédicas, como la profilaxis preexposición, utilizan una combinación de medios para reducir el riesgo de adquirir el VIH y suelen estar acompañadas por intervenciones conductuales. La influencia de factores estructurales y de justicia social, y la defensa de los derechos de las personas con VIH tienen importantes repercusiones en las estrategias de prevención. Las intervenciones estructurales tratan de incidir en estos factores y reducir la vulnerabilidad a la infección por VIH

HIV infection is still not controlled in Spain. New HIV infection prevention strategies are required, especially in populations of higher incidence, by means of combined interventions. Early diagnosis and treatment of HIV-infected individuals is the most cost-effective strategy to control the epidemic, including interventions designed to motivate behavioural changes. These types of campaigns must not only be directed to the general population through mass channels, but also to key populations through more specific channels and messages. Biomedical interventions like pre-exposure prophylaxis, uses a combination of biomedical tools to reduce the risk of HIV acquisition, and are usually accompanied of behavioural interventions. The influence of structural factors, social justice and defending the rights of people living with HIV have a significant impact on prevention strategies. Structural interventions are designed to influence these factors that make some individuals or populations more vulnerable to HIV infection

Modelo de seguimiento, organización y gestión de la infección por VIH / HIV infection follow-up, organisational and management model

Los avances en el tratamiento antirretroviral han hecho posible que la esperanza de vida de las personas infectadas por VIH se aproxime a la de población general. En este nuevo escenario están cobrando protagonismo las comorbilidades relacionadas con la edad y los síndromes geriátricos. Las experiencias de las diferentes iniciativas innovadoras para el cuidado de pacientes con enfermedades crónicas indican que la optimización de los resultados en salud no solo depende de buenos diagnósticos y tratamientos, sino también de la forma en que se organiza y gestiona la asistencia. Si se quieren cubrir las necesidades futuras de los pacientes infectados por VIH, tendrán que implantarse modelos asistenciales que hayan demostrado su efectividad en otro tipo de enfermedades crónicas; para ello será preciso disponer de un método fiable para estratificar a los pacientes según su nivel de complejidad o capacidad funcional con el fin de detectar a los más vulnerables

Thanks to advances in antiretroviral therapy, the life expectancy of people infected with HIV is approaching that of the general population. In this new clinical scenario, comorbidities related to age and geriatric syn-dromes are gaining prominence. The experiences from various innovative initiatives for the care of patients with chronic diseases indicate that the optimisation of health outcomes not only depends on proper diagnosis and treatment, but also on the way in which care is managed. To cover the future needs of HIV-infected patients, we will have to implement care models that have proven effective in other types of chronic di-seases. This will require a reliable method to stratify patients according to their level of complexity or functional capacity to detect the most vulnerable cases

Chronicity, ageing and multimorbidity. / Cronicidad, envejecimiento y multimorbilidad.

Thanks to highly active antiretroviral therapy (HAART), HIV-related mortality has been drastically reduced and HIV infection has become a chronic disease. The HIV-infected population is ageing prematurely. Despite good immunovirological control, HIV causes chronic inflammation and accelerated immunosenes-cence. This clinically manifests as an increased prevalence of age-related comorbidity and frailty occurring earlier than in the general population. The heterogeneity of older HIV-infected adults highlights the rele-vance of identifying those who are at risk of poor health, and frailty may be an effective indicator. The rela-tionship between ageing, HIV infection, antiretroviral treatment, comorbidities and frailty still needs to be clarified. Elderly HIV-infected adults are complex patients who require a specific, global and multidisci-plinary approach.

HIV infection follow-up, organisational and management model. / Modelo de seguimiento, organización y gestión de la infección por VIH.

Thanks to advances in antiretroviral therapy, the life expectancy of people infected with HIV is approaching that of the general population. In this new clinical scenario, comorbidities related to age and geriatric syn-dromes are gaining prominence. The experiences from various innovative initiatives for the care of patients with chronic diseases indicate that the optimisation of health outcomes not only depends on proper diagnosis and treatment, but also on the way in which care is managed. To cover the future needs of HIV-infected patients, we will have to implement care models that have proven effective in other types of chronic di-seases. This will require a reliable method to stratify patients according to their level of complexity or functional capacity to detect the most vulnerable cases.

Primary prevention. / Prevención primaria.

HIV infection is still not controlled in Spain. New HIV infection prevention strategies are required, especially in populations of higher incidence, by means of combined interventions. Early diagnosis and treatment of HIV-infected individuals is the most cost-effective strategy to control the epidemic, including interventions designed to motivate behavioural changes. These types of campaigns must not only be directed to the general population through mass channels, but also to key populations through more specific channels and messages. Biomedical interventions like pre-exposure prophylaxis, uses a combination of biomedical tools to reduce the risk of HIV acquisition, and are usually accompanied of behavioural interventions. The influence of structural factors, social justice and defending the rights of people living with HIV have a significant impact on prevention strategies. Structural interventions are designed to influence these factors that make some individuals or populations more vulnerable to HIV infection.

HIV testing and counselling for migrant populations living in high-income countries: a systematic review.

BACKGROUND: The barriers to HIV testing and counselling that migrants encounter can jeopardize proactive HIV testing that relies on the fact that HIV testing must be linked to care. We analyse available evidence on HIV testing and counselling strategies targeting migrants and ethnic minorities in high-income countries. METHODS: Systematic literature review of the five main databases of articles in English from Europe, North America and Australia between 2005 and 2009. RESULTS: Of 1034 abstracts, 37 articles were selected. Migrants, mainly from HIV-endemic countries, are at risk of HIV infection and its consequences. The HIV prevalence among migrants is higher than the general population's, and migrants have higher frequency of delayed HIV diagnosis. For migrants from countries with low HIV prevalence and for ethnic minorities, socio-economic vulnerability puts them at risk of acquiring HIV. Migrants have specific legal and administrative impediments to accessing HIV testing-in some countries, undocumented migrants are not entitled to health care-as well as cultural and linguistic barriers, racism and xenophobia. Migrants and ethnic minorities fear stigma from their communities, yet community acceptance is key for well-being. CONCLUSIONS: Migrants and ethnic minorities should be offered HIV testing, but the barriers highlighted in this review may deter programs from achieving the final goal, which is linking migrants and ethnic minorities to HIV clinical care under the public health perspective.