Jóvenes y VIH. Conocimiento y conductas de riesgo de un grupo residente en España / Young adults and HIV. Awareness and risk behaviour of a group living in Spain

Introducción: El contacto sexual es actualmente en España la primera vía de contagio de VIH. Pese a los descensos en el número de nuevas infecciones en mujeres y consumo de drogas, en hombres se mantiene estable. El presente estudio pretende evaluar conductas de riesgo y conocimientos sobre VIH en una muestra de jóvenes en España. Métodos: Se realizó un estudio observacional descriptivo transversal utilizando un cuestionario sobre salud sexual y conocimiento sobre el VIH adaptado del Instituto Nacional de Estadística. El grupo estuvo compuesto por jóvenes no infectados por VIH. Se incluyó la variable riesgo sexual (alto y bajo), siendo de riesgo alto los sujetos que habían tenido tres o más parejas y no utilizaban preservativo en todas las relaciones. Resultados: Se encuestaron 243 jóvenes (65,6% mujeres) de entre 16 y 36 años (media = 25,7; DE = 4,1) (16-24 años: 134 sujetos; 25-29 años, 60 sujetos; más de 30 años, 47 sujetos). El 40,9% contestaron que utilizaban el preservativo en todas sus relaciones y el 61% que no perciben ningún riesgo de infección. De forma mayoritaria no se encuentran diferencias significativas en conocimiento sobre vías de transmisión entre los grupos de alto y de bajo riesgo. Los métodos de protección que se asociaron significativamente con las diferencias en riesgo sexual fueron lavarse tras las relaciones sexuales, tener pocas parejas, uso de espermicidas y carga viral indetectable (p < 0,05). Conclusiones: El principal resultado del estudio es la infravaloración personal de riesgo indicado según las diferencias encontradas entre la valoración personal y el índice de riesgo sexual. Se encuentran resultados tanto positivos como negativos en cuanto al conocimiento sobre el VIH

Introduction: Sexual intercourse is currently the main route of HIV infection in Spain. Despite decreases in new infections among women and drug users, the rate remains stable in men. The aim of this study was to assess risk behaviour and HIV awareness in a sample of young adults in Spain. Methods: A cross-sectional, observational, descriptive study was performed on a non-HIV infected sample, using a questionnaire on sexual health and HIV awareness adapted from the Spanish National Institute of Statistics. A sexual risk variable was included (high and low), which was classified as high if subjects had had three or more sexual partners and did not always use a condom in all their sexual encounters. Results: 243 subjects were included (65.6% women) aged between 16 and 36 years (mean = 25.7; SD = 4.1) (16-24 years: 134 subjects; 25-29 years: 60 subjects; over 30 years: 47 subjects). Approximately 40.9% said that they used a condom in all sexual relations and 61% did not perceive any risk of infection. There were no significant differences in awareness of infection routes between the high and low risk profiles. Washing after sex, having few partners, spermicide use and having undetectable viral load were protective measures significantly associated with differences in sexual risk (P < .05). Conclusions: The main finding of the study was the underestimation of risk of infection, analysed after differences found between self-assessment and sexual risk. Both positive and negative results were found concerning HIV awareness

Young adults and HIV. Awareness and risk behaviour of a group living in Spain. / Jóvenes y VIH. Conocimiento y conductas de riesgo de un grupo residente en España.

INTRODUCTION: Sexual intercourse is currently the main route of HIV infection in Spain. Despite decreases in new infections among women and drug users, the rate remains stable in men. The aim of this study was to assess risk behaviour and HIV awareness in a sample of young adults in Spain. METHODS: A cross-sectional, observational, descriptive study was performed on a non-HIV infected sample, using a questionnaire on sexual health and HIV awareness adapted from the Spanish National Institute of Statistics. A sexual risk variable was included (high and low), which was classified as high if subjects had had three or more sexual partners and did not always use a condom in all their sexual encounters. RESULTS: 243 subjects were included (65.6% women) aged between 16 and 36years (mean=25.7; SD=4.1) (16-24years: 134 subjects; 25-29years: 60 subjects; over 30years: 47 subjects). Approximately 40.9% said that they used a condom in all sexual relations and 61% did not perceive any risk of infection. There were no significant differences in awareness of infection routes between the high and low risk profiles. Washing after sex, having few partners, spermicide use and having undetectable viral load were protective measures significantly associated with differences in sexual risk (P<.05). CONCLUSIONS: The main finding of the study was the underestimation of risk of infection, analysed after differences found between self-assessment and sexual risk. Both positive and negative results were found concerning HIV awareness.

Lack of Accuracy of Biomarkers and Physical Examination to Detect Bacterial Infection in Febrile Infants.

OBJECTIVES: The aim of this study was to analyze the usefulness of physical examination, C-reactive protein (CRP), procalcitonin (PCT), white blood cell (WBC) count, and absolute neutrophils counts (ANCs) for the diagnosis of invasive bacterial infections (IBIs) and potentially serious bacterial infections in infants younger than the age of 3 months presenting with fever without source (FWS) to the emergency department (ED). METHODS: A descriptive retrospective study that includes all infants aged younger than 3 months who presented with FWS to the ED between July 2008 and January 2012. We evaluated diagnostic performance for each test by receiver operating characteristic curve analysis. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were also calculated. RESULTS: Three hundred eighteen patients met the inclusion criteria. Eleven bacteremia (3.5%) and 76 urinary tract infections (23.9%) were diagnosed. To detect IBI, the areas under the curve for the different tests were as follows: PCT, 0.77 (95% confidence interval [CI], 0.57-0.96); CRP, 0.54 (95% CI, 0.36-0.73); ANC, 0.53 (95% CI, 0.34-0.71); and WBC, 0.42 (0.24-0.61). To detect potentially serious bacterial infections, the areas under the curve were as follows: PCT, 0.66 (95% CI, 0.59-0.74); CRP, 0.68 (0.60-0.76); ANC, 0.64 (0.56-0.71); and WBC, 0.66 (0.58-0.72). CONCLUSIONS: Procalcitonin is better than CRP, WBC, and ANC to confirm or dismiss the presence of an IBI in infants aged younger than 3 months presenting with FWS to the ED. However, it could not identify almost 30% of infants with IBI. Most patients diagnosed with IBI (10 of 11) presented abnormal values in at least one of the analytical parameters and/or physical appearance. Four of 5 patients with IBI and well appearing presented abnormal results in at least one of the analytical parameters. Therefore, the development of tools combining different tests including the new biomarkers could increase the reliability of the tests for the diagnosis of IBI in these patients.

Aspectos psicosociales en una cohorte de adolescentes con infección por el virus de la inmunodeficiencia humana por transmisión vertical. NeuroCoRISpeS / Psychosocial aspects in a cohort of vertically transmitted human immunodeficiency virus-infected adolescents

INTRODUCCIÓN: Los avances en el tratamiento antirretroviral han mejorado la esperanza de vida de niños con infección por VIH por transmisión vertical. Sin embargo, han aparecido nuevos retos. Planteamos este estudio con el objetivo de determinar los aspectos psicosociales y el conocimiento sobre su enfermedad en una cohorte de adolescentes con infección por VIH por transmisión vertical. MÉTODOS: Se incluyeron pacientes con infección por VIH por transmisión vertical con edades comprendidas entre 12-19 años. Los datos se obtuvieron mediante entrevista semiestructurada y el Strengths and Difficulties Questionnaire para cribado de trastornos emocionales y de conducta. RESULTADOS: Se evaluaron 96 pacientes (58% mujeres) con mediana de edad de 15 años (11-19,1) y mediana de edad del diagnóstico de 1,70 años (0-12,2). La mediana de CD4 en el momento del corte fue 626 céls/mm3 (132-998); el 72% de los pacientes presentaban una carga viral < 50 cop/ml. El 90% asistía al colegio; de ellos, el 60% había repetido algún curso. Conocían su diagnóstico el 81%. Solo el 30% conocía bien su enfermedad y el 18,2% había compartido el diagnóstico con sus amistades. Se detectaron 6 embarazos durante el periodo de estudio. El Strengths and Difficulties Questionnaire mostró riesgo de hiperactividad en el 33%. CONCLUSIÓN: Se objetivan dificultades psicosociales en un elevado porcentaje de pacientes (conocimiento de la enfermedad, relación con pares, fracaso escolar...) que podrían tener impacto en su incorporación a la vida adulta. Son necesarios más estudios para profundizar en el origen y evolución de las dificultades observadas, así como intervenir para prevenir y modificar esta situación

INTRODUCTION: Thanks to advances in antiretroviral treatment, children with HIV infections through vertical transmission have improved their life expectancy. However, new challenges have emerged. We propose this study in order to determine the psychosocial aspects and knowledge of infections in a cohort of adolescents with vertically transmitted HIV infections. METHODS: Patients with vertically-acquired HIV infection between 12 and 19 years old were included. Data were obtained through semi-structured interviews and a Strengths and Difficulties Questionnaire for emotional and behavioral disorders screening. RESULTS: We evaluated 96 patients (58% females) with a median age of 15 years (11-19.1) and a median age at diagnosis of 1.70 years (0-12.2). The median CD4 count was 626 cells/mm3 (132-998), and the viral load was < 50 cp/ml in 72% of patients. Among them, 90% attended school and 60% repeated at least one course. Although 81% of them knew of their diagnosis, only 30% understood their disease, with 18.2% having discussed it with friends. Six unwanted pregnancies occurred during the study period. Strengths and Difficulties Questionnaire showed hyperactivity risk in 33%. CONCLUSION: A high percentage of adolescents show difficulties in several areas (disease knowledge, peer relationship, school failure...) that can have an impact on their adult lives. Further studies are needed to evaluate their origin and development in depth, as well as interventions to modify this situation

Once-daily antiretroviral therapy in a cohort of HIV-infected children and adolescents.

We evaluated the evolution over time of once-daily antiretroviral therapy in HIV-infected children and its relationship with adherence. An increase on the prevalence of once-daily antiretroviral therapy was observed over time (from 0.9% in 2002 to 44.2% in 2011). There was no difference in adherence regarding once-daily or BID regimens in 2011. Adherence was related to age and pill burden.

[Psychosocial aspects in a cohort of vertically transmitted human immunodeficiency virus-infected adolescents]. / Aspectos psicosociales en una cohorte de adolescentes con infección por el virus de la inmunodeficiencia humana por transmisión vertical. NeuroCoRISpeS.

INTRODUCTION: Thanks to advances in antiretroviral treatment, children with HIV infections through vertical transmission have improved their life expectancy. However, new challenges have emerged. We propose this study in order to determine the psychosocial aspects and knowledge of infections in a cohort of adolescents with vertically transmitted HIV infections. METHODS: Patients with vertically-acquired HIV infection between 12 and 19 years old were included. Data were obtained through semi-structured interviews and a Strengths and Difficulties Questionnaire for emotional and behavioral disorders screening. RESULTS: We evaluated 96 patients (58% females) with a median age of 15 years (11-19.1) and a median age at diagnosis of 1.70 years (0-12.2). The median CD4 count was 626cells/mm(3) (132-998), and the viral load was<50cp/ml in 72% of patients. Among them, 90% attended school and 60% repeated at least one course. Although 81% of them knew of their diagnosis, only 30% understood their disease, with 18.2% having discussed it with friends. Six unwanted pregnancies occurred during the study period. Strengths and Difficulties Questionnaire showed hyperactivity risk in 33%. CONCLUSION: A high percentage of adolescents show difficulties in several areas (disease knowledge, peer relationship, school failure...) that can have an impact on their adult lives. Further studies are needed to evaluate their origin and development in depth, as well as interventions to modify this situation.

High prevalence of X4/DM-tropic variants in children and adolescents infected with HIV-1 by vertical transmission.

BACKGROUND: We studied HIV coreceptor tropism in vertically HIV-infected children and adolescents with the objective of predicting the proportion of children and adolescents that could be treated with CCR5 (R5) antagonists. METHODS: One hundred eighteen multidrug-resistant pediatric patients (36 children and 82 adolescents) were enrolled in a cross-sectional study. Viral tropism was assessed using the new phenotypic HIV-1 tropism coreceptor assay information and Trofile. RESULTS: Of 118 antiretroviral-experienced HIV-infected children and adolescents, 49 (57.0%) had dual-tropic and 20 (23.3%) had X4-tropic viruses by tropism coreceptor assay information testing. Only 17 (19.7%) showed R5-tropic variants. HIV-1 coreceptor usage was not detectable in 32 of 118 (27%) patients. Among 24 children and 62 adolescents with tropism coreceptor assay information results, 17 (70.8%) children and 51 (82.2%) adolescents showed viruses with dual-tropic or X4-tropic variants. Additionally, Trofile (ES) was performed in 42 of 118 patients with HIV-1 RNA > 1000 copies/mL. No patient showed X4-tropic variants; dual-tropic viruses were observed in 12 (28.6%) patients. In 6 (14.3%) patients, HIV tropism could not be determined. X4-tropic variants were more common in children (P = 0.031). CD4 T cell percentage was significantly lower in children (P = 0.011) and adolescents (P = 0.027) with R5-tropic viruses than in those with X4-tropic viruses. CONCLUSIONS: The presence of X4-tropic variants in more than 80% of our cohort of antiretroviral-experienced children and adolescents with vertical HIV-1 infection indicates a very limited role for CCR5 antagonists as part of salvage regimens for highly treatment-experienced vertically HIV-1-infected patients with extensive antiretroviral drug resistance and limited treatment options.

Long-term efficacy and safety of fosamprenavir in human immunodeficiency virus-infected pediatric patients.

Fosamprenavir (FPV) efficacy in human immunodeficiency virus (HIV)-infected pediatric patients is still being evaluated in ongoing clinical trials. The long-term efficacy and safety of FPV boosted with ritonavir (FPV/r) was evaluated in 20 antiretroviral-naive and antiretroviral-experienced HIV-vertically infected pediatric patients. Analyses of CD4(+) T-cells, HIV-ribonucleic acid (RNA), and clinical status were performed during a median of 180 weeks. Initially, median HIV-RNA was 4.6 log(10) in naive and 4.4 log(10) in pretreated patients. Median CD4(+) T-cell was 17% and 31%, respectively. After FPV/r treatment, 18 of 20 patients achieved undetectable HIV-RNA and 4 of 20 experienced adverse events. To date, FPV/r treatment has shown sustained antiviral response and immunologic improvement in our 20 patients.

Outcome of protease inhibitor substitution with nevirapine in HIV-1 infected children.

BACKGROUND: Protease inhibitors (PIs) have been associated with metabolic complications. There is a trend to switch to simpler therapy to improve these disturbances. We report a case-series describing the effects in metabolic abnormalities in seven HIV-infected children, previously treated with protease inhibitor (PI) after switching to nevirapine. METHODS: Seven children with stable PI-containing regimen and a long lasting HIV-1 RNA < 50 copies/ml were switched to nevirapine. All patients were naïve to non nucleoside reverse transcriptase inhibitor. PIs were switched to nevirapine. Preentry nucleoside reverse transcriptase inhibitors were maintained. The substitution of PIs with nevirapine was made when the patient showed hyperlipidemia or lipodystrophy or the physician and/or the patient's willingness to simplify. Clinical, laboratory data and anthropometric parameters were assessed every 3 months. Dual-energy X-Ray absorptiometry scans (DXA) was performed at baseline and at 12 months. RESULTS: Seven HIV-infected children were enrolled. Median age: 130 months (99,177). Median baseline CD4%: 32%. All had HIV-1 RNA < 50 copies/ml. Median length of preentry PI-therapy was 47 months (28, 91). Median age at the beginning of nevirapine was 120 months (99,177). Median decrease in cholesterol in 7.2 mmol/L was observed (P = 0.09), from baseline to 12 months. HDL-cholesterol increased in 5.1 mmol/L (P = 0.03) throughout the study period. No significant changes were observed in DXA with regard to body fat, but changes in total body bone mineral content and lean body content were significant. CD4% remained stable. All patients but one maintained viral load < 50 copies/ml at 12 months. The patient with virologic failure referred bad adherence. Children referred to take medication more easily. CONCLUSION: PI substitution with nevirapine improved lipid profile in our patients, although this strategy did not show significant changes in body fat or lipodystrophy.