Executive summary of the consensus document of the HIV quality of care indicators. GESIDA updated.

This article aims to review the main information taken into account for the update of the GESIDA PLWH quality indicators. Finally 54 indicators covering a major part of the clinical activity in PLWH were defined. They evaluate the detection and diagnosis of PLWH, their follow-up and prevention, initiation and adaptation of ART, women's specific aspects, comorbidities, hospitalization, and AIDS-related mortality.

Executive summary of the consensus document of the HIV quality of care indicators. GESIDA updated / Resumen ejecutivo del documento actualizado del consenso de los indicadores de Calidad de GESIDA

This article aims to review the main information taken into account for the update of the GESIDA PLWH quality indicators.Finally 54 indicators covering a major part of the clinical activity in PLWH were defined.They evaluate the detection and diagnosis of PLWH, their follow-up and prevention, initiation and adaptation of ART, women's specific aspects, comorbidities, hospitalization, and AIDS-related mortality.

Este artículo tiene como objetivo revisar la principal información que se tuvo en cuenta para la actualización de los indicadores de calidad de PVV de GESIDA.Finalmente, se definieron 54 indicadores que cubren la mayor parte de la actividad clínica en PVV. Los indicadores evalúan la detección y el diagnóstico de los PVV, su seguimiento y prevención, la iniciación y adherencia al TAR, aspectos específicos de la mujer, comorbilidades, hospitalización y mortalidad relacionada con el sida.

Implementation of pre-exposure prophylaxis programme in Spain. Feasibility of four different delivery models.

BACKGROUND: Pre-exposure prophylaxis (PrEP) is an effective and cost-effective strategy for HIV prevention. Spain carried out an implementation study in order to assess the feasibility of implementing PrEP programmes within its heterogeneous health system. METHODS: Observational longitudinal study conducted on four different types of health-care setting: a community centre (CC), a sexually transmitted infections clinic (STIC), a hospital-based HIV unit (HBHIVU) and a hospital-based STI unit (HBSTIU). We recruited gay, bisexual and other men who have sex with men (GBSM) and transgender women at risk of HIV infections, gave them PrEP and monitored clinical, behavioural PrEP-related and satisfaction information for 52 weeks. We collected perceptions on PrEP implementation feasibility from health-care professionals participating in the study. RESULTS: A total of 321 participants were recruited, with 99.1% being GBMSM. Overall retention was 87.2% and it was highest at the CC (92.6%). Condom use decreased during the study period, while STIs did not increase consistently. The percentage of people who did not miss any doses of PrEP during the previous week remained at over 93%. No HIV seroconversions occurred. We observed overall decreases in GHB (32.5% to 21.8%), cocaine (27.5% to 21.4%), MDMA (25.7% to 14.3%), speed (11.4% to 5.7%) and mephedrone use (10.7% to 5.0%). The overall participant satisfaction with PrEP was 98.6%. Health-care professionals' perceptions of PrEP feasibility were positive, except for the lack of personnel. CONCLUSIONS: PrEP implementation is feasible in four types of health-care settings. Local specificities have to be taken into consideration while implementing PrEP.

Estudio caso-control de tumores no definitorios de sida en una cohorte prospectiva de pacientes infectados por el VIH / A case-control study of non-AIDS-defining cancers in a prospective cohort of HIV-infected patients

Introducción: Presentamos un estudio caso-control de tumores no definitorios de sida (TNDS) en una cohorte de pacientes infectados por el VIH en la que valoramos las tasas de incidencia, supervivencia y factores pronósticos de mortalidad. Métodos: Se recogieron de forma prospectiva en 7 hospitales, los diagnósticos de TNDS realizados de 2007 a 2011, con seguimiento posterior hasta diciembre de 2013. Se seleccionaron de forma aleatoria un grupo control de 221 pacientes VIH sin diagnóstico de cáncer. Resultados: Se diagnosticaron 221 TNDS en una cohorte inicial de 7.067 pacientes VIH. Los más frecuentes: hepatocarcinoma 20,5%, pulmón 18,7%, cabeza y cuello 11,9% y anal 10,5%. La tasa de incidencia de desarrollo de TNDS fue de 7,84/1.000 pacientes-año. Además de la edad y el tabaco, el tiempo en TAR (OR 1,11; IC 95% 1,05-1,17) y el uso de IP (OR 1,72; IC 95% 1,0-2,96) aumentaron el riesgo de desarrollar un TNDS. Durante el seguimiento fallecieron el 53,42%, con una mediana de supervivencia de 199,5 días. En el análisis de los factores pronósticos de mortalidad, los valores bajos de CD4 en el momento del diagnóstico del tumor (OR 0,99; IC 95% 0,99-1,0; p=0,033) y el diagnóstico previo de sida (OR 2,06; IC 95% 1,08-3,92) se asociaron con una mayor mortalidad. Conclusiones: Los predictores de TNDS en nuestra cohorte fueron la edad, el consumo de tabaco, los linfocitos CD4 y el mayor tiempo en TAR. La mortalidad es alta, siendo factores de riesgo los CD4 bajos en el momento del diagnóstico del TNDS y el diagnóstico previo de sida

Introduction: We present a case-control study of non-AIDS-defining cancers (NADCs) in a cohort of HIV-infected patients where we value the incidence, survival and prognostic factors of mortality. Methods: All NADCs diagnosis conducted from 2007 to 2011 in 7 hospitals were collected prospectively, with a subsequent follow up until December 2013. A control group of 221 HIV patients without a diagnosis of cancer was randomly selected. Results: Two hundred and twenty-one NADCs were diagnosed in an initial cohort of 7,067 HIV-infected patients. The most common were: hepatocellular carcinoma 20.5%, lung 18.7%, head and neck 11.9% and anal 10.5%. The incidence rate of NADCs development was 7.84/1,000 people-year. In addition to aging and smoking, time on ART (OR 1.11; 95% CI 1.05-1.17) and PI use (OR 1.72; 95% CI 1.0-2.96) increased the risk of developing a NADC. During follow-up 53.42% died, with a median survival time of 199.5 days. In the analysis of the prognostic factors of mortality the low values of CD4 at tumour diagnosis (OR 0.99; 95% CI 0.99-1.0; P=.033), and the previous diagnosis of AIDS (OR 2.06; 95% CI 1.08-3.92) were associated with higher mortality. Conclusions: Predictors of NADCs in our cohort were age, smoking, CD4 lymphocytes and time on ART. Mortality is high, with NADC risk factors being low CD4 count and previous diagnosis of AIDS

A case-control study of non-AIDS-defining cancers in a prospective cohort of HIV-infected patients. / Estudio caso-control de tumores no definitorios de sida en una cohorte prospectiva de pacientes infectados por el VIH.

INTRODUCTION: We present a case-control study of non-AIDS-defining cancers (NADCs) in a cohort of HIV-infected patients where we value the incidence, survival and prognostic factors of mortality. METHODS: All NADCs diagnosis conducted from 2007 to 2011 in 7 hospitals were collected prospectively, with a subsequent follow up until December 2013. A control group of 221 HIV patients without a diagnosis of cancer was randomly selected. RESULTS: Two hundred and twenty-one NADCs were diagnosed in an initial cohort of 7,067 HIV-infected patients. The most common were: hepatocellular carcinoma 20.5%, lung 18.7%, head and neck 11.9% and anal 10.5%. The incidence rate of NADCs development was 7.84/1,000 people-year. In addition to aging and smoking, time on ART (OR 1.11; 95% CI 1.05-1.17) and PI use (OR 1.72; 95% CI 1.0-2.96) increased the risk of developing a NADC. During follow-up 53.42% died, with a median survival time of 199.5 days. In the analysis of the prognostic factors of mortality the low values of CD4 at tumour diagnosis (OR 0.99; 95% CI 0.99-1.0; P=.033), and the previous diagnosis of AIDS (OR 2.06; 95% CI 1.08-3.92) were associated with higher mortality. CONCLUSIONS: Predictors of NADCs in our cohort were age, smoking, CD4 lymphocytes and time on ART. Mortality is high, with NADC risk factors being low CD4 count and previous diagnosis of AIDS.

Clinical response to thalidomide in the treatment of intracranial tuberculomas: case report.

We describe a patient with multiple intracranial tuberculomas resistant to standard care with antituberculosis drugs and corticosteroids who responded well to thalidomide. Adjunctive thalidomide may have a role in the management of refractory intracranial tuberculomas, although it should be used conservatively owing to its potential adverse events.

Prevención de la transmisión del VIH (vertical, ocupacional y no ocupacional) / Prevention of HIV transmission (vertical, occupational and non-occupational)

En estas casi tres décadas de epidemia de infección por VIH, se han ido desarrollando estrategias para disminuir el riesgo de transmisión cuando una persona no infectada se pone en contacto con el VIH. Uno de los hitos clave fue la demostración de que la utilización de zidovudina desde el segundo trimestre de embarazo, durante el parto y durante unas semanas en el recién nacido disminuyó el riesgo de trasmisión vertical de la infección por VIH de 25 a 8%. Posteriormente, estas estrategias se han ido perfeccionando hasta conseguir tasas de transmisión vertical por debajo del 1%. Casi de una forma simultánea se han ido desarrollando estrategias para intentar disminuir el riesgo de transmisión de la infección tras accidentes ocupacionales laborales, y en los últimos años la profilaxis postexposición no ocupacional ha sido un campo de especial preocupación. Incluso en este último año se han publicando distintas experiencias de profilaxis preexposición que están generando un intenso debate sobre su aplicabilidad. En este artículo sintetizamos el estado del arte en la prevención de transmisión vertical y la profilaxis postexposición ocupacional y no ocupacional, desde una perspectiva de aplicación en el mundo desarrollado. Revisamos asimismo, los datos publicados respecto a profilaxis preexposición (AU)

In these almost thirty years since the epidemic of HIV infection strategies have been developed to decrease the transmission risk when a non-infected person comes into contact with HIV. One of the key landmarks was the use zidovudine was shown to reduce the risk of HIV infection by vertical transmission from 25%to 8% when given from the second trimester of pregnancy, during partum and for several weeks in the newborn. These strategies have been subsequently perfected until achieving vertical transmission rates less than 1%. Almost at the same time, strategies have been developed in an attempt to reduce the risk of transmission of infection after occupational accidents and, in the last few years prophylaxis after non-occupational exposure has been a field of particular concern. Even in this past year several experiments on pre-exposure prophylaxis have been published, which are generating an intense debate on is applicability. In this article, we analyse the state of the art in the prevention of vertical transmission and occupational and non-occupational prophylaxis, from a perspective of applying this in the developed world. We also review the published data on pre-exposure prophylaxis (AU)

[Prevention of HIV transmission (vertical, occupational and non-occupational)]. / Prevención de la transmisión del VIH (vertical, ocupacional y no ocupacional).

In these almost thirty years since the epidemic of HIV infection strategies have been developed to decrease the transmission risk when a non-infected person comes into contact with HIV. One of the key landmarks was the use zidovudine was shown to reduce the risk of HIV infection by vertical transmission from 25% to 8% when given from the second trimester of pregnancy, during partum and for several weeks in the newborn. These strategies have been subsequently perfected until achieving vertical transmission rates less than 1%. Almost at the same time, strategies have been developed in an attempt to reduce the risk of transmission of infection after occupational accidents and, in the last few years prophylaxis after non-occupational exposure has been a field of particular concern. Even in this past year several experiments on pre-exposure prophylaxis have been published, which are generating an intense debate on is applicability. In this article, we analyse the state of the art in the prevention of vertical transmission and occupational and non-occupational prophylaxis, from a perspective of applying this in the developed world. We also review the published data on pre-exposure prophylaxis.

Eligibility for and outcome of treatment of latent tuberculosis infection in a cohort of HIV-infected people in Spain.

BACKGROUND: Previous studies have demonstrated the efficacy of treatment for latent tuberculosis infection (TLTBI) in persons infected with the human immunodeficiency virus, but few studies have investigated the operational aspects of implementing TLTBI in the co-infected population.The study objectives were to describe eligibility for TLTBI as well as treatment prescription, initiation and completion in an HIV-infected Spanish cohort and to investigate factors associated with treatment completion. METHODS: Subjects were prospectively identified between 2000 and 2003 at ten HIV hospital-based clinics in Spain. Data were obtained from clinical records. Associations were measured using the odds ratio (OR) and its 95% confidence interval (95% CI). RESULTS: A total of 1242 subjects were recruited and 846 (68.1%) were evaluated for TLTBI. Of these, 181 (21.4%) were eligible for TLTBI either because they were tuberculin skin test (TST) positive (121) or because their TST was negative/unknown but they were known contacts of a TB case or had impaired immunity (60). Of the patients eligible for TLTBI, 122 (67.4%) initiated TLTBI: 99 (81.1%) were treated with isoniazid for 6, 9 or 12 months; and 23 (18.9%) with short-course regimens including rifampin plus isoniazid and/or pyrazinamide. In total, 70 patients (57.4%) completed treatment, 39 (32.0%) defaulted, 7 (5.7%) interrupted treatment due to adverse effects, 2 developed TB, 2 died, and 2 moved away. Treatment completion was associated with having acquired HIV infection through heterosexual sex as compared to intravenous drug use (OR:4.6; 95% CI:1.4-14.7) and with having taken rifampin and pyrazinamide for 2 months as compared to isoniazid for 9 months (OR:8.3; 95% CI:2.7-24.9). CONCLUSIONS: A minority of HIV-infected patients eligible for TLTBI actually starts and completes a course of treatment. Obstacles to successful implementation of this intervention need to be addressed.

Genotipado de Chlamydia trachomatis en un área del norte de España / Genotyping of Chlamydia trachomatis in an area of Northern Spain

IntroducciónSe estudiaron los genotipos circulantes de Chlamydia trachomatis que causan infección en nuestra área geográfica con el fin de detectar posibles peculiaridades epidemiológicas.MétodosSe genotiparon 177 cepas obtenidas entre 2006 y 2008 empleando una reacción en cadena de la polimerasa con cebadores del gen ompA y posterior secuenciación.ResultadosLos genotipos más frecuentes fueron el E (45,3%), el D (15,3%), el G (10,2%) y el F (9,6%). Otros genotipos encontrados fueron B, H, I, J, K y LGV II.ConclusiónLa técnica empleada tuvo una alta rentabilidad (89%) (AU)

IntroductionCirculating Chlamydia trachomatis genotypes that cause infection in our geographic area were studied with the aim of detecting possible epidemiological peculiarities.MethodsA total of 177 strains obtained between 2006 and 2008 were genotyped using a PCR with primers targeting the ompA gene, and later sequenced.ResultsThe most frequent genotypes were: E (45.3%), D (15.3%), G (10.2%) and F (9.6%). Other genotypes found were: B, H, I, J, K and LGV II.ConclusionThe molecular assay used had a high yield (89%) (AU)

[HIV infection in immigrants in Spain: Epidemiological characteristics and clinical presentation in the CoRIS Cohort (2004-2006)]. / Infección por virus de la inmunodeficiencia humana en inmigrantes en España: características epidemiológicas y presentación clínica en la cohorte CoRIS, 2004-2006.

INTRODUCTION: A growing number of immigrants are using the public health services for HIV in Spain. We describe the sociodemographic, epidemiological, and clinical characteristics of a cohort of naïve HIV-infected subjects (CoRIS cohort) according to their place of origin. METHODS: CoRIS is an open, hospital-based cohort of naïve, HIV-infected persons attended in 19 hospitals from 9 of the 19 autonomous regions in Spain. We describe the characteristics of the cohort members by place of origin, and compare them with the Spanish cases identified from January 2004 to October 2006, using the chi-square and Fisher exact tests. RESULTS: Of 2507 patients, 76.3% were men and median age was 36 years. By origin, 71.5% were Spanish, 16.0% Latin Americans (LA), 5.8% sub-Saharan Africans (SSA), 3.7% Western Europeans (WE), 1.7% Eastern Europeans (EE) and 1.4% North Africans (NA). Compared to Spaniards, there were significant differences by origin in sex, age, and transmission category. Median CD4 count at cohort entry was 352 cell/microL, with no differences according to origin. Median viral load was 48 962 copies/mL and was significantly lower for SSA. Over 11.4 months of follow-up, 57.9% initiated HAART with no differences by origin. Hepatitis C prevalence was 29.9% in Spaniards, 7.3% in Latin Americans, 11.7% in SSA, and 45.7% in EE (P<0.05). Overall, 13.4% were Mantoux-positive (28.6% in SSA and 30.8% in NA). Tuberculosis was more common among cases from EE (9.5%) and SSA (8.3%) compared to Spaniards (4.8%) (P<0.05). CONCLUSIONS: Almost one third of naïve HIV-infected patients in CoRIS are foreign-born. Their sociodemographic, epidemiological and clinical characteristics reflect the epidemic in their places of origin. However, their immunological status at cohort entry and initiation of HAART is no different from that of Spaniards.

[Genotyping of Chlamydia trachomatis in an area of northern Spain]. / Genotipado de Chlamydia trachomatis en un área del norte de España.

INTRODUCTION: Circulating Chlamydia trachomatis genotypes that cause infection in our geographic area were studied with the aim of detecting possible epidemiological peculiarities. METHODS: A total of 177 strains obtained between 2006 and 2008 were genotyped using a PCR with primers targeting the ompA gene, and later sequenced. RESULTS: The most frequent genotypes were: E (45.3%), D (15.3%), G (10.2%) and F (9.6%). Other genotypes found were: B, H, I, J, K and LGV II. CONCLUSION: The molecular assay used had a high yield (89%).

Varón con infección por VIH con alteración neurológica de aparición brusca / Sudden onset of neurological alterations in a man with HIV infection

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[Paludism due to Plasmodium falciparum in visitors to the Dominican Republic]. / Paludismo por Plasmodium falciparum en viajeros a República Dominicana.

We present two cases of P. falciparum malaria in visitors to tourist resorts on the East Coast of the Dominican Republic, traditionally believed to be an area without risk of malaria. In both patients the malaria was severe (with 20% parasitization in one) and there was a long interval between the onset of symptoms and diagnosis. These cases are possibly related (along with a further 17 reports by the Centers for Disease Control and Prevention) to an increase in the population of Anopheles sp as a consequence of increased rainfall and floods provoked by a hurricane in September 2004, as well as to the presence of a semi-immune population (Haitian immigrants working in the construction and tourist sectors). Both physicians and patients should be aware of this outbreak so that adequate precautions can be taken and early diagnoses can be made.

Paludismo por Plasmodium falciparum en viajeros a República Dominicana / Paludism due to Plasmodium falciparum in visitors to the Dominican Republic

Se presentan 2 casos de paludismo por Plasmodium falciparum en viajeros a centros turísticos de la costa este de República Dominicana, considerados clásicamente como libres de riesgo de paludismo. En ambos casos, se trató de pacientes con paludismo grave (con una parasitación del 20% en uno de ellos), con un tiempo largo entre el inicio de la sintomatología y el diagnóstico. Es posible que estos casos (junto con otros 17 comunicados por los Center for Disease Control and Prevention [CDC]) estén relacionados con un aumento en la población de Anopheles sp. como consecuencia del aumento de lluvias e inundaciones provocados por el paso de un huracán en septiembre de 2004, junto con la existencia de población semiinmune (inmigrantes haitianos trabajando en la construcción y el sector turístico). Es muy importante que tanto los médicos como los pacientes sean conscientes de este brote para facilitar la toma adecuada de precauciones y un diagnóstico precoz (AU)

We present two cases of P. falciparum malaria in visitors to tourist resorts on the East Coast of the Dominican Republic, traditionally believed to be an area without risk of malaria. In both patients the malaria was severe (with 20% parasitization in one) and there was a long interval between the onset of symptoms and diagnosis. These cases are possibly related (along with a further 17 reports by the Centers for Disease Control and Prevention) to an increase in the population of Anopheles sp as a consequence of increased rainfall and floods provoked by a hurricane in September 2004, as well as to the presence of a semi-immune population (Haitian immigrants working in the construction and tourists sectors). Both physicians and patients should be aware of this outbreak so that adequate precautions can be taken and early diagnoses can be made (AU)

Causas de mortalidad de los pacientes infectados por el virus de la inmunodeficiencia humana en la era del tratamiento antirretovírico de gran actividad / Causes of mortality among patients infected with the human immunodeficiency virus in the era of highly active antiretroviral therapy

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Administración de factor estimulante de colonias de granulocitos en pacientes con infección por el Virus de la Inmunodeficiencia Humana y neutropenia prolongada / Granulocyte colony-stimulating factor administration in HIV-infected patients with prolonged neutropenia

FUNDAMENTOS. La neutropenia persistente es frecuente en pacientes infectados por el virus de la inmunodeficiencia humana (VIH) con inmunodepresión grave. El factor estimulante de colonias de granulocitos (G-CSF) induce la proliferación y diferenciación de los precursores de los granulocitos. Nuestro objetivo ha sido valorar la respuesta a la terapia con G-CSF en pacientes con infección avanzada por VIH y neutropenia prolongada. M ÉTODOS. Revisión retrospectiva entre el 1-12-92 y el 30-1-98 de los episodios con un recuento de neutrófilos menor de 1.000 x 106/litro, durante al menos 7 días y que en algún momento han evolucionado a cifras menores de 500 x 106/litro. RESULTADOS. Se estudian 36 episodios. En 9 de ellos se realizó tratamiento con G-CSF con una mediana de duración de 9 (3-76) semanas. El número de episodios de neutropenia que precisaron ingresar por fiebre relacionada con la misma fue significativamente menor entre los que recibieron G-CSF frente a los que no lo hicieron (22,2 por ciento frente al 66,7 por ciento). CONCLUSIÓN. En este estudio, el menor riesgo de ingreso por fiebre y neutropenia se asocia significativamente con la administración de G-CSF en pacientes con recuentos de neutrófilos menores de 500 x 106/litro, con una buena tolerancia al tratamiento (AU)

Varón de 70 años con tumoración laterocervical izquierda y fiebre / Seventy-year old male patient with left laterocervical tumour and fever. Case report

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