Barriers and facilitators to HIV pre-exposure prophylaxis uptake among transgender women in Colombia: A qualitative analysis using the COM-B model.

Transgender women [TGW] in Colombia are disproportionately affected by HIV due to their low sociodemographic conditions, varied risk behaviours, difficulty accessing health services, and discrimination. Offering pre-exposure prophylaxis [PrEP] as part of a combination of prevention strategies is an appropriate option for this population to reduce their risk of HIV infection. However, little is known about how to implement a PrEP program for TGW in Colombia. Between June and October 2020, we conducted individual interviews with 16 TGW from four different cities in Colombia. The interviews assessed contextual influences, knowledge, skills, perceptions, and beliefs. We used qualitative thematic analysis to identify themes and the Capability, Opportunity, Motivation, and Behavior framework to further delineate barriers and possible interventions. After delineating the main themes across the three subdomains of the model, nine barriers were identified: one related to capability, knowledge, and perception of PrEP; six related to opportunity, which includes, family relations, sexual work environment, stable partner relations, interactions with healthcare workers, health service provision, and community interactions and opportunities; and two related to motivation, mental health, and concerns about medication side effects. Mapping barriers with interventions generated the following intervention functions: education, training, enablement, and environmental structure; and the following policy functions: communication/marketing, legislation, and changes in service provision. Examples of possible interventions are presented and discussed.

AC-2020-12-1420.R1 - HIV care providers' familiarity, concerns, and attitudes about HIV PrEP in Colombia: insights from the PrEP-Col-Study.

In 2019, Colombia approved the combination of tenofovir disoproxil fumarate/emtricitabine for HIV Pre-Exposure Prophylaxis (PrEP). Therefore, we conducted a situational analysis in HIV-care providers to identify barriers and facilitators for PrEP implementation. A survey was applied to a non-probabilistic sample of health care workers of HIV-specialized clinics. We examined PrEP awareness and familiarity, comfort with PrEP-related activities, perceived barriers for PrEP implementation, concerns, and attitudes. Poisson regressions assessed the relationship between these factors and the variable "having a plan to offer PrEP". The participation rate was 41% and included physicians (42.6%) and other health professionals (57.4%). Fifty-one percent of the participants reported more than five years of experience caring for people living with HIV. Forty-two percent of non-physician health care workers were nurses. Most reported high familiarity/comfort with PrEP-relevant activities. Concerns about PrEP were prevalent (> 50%) and included causing more harm than good, reducing condom use, medication non-adherence, drug resistance, and healthcare system barriers. Physicians had a plan to offer PrEP (72.2%) more often than other health professionals (52.6). Having a plan to offer PrEP was related to PrEP knowledge and comfort assessing sexual behavior and providing HIV counseling. Overall, about half of HIV-care providers seemed ready to offer PrEP and constitute an asset for PrEP implementation efforts in Colombia. PrEP awareness among non-physicians, PrEP concerns, and negative attitudes need to be addressed to enhance implementation.

Scales to Assess Knowledge, Motivation, and Self-Efficacy for HIV PrEP in Colombian MSM: PrEP-COL Study.

OBJECTIVE: We evaluated the construct validity Spanish version of knowledge, stigma, norms, and self-efficacy scales regarding PrEP in MSM. METHODS: Sample of 287 MSM. Exploratory confirmatory factor analysis and item response theory were used to validate the constructs. Correlations and confidence interval-based estimation of relevance analyses were conducted to correlate the scales with willingness and intention to use PrEP. RESULTS: Attitude, stigma, and descriptive and subjective norms scales showed good construct validity and were related to intention and willingness to use PrEP. However, the knowledge scale and self-efficacy scales require further refinement. CONCLUSIONS: The study provides useful information for assessing information, motivation, and self-efficacy related to PrEP use. Our results could be used to test the scales and the theoretical model in other contexts to confirm their usefulness.

Examining a syndemic framework for HIV and Sexually Transmitted Infections Risk in Cali, Colombia / Examinando un marco sindémico para el VIH y el riesgo de infecciones de transmisión sexual en Cali, Colombia / Examinando um marco sindémico para o vih e o risco de infeções de transmissão sexual em Cali, Colômbia

Objective: We examined the role played by four psychosocial conditions: forced sex, early sexual initiation, and misuse of alcohol and illicit drugs on the risk of HIV and sexually transmitted infections in Cali-Colombia between 2013 and 2015. Methods: Using data from an HIV counseling and testing campaign in Cali, Colombia, we tested the effect of the accumulation and interactions of the four psychosocial conditions on both outcomes. Results: A total of 604 participants were representative subjects from key affected communities: men who have sex with men, transgender women and female sex workers. A total of 733 participants were heterosexual women and men. Only drug abuse was associated with HIV positivity (Prevalence ratio=2.3, CI 95%: 1.3­4.1), while all psychosocial conditions were associated with sexually transmitted infection history. The accumulation of the syndemic conditions was related to a higher likelihood of sexually transmitted infection history. None of the interactions tested was significant. Conclusions: Our findings highlight the importance of comprehensive mental health interventions in addressing HIV epidemics in Colombia.

Objetivo: Examinar el papel desempeñado por cuatro afecciones psicosociales: sexo forzado, iniciación sexual temprana, uso inadecuado de alcohol y drogas ilícitas en el riesgo de VIH e infecciones de transmisión sexual, en Cali-Colombia entre 2013-2015. Métodos: Utilizando datos de una campaña de consejería y pruebas de VIH en Cali, Colombia, probamos el efecto de la acumulación e interacciones de las cuatro condiciones psicosociales en la positividad al VIH y la positividad a otras enfermedades de transmisión sexual. Resultados: 604 participantes de las principales comunidades afectadas: hombres que tienen sexo con hombres, mujeres transgénero y trabajadoras sexuales. 733 participantes mujeres y hombres heterosexuales. Solo, abuso de drogas se asoció con positividad VIH (Razón de prevalencia = 2.3, IC 95%: 1.3­4.1), mientras que, todas las condiciones psicosociales se asociaron con historia de infecciones de transmisión sexual. La acumulación de condiciones sindémicas se relacionó con mayor probabilidad de historia de infecciones de transmisión sexual. Ninguna interacción probada fue significativa. Conclusiones: Nuestros hallazgos resaltan la importancia de intervenciones integrales de salud mental para abordar la epidemia de VIH en Colombia

Objetivo: Examinar o papel desempenhado por quatro afeções psicossociais: sexo forçado, iniciação sexual precoce, uso inadequado de álcool e drogas ilícitas no risco de VIH e infeções de transmissão sexual, em Cali-Colômbia entre 2013-2015. Métodos: Utilizando dados duma campanha de aconselhamento e testes de VIH em Cali, Colômbia, testamos o efeito da acumulação e interações das quatro condições psicossociais na positividade ao VIH e a positividade a outras doenças de transmissão sexual. Resultados: 604 participantes das principais comunidades afetadas: homens que tem sexo com homens, mulheres transgênero e trabalhadoras sexuais. 733 participantes mulheres e homens heterossexuais. Só, abuso de drogas se associou com positividade VIH (Razão de prevalência = 2.3, IC 95%: 1.3­4.1), enquanto que, todas as condições psicossociais se associaram com história de infeções de transmissão sexual. Acumulação de condições sindémicas (palavra que reúne o social e o biológico) se relacionou com maior probabilidade de história de infeções de transmissão sexual. Nenhuma interação provada foi significativa. Conclusões: Nossos descobrimentos ressaltam a importância de intervenções integrais de saúde mental para abordar a epidemia de VIH na Colômbia.

Examining a syndemic framework for HIV and sexually transmitted infections risk in Cali, Colombia / Examinando un marco sindémico para el VIH y el riesgo de infecciones de transmisión sexual en Cali, Colombia / Examinando um marco sindémico para o vih e o risco de infeções de transmissão sexual em Cali, Colômbia

Abstract Objective: We examined the role played by four psychosocial conditions: forced sex, early sexual initiation, and misuse of alcohol and illicit drugs on the risk of HIV and sexually transmitted infections in Cali-Colombia between 2013 and 2015. Methods: Using data from an HIV counseling and testing campaign in Cali, Colombia, we tested the effect of the accumulation and interactions of the four psychosocial conditions on both outcomes. Results: A total of 604 participants were representative subjects from key affected communities: men who have sex with men, transgender women and female sex workers. A total of 733 participants were heterosexual women and men. Only drug abuse was associated with HIV positivity (Prevalence ratio=2.3, CI 95%: 1.3-4.1), while all psychosocial conditions were associated with sexually transmitted infection history. The accumulation of the syndemic conditions was related to a higher likelihood of sexually transmitted infection history. None of the interactions tested was significant. Conclusions: Our findings highlight the importance of comprehensive mental health interventions in addressing HIV epidemics in Colombia.

Resumen Objetivo: Examinar el papel desempeñado por cuatro afecciones psicosociales: sexo forzado, iniciación sexual temprana, uso inadecuado de alcohol y drogas ilícitas en el riesgo de VIH e infecciones de transmisión sexual, en Cali-Colombia entre 2013-2015. Métodos: Utilizando datos de una campaña de consejería y pruebas de VIH en Cali, Colombia, probamos el efecto de la acumulación e interacciones de las cuatro condiciones psicosociales en la positividad al VIH y la positividad a otras enfermedades de transmisión sexual. Resultados: 604 participantes de las principales comunidades afectadas: hombres que tienen sexo con hombres, mujeres transgénero y trabajadoras sexuales. 733 participantes mujeres y hombres heterosexuales. Solo, abuso de drogas se asoció con positividad VIH (Razón de prevalencia = 2.3, IC 95%: 1.3-4.1), mientras que, todas las condiciones psicosociales se asociaron con historia de infecciones de transmisión sexual. La acumulación de condiciones sindémicas se relacionó con mayor probabilidad de historia de infecciones de transmisión sexual. Ninguna interacción probada fue significativa. Conclusiones: Nuestros hallazgos resaltan la importancia de intervenciones integrales de salud mental para abordar la epidemia de VIH en Colombia.

Resumo Objetivo: Examinar o papel desempenhado por quatro afeções psicossociais: sexo forçado, iniciação sexual precoce, uso inadequado de álcool e drogas ilícitas no risco de VIH e infeções de transmissão sexual, em Cali-Colômbia entre 2013-2015. Métodos: Utilizando dados duma campanha de aconselhamento e testes de VIH em Cali, Colômbia, testamos o efeito da acumulação e interações das quatro condições psicossociais na positividade ao VIH e a positividade a outras doenças de transmissão sexual. Resultados: 604 participantes das principais comunidades afetadas: homens que tem sexo com homens, mulheres transgênero e trabalhadoras sexuais. 733 participantes mulheres e homens heterossexuais. Só, abuso de drogas se associou com positividade VIH (Razão de prevalência = 2.3, IC 95%: 1.3-4.1), enquanto que, todas as condições psicossociais se associaram com história de infeções de transmissão sexual. Acumulação de condições sindémicas (palavra que reúne o social e o biológico) se relacionou com maior probabilidade de história de infeções de transmissão sexual. Nenhuma interação provada foi significativa. Conclusões: Nossos descobrimentos ressaltam a importância de intervenções integrais de saúde mental para abordar a epidemia de VIH na Colômbia.

Resistance to antiretroviral therapy (ART) in patients with HIV/AIDS after therapeutic failure / Resistencia a la terapia antirretroviral (TAR) en pacientes VIH/SIDA en fracaso terapéutico

Abstract Introduction: HIV replication and the suboptimal use of antiretrovirals are directly related to the appearance of resistant mutations. The objective of this study was to describe the resistance mutations (RMs) present in HIV infected patients who experienced antiretroviral treatment failure between 2002 and 2015 in Cali, Colombia. Method: 403 genotypes of adult patients with HIV/AIDS who received ART and experienced virological failure were analyzed. With informed consent, resistance genotype testing was performed using TRUGENE HIV-1; the RMs were defined according to the International AIDS Society-2015 list. The sample was subdivided by periods (2002-2006 vs 2007-2015) and early versus late genotyping. Mutations with ≥15 points to some ARV were considered, according to the Stanford HIV database. Results: comparing the periods, there were more RMs for non-nucleoside reverse transcriptase inhibitors (NNRTIs) in 2007-2015 than in 2002-2006 (85% vs. 60%, respectively, p<0.0001), but protease inhibitors were less affected in 2007-2015 than in 2002-2006 (11% vs. 29%, respectively, p < 0.001). The M184V and K103 N mutations were the most frequent RMs in reverse transcriptase (RT) for NRTIs and NNRTIs, respectively. A total of 67.5% were early genotypes. There was a higher prevalence of certain RMs in late genotypes compared to early ones, mainly for RMs to PIs (D30N, L90M) and NRTIs (M41L, D67N, K70R, L210W); but a lower prevalence of RMs to NNRTIs (Y181C). Conclusion: the late resistance genotypes were associated with higher levels of resistance mutations, mainly to the NNRTI and NRTI families, limiting their use as a rescue therapy alternative. (Acta Med Colomb 2019; 44. DOI:https://doi.org/10.36104/amc.2019.1546).

Resumen Introducción: la replicación del VIH y la utilización subóptima de antirretrovirales, se relacionan directamente con la aparición de mutaciones de resistencias. el objetivo del estudio fue describir las mutaciones de resistencia (mdr) presentes en pacientes infectados por vih que fracasaron a la terapia antirretroviral entre 2002 y 2015 en cali, colombia. Metodología: se analizaron 403 genotipos de pacientes adultos con VIH/SIDA que recibían TAR y experimentaban fracaso virológico. Bajo consentimiento informado, se llevó a cabo la prueba de genotipo de resistências usando TRUGENE HIV-1, se definieron las MDR según el listado de International AIDS Society-2015. Se subdividió la muestra por periodos (2002-2006 vs 2007-2015) y momento de genotipificación temprano versus tardio. Mutaciones con ≥15 puntos a algún ARV fueron consideradas, según la HIV-database de Stanford. Resultados: comparando los periodos, en 2007-2015 hubo mayor afectación de MDR para los inhibidores no nucleosídicos de la transcriptasa reversa (ITINAN) frente a 2002-2006 (85% vs. 60%, respectivamente, p<0.0001), pero menor afectación en 2007-2015 frente a 2002-2006 para inhibidores de la proteasa (11% vs. 29%, respectivamente p < 0.001). Mutaciones M184V y K103N fueron las MDR más frecuentes en la retrotranscriptasa (RT) para ITIAN e ITINAN, respectivamente. El 67.5% fueron genotipos considerados tempranos. Mayor prevalencia de ciertas MDR cuando el genotipo fue tardío frente al temprano, principalmente para MDR a IP (D30N, L90M), ITIAN (M41L, D67N, K70R, L210W), pero menor para MDR a ITINAN (Y181C). Conclusion: los estudios de genotipo de resistencias realizados tardiamente, se asociaron con mayores niveles de mutaciones que confieren resistencias, principalmente a las familias de ITINAN e ITIAN, limitando su uso como alternativa terapéutica de rescate. (Acta Med Colomb 2019; 44. DOI:https://doi.org/10.36104/amc.2019.1546).

[Effectiveness and safety of generic version of lamivudine/tenofovir and efavirenz in treatment naïve HIV-infected patients: a nonrandomized, open-label, phase IV study in Cali-Colombia, 2012-2014]. / Efectividad y seguridad del esquema genérico lamivudina/tenofovir y efavirenz en pacientes con VIH/SIDA naïve: estudio fase IV no aleatorizado, Cali-Colombia 2012-2014.

BACKGROUND: Clinical studies aimed to evaluating the quality of generic drugs may be useful to strengthen policies of access to combined antiretroviral therapy (cART). AIM: To describe the effectiveness and safety of the generic schema lamivudine/tenofovir/efavirenz (3TC/TDF/EFV) in patients with HIV/AIDS naive, belonging to a comprehensive care program. METHODS: A nonrandomized, open-label, phase IV study, during 2012 to 2014 naive HIV-infected patients 18 years or older with indication to receive cART were recruited. Patients were treated with generic scheme 3TC/TDF/EFV and were followed-up during 12 months. Clinical, immunological and laboratory parameters were assessed at baseline, 3, 6 and 12 months of treatment. RESULTS: Of the 40 patients, 30 (75%) met the 12 months of treatment; of them, 80% achieved undetectable viral load (< 40 copies/mL) and 83.3% viral load < 50 copies/mL. Additionally, there was a significant increase (173 cells/mm3) in the median for CD4 T lymphocyte count. Moreover, the results of the whole blood count, creatinine and transaminases were preserved in normal ranges and did not generate changes in the cART. Potential side effects of antiretroviral drugs occurred in less than 10% of patients and had no serious implications. CONCLUSIONS: In this small group of patients, the generic scheme 3TC/TDF/EFV is effective and safe in the treatment of patients with HIV/AIDS naïve, and its effectiveness and safety profile is similar to show by innovator scheme 3TC/TDF/EFV in patients with similar clinical conditions. Registro Estudio: Registro Público Cubano de Ensayos Clínicos (RPCEC) ID: RPCEC00000134. Registered 20 July 2012.

Psychometric properties and validity of the Center for Epidemiological Studies Depression Scale (CES-D) in a population attending an HIV clinic in Cali, Colombia / Propiedades psicométricas y validez de la escala de depresión del Center for Epidemiological Studies (CES-D) en personas atendidas en una clínica de HIV en Cali, Colombia

INTRODUCTION: Depression in people living with HIV/AIDS is associated with poor health outcomes. Despite this, assessment of depressive symptoms is not a routine clinical practice in the care of people with HIV in Colombia. One reason could be the lack of validated depression screening scales for this population. OBJECTIVE: To test the reliability and construct validity of the 20- and 10-item-Center for Epidemiological Studies Depression Scale in patients attending an HIV clinic in Cali, Colombia. MATERIALS AND METHODS: A non-random sample of 105 adults was enrolled. The 20 item-CES-D (CES-D-20) scale was administered twice: At baseline and 2-4 weeks later. We calculated the Cronbach's alpha coefficient and the intraclass correlation coefficient. In addition, we used an exploratory and confirmatory factorial analysis, as well as the item response theory to assess the validity of the scale. RESULTS: Most participants were men (73%), with a mean age of 40 years, 53% of whom had not completed high school. Cronbach's coefficients were 0.92 and 0.94 at baseline and at the second interview, respectively. The intraclass correlation was 0.81 (95% CI: 0.72-0.88). Although all 20 items loaded distinctly in 4 factors, 5 items did not load as expected. The structure factor of the CES-D-20 was not confirmed, as 4 items had poor goodness of fit. The CES-D-10 appeared to perform better in this population. CONCLUSIONS: These results support the reliability and validity of the CES-D-10 instrument to screen for depressive symptoms in people living with HIV in Colombia.

Introducción. La depresión en personas con HIV/sida se asocia con resultados negativos para la salud. La evaluación de los síntomas depresivos no es una práctica clínica rutinaria en el cuidado de personas con HIV/sida en Colombia, lo cual puede deberse a la carencia de escalas validadas para la tamización de la depresión en esta población. Objetivo. Evaluar la reproducibilidad y validez de constructo de dos versiones de la escala de depresión del Center for Epidemiological Studies (CES-D), la de 20 ítems y la de 10 ítems, en personas con HIV/sida atendidas en una clínica de Cali, Colombia. Materiales y métodos. Se seleccionó una muestra no probabilística de 105 adultos con HIV/sida. La escala CES-D se utilizó dos veces (línea basal y 2 a 4 semanas después). La consistencia interna fue evaluada con el coeficiente alfa de Cronbach. La reproducibilidad se evaluó con el coeficiente de correlación intraclase. Para verificar la validez del constructo se utilizó un análisis factorial exploratorio y la teoría de respuesta al ítem. Resultados. El 73 % de la muestra correspondía a hombres, la edad promedio fue de 40 años y el 53 % tenía baja escolaridad. El coeficiente alfa de Cronbach fue de 0,92 (línea basal) y de 0,94 (segunda entrevista). El coeficiente de correlación intraclase fue de 0,81 (IC95% 0,72-0,88). Aunque en cuatro de los factores en la escala de 20 ítems claramente hubo carga factorial, cinco de los ítems no tuvieron un ajuste adecuado. La CES-D de 10 ítems parece funcionar mejor en esta población. Conclusiones. Los resultados respaldaron la reproducibilidad y la validez de la escala CES-D para la tamización de síntomas depresivos en personas con HIV/sida en Colombia.

Psychometric properties and validity of the Center for Epidemiological Studies Depression Scale (CES-D) in a population attending an HIV clinic in Cali,Colombia / Propiedades psicométricas y validez de la escala de depresión del Center for Epidemiological Studies (CES-D) en personas atendidas en una clínica de HIV en Cali, Colombia

Abstract Introduction: Depression in people living with HIV/AIDS is associated with poor health outcomes. Despite this, assessment of depressive symptoms is not a routine clinical practice in the care of people with HIV in Colombia. One reason could be the lack of validated depression screening scales for this population. Objective: To test the reliability and construct validity of the 20- and 10-item-Center for Epidemiological Studies Depression Scale in patients attending an HIV clinic in Cali, Colombia. Materials and methods: A non-random sample of 105 adults was enrolled. The 20 item- CES-D (CES-D-20) scale was administered twice: At baseline and 2-4 weeks later. We calculated the Cronbach's alpha coefficient and the intraclass correlation coefficient. In addition, we used an exploratory and confirmatory factorial analysis, as well as the item response theory to assess the validity of the scale. Results: Most participants were men (73%), with a mean age of 40 years, 53% of whom had not completed high school. Cronbach's coefficients were 0.92 and 0.94 at baseline and at the second interview, respectively. The intraclass correlation was 0.81 (95% CI: 0.72- 0.88). Although all 20 items loaded distinctly in 4 factors, 5 items did not load as expected. The structure factor of the CES-D-20 was not confirmed, as 4 items had poor goodness of fit. The CES-D-10 appeared to perform better in this population. Conclusions: These results support the reliability and validity of the CES-D-10 instrument to screen for depressive symptoms in people living with HIV in Colombia.

Resumen Introducción: La depresión en personas con HIV/sida se asocia con resultados negativos para la salud. La evaluación de los síntomas depresivos no es una práctica clínica rutinaria en el cuidado de personas con HIV/sida en Colombia, lo cual puede deberse a la carencia de escalas validadas para la tamización de la depresión en esta población. Objetivo. Evaluar la reproducibilidad y validez de constructo de dos versiones de la escala de depresión del Center for Epidemiological Studies (CES-D), la de 20 ítems y la de 10 ítems, en personas con HIV/sida atendidas en una clínica de Cali, Colombia. Materiales y métodos. Se seleccionó una muestra no probabilística de 105 adultos con HIV/sida. La escala CES-D se utilizó dos veces (línea basal y 2 a 4 semanas después). La consistencia interna fue evaluada con el coeficiente alfa de Cronbach. La reproducibilidad se evaluó con el coeficiente de correlación intraclase. Para verificar la validez del constructo se utilizó un análisis factorial exploratorio y la teoría de respuesta al ítem. Resultados. El 73 % de la muestra correspondía a hombres, la edad promedio fue de 40 años y el 53 % tenía baja escolaridad. El coeficiente alfa de Cronbach fue de 0,92 (línea basal) y de 0,94 (segunda entrevista). El coeficiente de correlación intraclase fue de 0,81 (IC95% 0,72-0,88). Aunque en cuatro de los factores en la escala de 20 ítems claramente hubo carga factorial, cinco de los ítems no tuvieron un ajuste adecuado. La CES-D de 10 ítems parece funcionar mejor en esta población. Conclusiones. Los resultados respaldaron la reproducibilidad y la validez de la escala CES-D para la tamización de síntomas depresivos en personas con HIV/sida en Colombia.

Efectividad y seguridad del esquema genérico lamivudina/tenofovir y efavirenz en pacientes con VIH/SIDA naïve: estudio fase IV no aleatorizado, Cali-Colombia 2012-2014 / Effectiveness and safety of generic version of lamivudine/tenofovir and efavirenz in treatment naïve HIV-infected patients: a nonrandomized, open-label, phase IV study in Cali-Colombia, 2012-2014

Resumen Antecedentes: Los estudios clínicos orientados a evaluar la calidad de medicamentos genéricos pueden ser útiles para fortalecer políticas de acceso a terapia anti-retroviral combinada (TARc). Objetivo: Describir la efectividad y seguridad del esquema genérico lamivudina/tenofovir/efavirenz (3TC/TDF/EFV) en pacientes con infección por VIH/SIDA naïve, pertenecientes a un programa de atención integral. Materiales/Métodos: Estudio clínico prospectivo fase IV abierto y sin grupo control. Entre 2012-2014, se incluyeron y siguieron 40 pacientes con infección por VIH/SIDA naïve y con indicación para iniciar tratamiento. Los pacientes fueron tratados con el esquema genérico 3TC/TDF/EFV y fueron seguidos durante 12 meses. El seguimiento incluyó valoración clínica, parámetros inmunovirológicos y de laboratorio, al inicio del tratamiento y a los 3, 6 y 12 meses. Resultados: De los 40 pacientes, 30 (75%) cumplieron los doce meses de tratamiento; de ellos, 80% alcanzó CV indetectable (< 40 copias/mL) y 83,3% CV < 50 copias/mL. Adicionalmente, en el grupo hubo un incremento en la mediana de 173 linfocitos TCD4/mm3. Por su parte, los resultados del hemograma completo, creatininemia y transaminasas hepáticas se conservaron en rangos normales y no generaron cambios del TARc. Los efectos adversos reconocidos para estos medicamentos se presentaron en menos de 10% de los pacientes y no tuvieron implicaciones graves. Conclusiones: En este grupo pequeño de pacientes, el esquema genérico 3TC/TDF/EFV es efectivo y seguro en el tratamiento de pacientes con infección por VIH/SIDA naïve, y su perfil de efectividad y seguridad es similar al del esquema 3TC/TDF/EFV innovador en pacientes con condiciones clínicas similares.

Background: Clinical studies aimed to evaluating the quality of generic drugs may be useful to strengthen policies of access to combined antiretroviral therapy (cART). Aim: To describe the effectiveness and safety of the generic schema lamivudine/tenofovir/efavirenz (3TC/TDF/EFV) in patients with HIV/AIDS naive, belonging to a comprehensive care program. Methods: A nonrandomized, open-label, phase IV study, during 2012 to 2014 naive HIV-infected patients 18 years or older with indication to receive cART were recruited. Patients were treated with generic scheme 3TC/TDF/EFV and were followed-up during 12 months. Clinical, immunological and laboratory parameters were assessed at baseline, 3, 6 and 12 months of treatment. Results: Of the 40 patients, 30 (75%) met the 12 months of treatment; of them, 80% achieved undetectable viral load (< 40 copies/mL) and 83.3% viral load < 50 copies/mL. Additionally, there was a significant increase (173 cells/mm3) in the median for CD4 T lymphocyte count. Moreover, the results of the whole blood count, creatinine and transaminases were preserved in normal ranges and did not generate changes in the cART. Potential side effects of antiretroviral drugs occurred in less than 10% of patients and had no serious implications. Conclusions: In this small group of patients, the generic scheme 3TC/TDF/EFV is effective and safe in the treatment of patients with HIV/AIDS naïve, and its effectiveness and safety profile is similar to show by innovator scheme 3TC/TDF/EFV in patients with similar clinical conditions. Registro Estudio: Registro Público Cubano de Ensayos Clínicos (RPCEC) ID: RPCEC00000134. Registered 20 July 2012.

Perceptions about sexual risk, HIV and HIV-testing in Cali, Colombia.

INTRODUCTION: In Colombia, 20%-54% of the population with sexual practices at higher risk for HIV infection (men who have sex with men, transgender women, women sex workers) has sometime been tested. OBJECTIVE: To describe perceptions of sexual risk, HIV and HIV testing in people with risky sexual practices and people who identify themselves as heterosexual. METHODS: Between 2012 and 2014, it was carried a descriptive study using HIV screening out in Cali-Colombia with the voluntary participation of 940 people aged over 18 years. There were used: informed consent, structured questionnaire and HIV testing. Descriptive, bivariate and multivariate Poisson regression models were performed. RESULTS: Average age 28.5 ±10.9 years; 50% men. 357 (38%) were people from the traditional risk group for HIV infection; and 583 (62%) corresponded to the non-traditional risk group (heterosexual men and women). Likewise, 62% and 41% respectively had HIV test. 51% to 53% reported having sex when they consumed liquor; commercial sex was higher in the group with risky sexual practices (32% vs 3%), as well as anal relations (77% vs 23%), consistent use of condom (32% vs 9%), and HIV positive test (14.3% vs 1.6%). The multivariate analysis showed for both groups that having HIV test was associated with being older than 25 years and a history of sexually transmitted infection. CONCLUSIONS: Differentiated education strategies are needed based on risky sexual behaviors and that consider the importance of regular HIV tests for early diagnosis and timely enrollment in care and treatment.

INTRODUCCIÓN: En Colombia, 20%-54% de la población con prácticas sexuales de mayor riesgo para infección por VIH (Hombres que tienen sexo con hombres, mujeres transgénero, mujeres trabajadoras sexuales) se ha hecho la prueba alguna vez. OBJETIVO: Describir las percepciones sobre riesgo sexual, VIH y prueba del VIH, en personas con prácticas sexuales de riesgo y personas que se identifican heterosexuales. MÉTODOS: Entre 2012 y 2014 se hizo en Cali-Colombia un estudio descriptivo mediante tamizaje para VIH con participación voluntaria de 940 personas mayores de 18 años. Fueron utilizados: consentimiento informado, cuestionario estructurado y prueba VIH. Se realizaron análisis descriptivos, bivariado y modelo de regresión multivariada Poisson. RESULTADOS: Edad promedio 28.5 ±10.9 años, 50% hombres. 357(38%) eran personas de grupos tradicionales de riesgo para infección VIH y 583(62%) correspondían a grupo no tradicional de riesgo (hombres y mujeres heterosexuales). Así mismo, 62% y 41% respectivamente, tenían prueba de VIH. Reportaron tener relaciones sexuales cuando consumieron licor 51% a 53%; sexo comercial fue mayor en grupo con prácticas sexuales de riesgo (32% vs 3%), igual que relaciones anales (77% vs 23%), uso consistente de condón (32% vs 9%) y prueba VIH positiva (14.3% vs 1.6%). El análisis multivariado mostro para ambos grupos, que tener prueba de VIH se asoció con ser mayor de 25 años y antecedente de infección de transmisión sexual. CONCLUSIONES: Se necesitan estrategias de educación diferenciadas según comportamientos sexuales de riesgo y que consideren la importancia de las pruebas regulares del VIH para el diagnóstico temprano e inscripción oportuna en la atención y tratamiento.

Características de personas que retornan voluntariamente a repetirse la prueba de VIH, 2012-2015 / Characteristics of people who voluntarily repeat the HIV test, 2012-2015

RESUMEN Objetivo Comparar características de personas con prácticas sexuales de riesgo que acudieron a campañas voluntarias de toma de una primera prueba de Virus de la Inmunodeficiencia Humana (VIH) y el retorno voluntario a repetirse la prueba en meses posteriores. Método Entre 2012 y 2015 en Cali, participaron voluntariamente 82 personas mayores de 18 años. Se implementó un cuestionario estructurado para evaluar características sociodemográficas, conocimientos y comportamientos relacionados con VIH. Se hicieron análisis descriptivos y de comparación de muestras relacionadas. Resultados Edad promedio de participantes 26,9±8,6 años. El 100% eran hombres con orientación sexual homosexual. La mayoría con baja escolaridad e ingresos. Cerca de la mitad reportó consumo riesgoso de alcohol y sustancias psicoactivas. La mayoría tenía bajo conocimiento sobre la transmisión del VIH y bajo uso de condón con pareja estable. La comparación entre el momento de la primera prueba de VIH y la repetición posterior no evidenció cambios significativos en conocimientos y comportamientos, únicamente se observó menor reporte del consumo de sustancias (p=0,0209) y aumento de realización de tatuajes/piercing (p=0,0455). Resultado reactivo en la repetición de la prueba fue 4,9% (I.C95% 0,1%-9,6%). Conclusión Los resultados sugieren que el retorno voluntario a repetirse la prueba del VIH en este grupo de personas que comparten prácticas de riesgo para la infección por VIH no evidencia cambios en los conocimientos o comportamientos.(AU)

ABSTRACT Objective To compare the characteristics of people with risky sexual behavior who participated in campaigns directed to take the first HIV test and voluntarily returned to retake the test afterwards. Materials and Methods In Cali Colombia, between 2012 and 2015, 82 people over the age of 18 participated voluntarily in this campaign. A structured questionnaire was applied to assess sociodemographic characteristics, knowledge and behaviors related to HIV. Descriptive and comparative analyses of related samples were performed. Results The average age of the participants was 26.9±8.6 years. 100% were homosexual men, mostly with low educational attainment and income. Nearly half of the sample reported risky use of alcohol and psychoactive substances. Most of them had little knowledge about HIV transmission and a low rate of condom use with a stable partner. The comparison between the moment when the first HIV test was taken and the repetition did not show significant changes regarding knowledge and behaviors, only a lower report of substance use (p=0.0209) and an increase in the practice of tattoos/piercings (p=0.0455). The reactive result of the second test was 4.9% (95%CI: 0.1%-9.6%). Conclusion The results suggest that the voluntary return to retake the HIV test in this group of people who share risk practices for HIV infection does not show changes in knowledge or behavior.(AU)

Perceptions about sexual risk, HIV and HIV-testing in Cali, Colombia / Percepciones sobre riesgo sexual, VIH y prueba del VIH en Cali, Colombia

Abstract Introduction: In Colombia, 20%-54% of the population with sexual practices at higher risk for HIV infection (men who have sex with men, transgender women, women sex workers) has sometime been tested. Objective: To describe perceptions of sexual risk, HIV and HIV testing in people with risky sexual practices and people who identify themselves as heterosexual. Methods: Between 2012 and 2014, it was carried a descriptive study using HIV screening out in Cali-Colombia with the voluntary participation of 940 people aged over 18 years. There were used: informed consent, structured questionnaire and HIV testing. Descriptive, bivariate and multivariate Poisson regression models were performed. Results: Average age 28.5 ±10.9 years; 50% men. 357 (38%) were people from the traditional risk group for HIV infection; and 583 (62%) corresponded to the non-traditional risk group (heterosexual men and women). Likewise, 62% and 41% respectively had HIV test. 51% to 53% reported having sex when they consumed liquor; commercial sex was higher in the group with risky sexual practices (32% vs 3%), as well as anal relations (77% vs 23%), consistent use of condom (32% vs 9%), and HIV positive test (14.3% vs 1.6%). The multivariate analysis showed for both groups that having HIV test was associated with being older than 25 years and a history of sexually transmitted infection. Conclusions: Differentiated education strategies are needed based on risky sexual behaviors and that consider the importance of regular HIV tests for early diagnosis and timely enrollment in care and treatment.

Resumen Introducción: En Colombia, 20%-54% de la población con prácticas sexuales de mayor riesgo para infección por VIH (Hombres que tienen sexo con hombres, mujeres transgénero, mujeres trabajadoras sexuales) se ha hecho la prueba alguna vez. Objetivo: Describir las percepciones sobre riesgo sexual, VIH y prueba del VIH, en personas con prácticas sexuales de riesgo y personas que se identifican heterosexuales. Métodos: Entre 2012 y 2014 se hizo en Cali-Colombia un estudio descriptivo mediante tamizaje para VIH con participación voluntaria de 940 personas mayores de 18 años. Fueron utilizados: consentimiento informado, cuestionario estructurado y prueba VIH. Se realizaron análisis descriptivos, bivariado y modelo de regresión multivariada Poisson. Resultados: Edad promedio 28.5 ±10.9 años, 50% hombres. 357(38%) eran personas de grupos tradicionales de riesgo para infección VIH y 583(62%) correspondían a grupo no tradicional de riesgo (hombres y mujeres heterosexuales). Así mismo, 62% y 41% respectivamente, tenían prueba de VIH. Reportaron tener relaciones sexuales cuando consumieron licor 51% a 53%; sexo comercial fue mayor en grupo con prácticas sexuales de riesgo (32% vs 3%), igual que relaciones anales (77% vs 23%), uso consistente de condón (32% vs 9%) y prueba VIH positiva (14.3% vs 1.6%). El análisis multivariado mostro para ambos grupos, que tener prueba de VIH se asoció con ser mayor de 25 años y antecedente de infección de transmisión sexual. Conclusiones: Se necesitan estrategias de educación diferenciadas según comportamientos sexuales de riesgo y que consideren la importancia de las pruebas regulares del VIH para el diagnóstico temprano e inscripción oportuna en la atención y tratamiento.

Resistencias transmitidas del VIH-1 en pacientes sin exposición previa a terapia antirretroviral (Naïve) Cali-Colombia 2008-2015 / Transmitted HIV-1 resistance in never exposed to antiretroviral therapy patients, Cali-Colombia 2008-2015

Objetivo: Determinar la frecuencia de resistencias transmitidas en pacientes VIH no expuestos a terapia antirretroviral. Metodología: Estudio transversal, entre 2008 y 2015 participaron 342 pacientes mayores de 18 años, con infección VIH-1, sin exposición a antirretrovirales, con genotipo de resistencias previo al inicio con antirretrovirales y consentimiento informado. Se incluyeron mutaciones de resistencias definidas por Organización Mundial de Salud (OMS)-2009 e internacional AIDS Society-USA 2015. Se recolectaron características sociodemográficas y clínicas relacionadas con VIH. Resultados: Edad promedio 32±10,5 años; 74% hombres. Al genotipo, mediana de carga viral 26.802 copias/mL, y 343 células T-CD4/mm3 . Según lista de Organización Mundial de Salud-2009 la frecuencia de mutaciones fue 3.2% y considerando mutaciones de internacional AIDS Society y base de datos VIH-Stanford, esta fue 7.9%. Mutaciones más comunes: K103N/S (2.1%), Q58E (2%), V108I y E138A (1.2%). Mutaciones en transcriptasa reversa 4.4% para inhibidores no nucleosídicos y 1.2% para nucleosídicos; para inhibidores de proteasa 2.3%. En pacientes con probable infección retroviral <1 año, la prevalencia de resistencias transmitidas, según la lista de OMS-2009, fue 7.3%, mientras que, con infección ≥1 año fue 1.6% (p=0.008). Conclusión: En pacientes con probable infección <1 año, la frecuencia de mutaciones transmitidas superó el umbral recomendado por la Organización Mundial de Salud para implementar genotipo de resistencias.

Introduction: This study determined the frequency of transmitted drug resistance in patients not exposed to ART, attended in Cali-Colombia. Methodology: A cross-sectional study between 2008 and 2015 involved 342 patients older than 18 years, with confirmed HIV infection, without exposure to antiretrovirals, with resistance genotype prior to initiation of antiretroviral and informed consent. Resistance mutations defined by WHO-2009 and international AIDS Society-USA 2015 were included. Sociodemographic and clinical characteristics related to HIV were also collected. Results: The mean age was 32 ± 10.5 years; 74% were men. At the time of genotype, median viral load was 26,802 copies / mL, and 343 T-CD4 / mm3 cells. According to the WHO-2009 list, the frequency of mutations was 3.2% and considering the AIDS Society-USA list and the Stanford HIV database mutations, this reached 7.9%. The most common mutations were K103N/S (2.1%), Q58E (2%), V108I and E138A (1.2%). Reverse transcriptase mutations were found in 4.4% for non-nucleoside inhibitors and 1.2% for nucleoside; for protease inhibitors were 2.3%. In patients with retroviral infection <1 year, the transmitted resistances prevalence, using only the WHO-2009 list, reach 7.3%, while in those with ≥1 year only was 1.6% (p=0.008). Conclusions: The frequency of transmitted mutations in naïve patients with retroviral infection <1 year exceeded the prevalence threshold recommended by the WHO to implement the resistance genotype.

[Characteristics of people who voluntarily repeat the HIV test, 2012-2015]. / Características de personas que retornan voluntariamente a repetirse la prueba de VIH, 2012-2015.

OBJECTIVE: To compare the characteristics of people with risky sexual behavior who participated in campaigns directed to take the first HIV test and voluntarily returned to retake the test afterwards. MATERIALS AND METHODS: In Cali Colombia, between 2012 and 2015, 82 people over the age of 18 participated voluntarily in this campaign. A structured questionnaire was applied to assess sociodemographic characteristics, knowledge and behaviors related to HIV. Descriptive and comparative analyses of related samples were performed. RESULTS: The average age of the participants was 26.9±8.6 years. 100% were homosexual men, mostly with low educational attainment and income. Nearly half of the sample reported risky use of alcohol and psychoactive substances. Most of them had little knowledge about HIV transmission and a low rate of condom use with a stable partner. The comparison between the moment when the first HIV test was taken and the repetition did not show significant changes regarding knowledge and behaviors, only a lower report of substance use (p=0.0209) and an increase in the practice of tattoos/piercings (p=0.0455). The reactive result of the second test was 4.9% (95%CI: 0.1%-9.6%). CONCLUSION: The results suggest that the voluntary return to retake the HIV test in this group of people who share risk practices for HIV infection does not show changes in knowledge or behavior.

OBJETIVO: Comparar características de personas con prácticas sexuales de riesgo que acudieron a campañas voluntarias de toma de una primera prueba de Virus de la Inmunodeficiencia Humana (VIH) y el retorno voluntario a repetirse la prueba en meses posteriores. MÉTODO: Entre 2012 y 2015 en Cali, participaron voluntariamente 82 personas mayores de 18 años. Se implementó un cuestionario estructurado para evaluar características sociodemográficas, conocimientos y comportamientos relacionados con VIH. Se hicieron análisis descriptivos y de comparación de muestras relacionadas. RESULTADOS: Edad promedio de participantes 26,9±8,6 años. El 100% eran hombres con orientación sexual homosexual. La mayoría con baja escolaridad e ingresos. Cerca de la mitad reportó consumo riesgoso de alcohol y sustancias psicoactivas. La mayoría tenía bajo conocimiento sobre la transmisión del VIH y bajo uso de condón con pareja estable. La comparación entre el momento de la primera prueba de VIH y la repetición posterior no evidenció cambios significativos en conocimientos y comportamientos, únicamente se observó menor reporte del consumo de sustancias (p=0,0209) y aumento de realización de tatuajes/piercing (p=0,0455). Resultado reactivo en la repetición de la prueba fue 4,9% (I.C95% 0,1%-9,6%). CONCLUSIÓN: Los resultados sugieren que el retorno voluntario a repetirse la prueba del VIH en este grupo de personas que comparten prácticas de riesgo para la infección por VIH no evidencia cambios en los conocimientos o comportamientos.

Características relacionadas en hombres que tienen sexo con hombres (HSH) con diagnóstico positivo de VIH en Cali-Colombia, 2012-2015 / Related Characteristics in men who have sex with men (MSM) that have an HIV+ Diagnostic in Cali Colombia, 2012-2015 / Características relacionadas em homens que fazem sexo com homens (HSH) com diagnose positivo de VIH em Cali-Colômbia, 2012-2015

Resumen En Colombia la toma voluntaria de pruebas para VIH en poblaciones de mayor riesgo oscila entre 20% y 50%. El conocimiento de características en personas recién diagnosticadas podría direccionar estrategias para tamizaje y educación. Objetivo: determinar la frecuencia de VIH+ y su relación con factores sociodemográficos, conocimientos y comportamientos en hombres que tienen sexo con hombres (HSH). Metodología: entre 2012 y 2015 se hizo en Cali-Colombia un estudio descriptivo mediante tamizaje para VIH con participación voluntaria de 503 HSH mayores de 18 años. Previo consentimiento informado se usó cuestionario estructurado y prueba rápida para VIH. Se hicieron análisis descriptivos, de comparación de grupos según diagnóstico de VIH y regresión logística multivariada. Resultados: edad promedio 27,3±8,9 años. El 63% tuvo prueba previa de VIH; frecuencia de VIH+ 13,9% I.C95%(10,9%-17%). Se observó mayor frecuencia de diagnóstico VIH+ en >25 años (OR=3,1; IC95%[1,5-6,6]), con escolaridad media (OR=2,8; IC95%[1,3-6.0]), consumo de sustancias psicoactivas (OR=2,0; IC95%[1,0-4,1]), tatuajes/piercing (OR=2,4; IC95%[1,1-5]), antecedente de infecciones de transmisión sexual (ITS) (OR=2,6; IC95%[1,3-5,4]) y en quienes se creían en riesgo (OR=3,2; IC95%[1,5-6,9]). Conclusión: los resultados sugieren características que pueden direccionar la búsqueda de VIH en personas con factores de riesgo adicionales a su vulnerabilidad por prácticas sexuales.

Abstract In Colombia, voluntary HIV testing in high-risk populations ranges from 20% to 50%. Knowing the characteristics of people who have recently been diagnosed could direct screening and education strategies. Objective: to determine the hiv+ frequency and its relation with social demographic factors, knowledge, and behavior in men who have sex with men (msm). Methodology: From 2012 to 2015, a descriptive study was conducted in Cali Colombia using HIV screening with the participation of 503 MSM over 18 years of age. Prior informed consent, we used a structured questionnaire and a quick HIV test. The study conducted descriptive analyses comparing groups depending on their HIV diagnosis and used multivariate logistic regression. Results: Average age 27.3±8.9 years old. Sixty/three percent had been previously tested for HIV; HIV positive frequency was 13.9%, 95% CI (10.9%-17.0%). There was a higher frequency of HIV positive diagnostic in people >25 (OR=3.1; 95% CI ); with mid-school education (OR=2.8, 95% CI ); use of psychoactive substances (OR=2.0; CI 95%); tattoos/piercings (OR=2.4; , 95% CI ); history of STIs (OR=2.6; , 95% CI ); and those who believed they were at risk (OR=3.2; , 95% CI ). Conclusions: The results of the study suggest characteristics that could lead an HIV search in people who have risk factors in addition to their vulnerability because of their sexual practices.

Resumo Na Colômbia a toma voluntária de provas para VIH em populações de major risco varía entre 20% e 50%. O conhecimento de características em pessoas recém diagnosticadas poderia direcionar estratégias para tamisado e educação. Objetivo: determiar a frequência de vih+ e a sua relação com fatores sócio demográficos, conhecimentos e comportamentos em homens que praticam sexo com outros homens (hsh). Metodologia: Entre 2012 e 2015 se realizou em Cali-Colômbia um estudo descritivo mediante tamisado para VIH com participação voluntaria de 503 HSH majores de 18 anos. Prévio consentimento informado se usou questionário estruturado e prova rápida para VIH. Se fizeram análises descritivos, de comparação de grupos segundo diagnose de VIH e regressão logística multivariada. Resultados: Idade termo médio 27.3±8.9 anos. O 63% teve prova prévia de VIH; frequência de VIH+ 13.9% I.C95%(10.9%-17.0%). Se observou major frequência de diagnose VIH+ em >25 anos (OR=3.1; IC95%), com escolaridade media (OR=2.8; IC95%), consumo de sustâncias psicoativas (OR=2.0; IC95%), tatuagens/piercing (OR=2.4; IC95%), antecedente de infecções de transmissão sexual (ITS) (OR=2.6; IC95%) e daqueles que se creiam em risco (OR=3.2; IC95%). Conclusão: Os resultados sugerem características que podem direcionar a busca de VIH em pessoas com fatores de risco adicionais a sua vulnerabilidade por práticas sexuais.

Effectiveness and safety of generic version of abacavir/lamivudine and efavirenz in treatment naïve HIV-infected patients: a nonrandomized, open-label, phase IV study in Cali-Colombia, 2011-2012.

BACKGROUND: Generic drug policies are often associated with concerns about the quality and effectiveness of these products. Phase IV clinical trials may be a suitable design to assess the effectiveness and safety of generic drugs. The objective of this study was to describe the effectiveness and the safety of the generic abacavir/lamivudine and efavirenz in treatment-naïve HIV-infected patients. METHODS: A monocentric, nonrandomized, open-label, phase IV study in treatment naïve HIV-infected patients 18 years or older with indication to receive abacavir/lamivudine and efavirenz were recruited from a program that provides comprehensive outpatient consultation and continuing care. The primary end-point was to achieve viral load <40 copies/mL at 12 months after baseline to assess effectiveness. Secondary end-point of the study were 1) to asses increasing in T-CD4 lymphocytes levels as accompaniment to asses effectiveness, and 2) to assess both gastrointestinal, skin, and central nervous system symptoms, and lipid profile, cardiovascular risk, renal, and hepatic function as safety profile. Data were determined at baseline, 3, 6, and 12 months. Close clinical monitoring and pharmaceutical care were used for data collection. Wilcoxon matched-pairs signed-rank test was used to compare proportions or medians. RESULTS: Sixty patients were invited to participate in the study; 42 were enrolled and 33 completed the follow-up. Of the nine patients excluded from the study, only one was withdrawn due to adverse events. At 12 months, 31 of 42 patients (73.8 % in intention-to-treat analysis) achieved a viral load of HIV1 RNA <40 copies/mL. There was a significant increase (172 cells/mm3) in the median for CD4 T lymphocyte count. The adverse events were mild and met the safety profile for this antiretroviral regimen, mainly of central nervous system symptoms, skin rash, lipid abnormalities, and an increase of 2 % in the median of the percentage of cardiovascular risk. CONCLUSIONS: The clinical outcomes of generic version of abacavir/lamivudine and efavirenz in HIV treatment naïve patients showed the expected safety and effectiveness profile of proprietary ARV drugs. TRIAL REGISTRATION: Registro Público Cubano de Ensayos Clínicos (RPCEC) ID: RPCEC00000202 . Registered 19 November 2015.

Conocimientos, actitudes y prácticas frente a la alimentación de personas con VIH/SIDA y su relación con síndrome metabólico, Cali-Colombia / Knowledge, attitudes and practices towards nutrition among persons living with HIV/AIDS and their relation with metabolic syndrome. Cali-Colombia

Antecedentes: las tasas de morbilidad y mortalidad entre pacientes VIH+ han disminuido notablemente con la terapia antirretroviral, paradójicamente los problemas nutricionales que enfrentan las personas VIH+ se han multiplicado. Objetivo: determinar conocimientos, actitudes y prácticas sobre la alimentación y su relación con la presencia de síndrome metabólico en pacientes VIH/ SIDA bajo tratamiento antirretroviral. Materiales y métodos: estudio transversal. Se entrevistaron, previo consentimiento informado, 102 pacientes VIH/SIDA mayores de 18 años de una clínica especializada en VIH/SIDA en Cali-Colombia. Se utilizó un cuestionario estructurado para características socio-demográficas y clínicas relacionadas con VIH/SIDA, así como para evaluación conocimientos, actitudes y prácticas de nutrición y medición de marcadores de síndrome metabólico. Se llevó a cabo análisis descriptivo y multivariado. Resultados: adecuado nivel de conocimientos relacionados con nutrición 3,9%; prácticas saludables adecuadas frente a nutrición 2,0% y actitud favorable hacia la alimentación saludable 46,1%. El 36% presentó síndrome metabólico (principalmente colesterol HDL bajo 67,6% y triglicéridos alterados 59,8%). Tener síndrome metabólico se relacionó con algunas características de conocimientos (p<0,021) y actitudes (p=0,006), así como con un IMC≥25 (p=0,001) y contener más de tres años de tratamiento antirretroviral (p=0,003). Conclusiones: es necesario fortalecer estrategias amigables que mejoren conocimientos y comportamientos hacia la nutrición en esta población, sin afectar el control del VIH/SIDA.

Background: Morbidity and mortality among HIV+ patients have decreased significantly with antiretroviral therapy; paradoxically, nutritional problems in HIV+ people have multiplied. Aim: To determine knowledge, attitudes and practices towards nutrition, and its relation with the prevalence of metabolic syndrome among HIV+ patients receiving antiretroviral treatment. Methods: cross-sectional study, 102 HIV+ patients were interviewed, prior informed consent. Participants were over 18 year's old, and receiving comprehensive care in an HIV outpatient clinic in Cali-Colombia. A structured questionnaire was administered, which included questions about socio-demographic and clinical characteristics related to HIV/AIDS, and knowledge, attitudes and practices related to nutrition, physical activity and cardiac health. The levels of markers of metabolic syndrome were evaluated. Descriptive and multivariate analysis was performed. Results: Inadequate level of knowledge (in 3,9%) and healthy practices towards nutrition (in 2,0%) were identified, although most of the participants reported favorable attitudes regarding healthy eating habits (46,1%). 35,9% were diagnosed with metabolic syndrome (mainly related to low HDL cholesterol in 67,6% or triglycerides altered in 59,8%). The knowledge (p<0,021), attitudes (p=0,006), as well as aBMI≥25 (p=0,001) and Antiretroviral therapy for more than 3 years (p=0,003), yielded significant associations with metabolic syndrome. Conclusions: Friendly Strategies need to be strengthened to improve knowledge and behaviors toward nutrition in this population, without affecting the control of HIV/AIDS.

HIV Testing and Counselling in Colombia: Local Experience on Two Different Recruitment Strategies to Better Reach Low Socioeconomic Status Communities.

HIV testing rates remain very low in Colombia, with only 20% of individuals at risk ever tested. In order to tackle this issue, the Corporacion de Lucha Contra el Sida (CLS) has implemented a multidisciplinary, provider-initiated, population-based HIV testing/counselling strategy named BAFI. In this report, we describe the experience of CLS at reaching populations from low socioeconomic backgrounds in 2008-2009. Two different approaches were used: one led by CLS and local health care providers (BAFI-1) and the other by CLS and community leaders (BAFI-2). Both approaches included the following: consented HIV screening test, a demographic questionnaire, self-reported HIV knowledge and behaviour questionnaires, pre- and posttest counselling, confirmatory HIV tests, clinical follow-up, access to comprehensive care and antiretroviral treatment. A total of 2085 individuals were enrolled in BAFI-1 and 363 in BAFI-2. The effectiveness indicators for BAFI-1 and BAFI-2, respectively, were HIV positive-confirmed prevalence = 0.29% and 3.86%, return rate for confirmatory results = 62.5% and 93.7%, return rate for comprehensive care = 83.3% and 92.8%, and ART initiation rate = 20% and 76.9%. Although more people were reached with BAFI-1, the community-led BAFI-2 was more effective at reaching individuals with a higher prevalence of behavioural risk factors for HIV infection.

Resistencia a fármacos en pacientes en tratamiento antirretroviral, Cali, Colombia, 2008-2010 / HIV drug resistance in ART-experienced patients in Cali, Colombia, 2008-2010

Introducción. En Colombia se ha publicado poco sobre farmacorresistencia del VIH en pacientes que reciben tratamiento antirretroviral. Las guías de VIH de Colombia de 2006, no recomiendan el uso de los estudios de genotipo de resistencia en pacientes nunca expuestos a medicamentos antirretrovirales ni después del primer fracaso terapéutico. Objetivo. Determinar la frecuencia de mutaciones de resistencia y el grado de sensibilidad/resistencia del VIH a los antirretrovirales en pacientes que han recibido tratamiento antirretroviral. Materiales y métodos. Se reclutó una muestra no probabilística de 170 pacientes con infección por VIH que recibían tratamiento antirretroviral, experimentaban fracaso virológico y que tenían estudios de genotipo de resistencia. Se estudió la farmacorresistencia del VIH en dos grupos: estudios de genotipo de resistencia tempranos Vs . tardíos. Resultados. El tipo de resistencia más frecuente en pacientes bajo tratamiento antirretroviral, afectó a los inhibidores no nucleosídicos (76 %). El grupo de estudio tardío tuvo mayor riesgo de resistencia a inhibidores nucleosídicos y a los inhibidores de proteasa, mayor número de mutaciones de resistencia y mayor complejidad de las resistencias, que el grupo de estudio temprano. También, se encontró un alto grado (30 %) de resistencia cruzada a los inhibidores nucleosídicos en el grupo de estudio tardío. Los medicamentos menos afectados fueron tenofovir y darunavir. Conclusiones. Los resultados de este estudio sugieren que practicar estudios de genotipo de resistencia tardíos se asocia con altos niveles de resistencia, lo cual puede restringir el uso de un gran número de antirretrovirales esenciales en esquemas subsiguientes. Es necesario revisar las actuales recomendaciones sobre el uso de dichos exámenes en las guías colombianas de manejo de VIH.

Introduction: Little has been published in Colombia on HIV drug resistance in patients taking antiretroviral treatment (ART). Currently, the Colombian guidelines do not recommend the use of genotypic antiretroviral resistance tests (GART) for treatment-naive patients or for those experiencing a first therapeutic failure. Objective: To determine the frequency of relevant resistance mutations and the degree of susceptibility/ resistance of HIV to antiretroviral drugs (ARVs) in ART-experienced patients. Materials and methods: A non-random sample of 170 ART-experienced HIV patients with virologic failure and who underwent GART was recruited. A study of HIV drug resistance was carried out in two groups of patients: one group that underwent early GART and the other group that received late GART testing. Results: The most frequent type of resistance affected the non-nucleoside class (76%). The late-GART group had higher risk of nucleoside analog and protease inhibitor drug resistance, a higher number of resistance mutations and more complex mutational profiles than the early-GART group. A high cross resistance level (30%) was found in the nucleoside analog class. The least affected medications were tenofovir and darunavir. Conclusions: Our results suggest that performing GART late is associated with levels of ARV resistance that could restrict the use of an important number of essential ARV in subsequent regimens. There is a need to revise the current recommendations to include GART prior to start of treatment and after the first virologic failure.