AIDS situation in SpainS. Benet Garrabé1, G. Verdejo Muñoz2, L.J. Garcia-Fraile Fraile3, A.C....
Transcript of AIDS situation in SpainS. Benet Garrabé1, G. Verdejo Muñoz2, L.J. Garcia-Fraile Fraile3, A.C....
S. Benet Garrabé1, G. Verdejo Muñoz2, L.J. Garcia-Fraile Fraile3, A.C. Silva Klug4
1Hospital Universitari Germans Trias i Pujol, Badalona 2Hospital Clínico Lozano Blesa, Zaragoza 3Hospital U La Princesa, Madrid 4Hospital Universitari de Bellvitge, Barcelona
HIV/AIDS SITUATION IN SPAIN
THE HIV/AIDS EPIDEMIC IN SPAIN DELAY ON HIV DIAGNOSIS
NEW HIV INFECTIONS IN SPAIN (2015)
10 new cases per day3.428 new HIV diagnosis in 2015497 new AIDS diagnosis in 2015140.700 people living with HIV
85.720 total AIDS diagnosis
85,9%14,1%
36 years old
GENDER HIV TRANSMISSION
ORIGIN
53,6% 0%25,4% 2,8%
MSM Mother-to-childHeterosexualInjectiondrug use
Spain Other countries
69,7% 30,3%
46,5%
<200 CD427,1%
200-349 CD419,4%
<350 CD4
Sevilla
Mardrid
Barcelona BCN Checkpoint
Adhara
Apoyo Positivo
Community centers for early diagnosis of STD
54,5% ofwomen
45,3% ofmen
38,4%of
54,4%of
60% of
MSM HeterosexualInjection
drug users
< < <
Heterosexual
63,1%of
New HIV/AIDS diagnosis in Spain according to gender, age, mechanism of HIV transmission and origin.
Despite MSM represent the higher volume of new HIV infections, they have a lower delayed HIV diagnosis ratio. In Spain, there are three community centers that together with healthcare centers promote early diagnosis of STD on MSM.
CHANGES IN THE NATURAL HISTORY OF HIV
In 2015, 46,5% of new HIV infected people presented a delayed HIV diagnosis.
THE HIV TREATMENT CASCADE CLINICAL MANAGEMENT
100%
82%
76%
81%
People living with HIV
HIV diagnosed
On cART
Virally supressed 50%
An estimated 50% people living with HIV in Spain are virally supressed.
Aging
Antiretroviral drug toxicity
CoinfectionHCV, HPV, syphilis
Drug-druginteractions
Comorbiditiescardiovascular, bone, kidney,
neurocognitive, neoplasia
Early detection of anal cancer
Anoscopy,anal-rectal
cytology
Multidisciplinaryattention
AIDS RELATED DISEASES
0 10 20 30
Extrapulmonary cryptococcosis
HIV-related encephalopathy
Bacterial pneumonia
Progressive multifocal leukoencephalopathyCytomegalovirus
Cerebral toxoplasmosis
No hodgkin lymphoma
wasting syndrome
Kaposi's sarcoma
Esophageal candidiasis
Tuberculosis
P. jirovecii pneumonia
%
HIV/HCV COINFECTIONMORTALITY CAUSES IN HIV INFECTED INDIVIDUALS
A multidisciplinary attention is offered to HIV infected patients, with special care to other STD and anal cancer detection.
P. jirovecii pneumonia is the most frequent AIDS related disease (27%), followed by tu-berculosis (21,4%) and esophageal candi-diasis (13,2%).
2000
2005
2010
2015
0
3
6
9
12
Rat
e pe
r 100
.000
pop
ulat
ion
Gonorrhea
Syphilis
TRENDS IN SEXUALLY TRANSMITTED DISEASES
The incidence of gonorrhea and syphilis in the HIV population has in-creased 4-fold over the last 10 years.
The incidence of HIV/HCV coinfection has dropped significantly due to the appearance of new antiviral drugs and the reduction of injection drug users.
4X
497
7494
New HIV/AIDS cases
201519951981
Number of HIV/AIDS deaths
5857
201519951981
633
1,4/100.000 inhabitants513 120
HAART
Since 1997, with the begining of HAART there was a marked decline in the number of new HIV/AIDS diagnosis and the number of HIV/AIDS related deaths.
TDF/FTC + RAL or TAF/FTC + RAL
TDF/FTC + DTG or TAF/FTC + DTG
ABC/3TC + DTG
TAF/FTC + EVG/COBI
TDF/FTC + RPVTDF/FTC + DRV/r
TDF/FTC + EVG/COBI
Preferred combinationsAlternatives
The rate of new HIV diagnosis decreases over time among drug injection users and heterosexual trans-mission, but remains stable for MSM until 2014.
EVOLUTION OF NEW HIV DIAGNOSISACCORDING TO THE MECHANISM OF TRANSMISSION
2009
2011
2013
2015
0
500
1000
1500
2000
Num
ber o
f cas
es
Drug injection users
Heterosexual
MSM
Overall, AIDS associated diseases, non-AIDS-defining malingnancies and liver disease are the main causes of mortality in HIV infected individuals. (Alejos B. et al. Medicine (Baltimore); sep 2016).
AIDS associated diseasesNon-AIDS-defining malignanciesLiver diseaseNon-AIDS infectionsCardiovascular diseasesPulmonary diseasesDrug abuseSuicideExternal causesOther
(Vigilancia epidemiológica del VIH y SIDA en España. Ministerio de Sanidad, Asuntos Sociales e Igualdad, Junio 2016)
(Vigilancia epidemiológica del VIH y SIDA en España. Ministerio de Sanidad, Asuntos Sociales e Igualdad, Junio 2016)
(Vigilancia epidemiológica del VIH y SIDA en España. Ministerio de Sanidad, Asuntos Sociales e Igualdad, Junio 2016)
(Gourlay A. et al. CID; June 2017)