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)