Editorial
Is it time to start new HIV prevention strategies in Spain?
¿Es el momento de poner en marcha nuevas estrategias de prevención de la infección por VIH en España?
a Servicio de Enfermedades Infecciosas, Hospital Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
b Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "271" "paginaFinal" => "272" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Antonio Rivero, Santiago Moreno" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Antonio" "apellidos" => "Rivero" "email" => array:1 [ 0 => "ariveror@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Santiago" "apellidos" => "Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Enfermedades Infecciosas, Hospital Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Es el momento de poner en marcha nuevas estrategias de prevención de la infección por VIH en España?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The success of antiretroviral therapy has minimised the clinical complications of HIV infection and, as a result, has contributed to the perception that this disease is under control. However, this perception does not match the reality of the spread of the epidemic. In Spain, HIV infection continues to spread, despite the availability of effective treatments which are accessible to all affected people. Some figures may put this statement into perspective. Currently, the number of people infected with HIV in Spain is estimated at approximately 150,000. This represents a prevalence in the general population of 0.4% (95% CI: 0.4–0.5) and a prevalence of occult infection of 0.1%.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> Furthermore, according to the Spanish System of Information on New Diagnoses of HIV Infection (SINIVIH), 3366 new diagnoses were recorded in 2014. This represents a rate of 7.25 per 100,000 inhabitants (9.34 per 100,000 inhabitants, adjusting for a reporting delay).<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> These figures are higher than those of neighbouring high-income countries.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Moreover, all Spanish national records of HIV infection reflect a significant epidemiological change. In recent years in Spain, unprotected sexual relations between men have represented the most significant risk practice for acquiring HIV infection (64%), followed by unprotected sexual relations between opposite-sex people (31%). Therefore, overall, transmission through unprotected sex is responsible for more than 95% of all new HIV infections in Spain.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> Strategies that manage to control the sexual transmission of HIV could have a definitive impact on limiting the spread of the infection. Although the use of a condom and other barrier methods aid in achieving this goal, they are clearly insufficient. Additional strategies are required to reduce the number of new infections.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Among the strategies proposed, pre-exposure prophylaxis (PrEP) has been demonstrated to be effective in preventing HIV transmission. PrEP consists of administering antiretroviral drugs to people without HIV infection in order to reduce the likelihood of acquiring the infection. The evidence on the efficacy and safety of this new HIV prevention strategy has been evaluated in various clinical trials, conducted in various groups, which have included men who have sex with men (MSM),<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">2–4</span></a> heterosexual men and women,<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">5–8</span></a> and parenteral drug users (PDUs).<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> The high level of efficacy and safety of PrEP demonstrated in the majority of these studies has incited various international bodies such as the Centers for Disease Control and Prevention<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">10,11</span></a> and the WHO<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a> to approve its use as an HIV prevention strategy. In Spain, the AIDS Study Group (GESIDA) of the Spanish Society of Infectious Diseases and Clinical Microbiology has prepared some recommendations advising and standardising the use of PrEP as an HIV prevention strategy.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">13</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The main problem faced in implementing a PrEP programme in Spain in any context is undoubtedly identifying the people who benefit most from receiving the drug, in order for them to render the strategy cost-effective. For this purpose, studies on sentinel populations are essential, as they help to identify both the risk of acquiring the infection in the group and the characteristics that help identify the people at highest risk. Hence, a study by Ayerdi-Aguirrebengoa et al.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a> in this issue of <span class="elsevierStyleSmallCaps">Enfermedades Infecciosas y Microbiología Clínica</span> is particularly relevant. It evaluates the socio-demographic characteristics and behavioural habits of patients recently infected with HIV and cared for at a sexually transmitted infection clinic in Madrid. Some data provided are particularly telling. In a single year (2014), 307 patients were diagnosed with HIV infection at this clinic; among them, 61 (20%) had tested negative in the previous year. This means that this high number of patients were aware of the risk (they had previously sought HIV testing at the same clinic) and had not subsequently adopted the recommended preventive measures. Moreover, this population recently diagnosed with HIV infection had highly pronounced characteristics: it consisted of MSM (98%), who had used recreational drugs in the last year (88%), under whose effect they engaged in unprotected sexual practices, and who had engaged in anal intercourse without a condom with casual sexual partners (76%). Thus the authors sketched the profile of people with high-risk practices for acquiring HIV infection.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The data provided by Ayerdi-Aguirrebengoa may be added to those of other studies in Spain supporting the recommendations of adopting PrEP as a preventive strategy in addition to those already considered. Monitoring through a cohort of HIV-negative MSM yielded an incidence figure that directly reflected the situation in this group. The data obtained through the BCN Checkpoint Cohort enabled calculation of an overall incidence from 2009 to 2014 in MSM of 2.51% (95% CI: 2.25–2.81), which could range from 8.4% and 24.7% people per year when condoms were not always used, when the individual has been diagnosed with an STI and has had more than 10 sexual partners in the last 6 months regardless of their role in anal intercourse.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> The data were precise and consistent in the 2 studies and established rates of incidence higher than those considered cost-effective (2–3%, according to the agency) when the target population was suitably selected.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Given the current state of the HIV infection epidemic in Spain, it seems clear that, in addition to promoting the use of a condom and sex education, new strategies are required to reduce the rates of new HIV infections. There is no doubt that early diagnosis and treatment of all HIV-infected individuals is the most effective method to prevent transmission. In fact, in Spain, administration of antiretroviral therapy is recommended for all patients with HIV infection to prevent disease progression, decrease virus transmission and limit the harmful effect on potential concomitant morbidities by suppressing viral replication.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a> However, while measures are being taken to diagnose all infected people and the objective of treating everybody is being achieved, PrEP constitutes a powerful weapon to be incorporated into control of transmission.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The data on incidence of HIV infection in people with high-risk practices in Spain and the efficacy of PrEP demonstrated in clinical trials and observational studies do not leave room for contemplation. Groups concerned about the course of the epidemic, both inside and outside of healthcare, cannot stand idly by and must insist on the need to develop comprehensive programmes that include PrEP to prevent the development of new cases of HIV infection. The health authorities responsible for making decisions should take this reality into account. Now is the time to implement new strategies to prevent HIV transmission in Spain.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rivero A, Moreno S. ¿Es el momento de poner en marcha nuevas estrategias de prevención de la infección por VIH en España? Enferm Infecc Microbiol Clin. 2017;35:271–272.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Área de Vigilancia de VIH y Conductas de Riesgo. Vigilancia epidemiológica del VIH/sida en España: Sistema de Información sobre Nuevos Diagnósticos de VIH y Registro Nacional de Casos de Sida. Plan Nacional sobre el Sida-SG de Promoción de la Salud y Epidemiología-Centro Nacional de Epidemiología-ISCIII, June, 2015. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 30 | 1 | 31 |
| 2024 October | 229 | 11 | 240 |
| 2024 September | 363 | 18 | 381 |
| 2024 August | 262 | 11 | 273 |
| 2024 July | 201 | 6 | 207 |
| 2024 June | 249 | 2 | 251 |
| 2024 May | 302 | 5 | 307 |
| 2024 April | 213 | 6 | 219 |
| 2024 March | 262 | 11 | 273 |
| 2024 February | 205 | 4 | 209 |
| 2024 January | 290 | 7 | 297 |
| 2023 December | 300 | 10 | 310 |
| 2023 November | 295 | 28 | 323 |
| 2023 October | 288 | 9 | 297 |
| 2023 September | 186 | 3 | 189 |
| 2023 August | 189 | 0 | 189 |
| 2023 July | 261 | 6 | 267 |
| 2023 June | 248 | 8 | 256 |
| 2023 May | 362 | 11 | 373 |
| 2023 April | 324 | 7 | 331 |
| 2023 March | 243 | 4 | 247 |
| 2023 February | 218 | 9 | 227 |
| 2023 January | 193 | 3 | 196 |
| 2022 December | 126 | 8 | 134 |
| 2022 November | 206 | 9 | 215 |
| 2022 October | 185 | 5 | 190 |
| 2022 September | 185 | 25 | 210 |
| 2022 August | 188 | 5 | 193 |
| 2022 July | 193 | 8 | 201 |
| 2022 June | 165 | 13 | 178 |
| 2022 May | 204 | 13 | 217 |
| 2022 April | 180 | 7 | 187 |
| 2022 March | 166 | 4 | 170 |
| 2022 February | 136 | 9 | 145 |
| 2022 January | 215 | 6 | 221 |
| 2021 December | 155 | 8 | 163 |
| 2021 November | 179 | 14 | 193 |
| 2021 October | 155 | 19 | 174 |
| 2021 September | 187 | 13 | 200 |
| 2021 August | 189 | 12 | 201 |
| 2021 July | 117 | 13 | 130 |
| 2021 June | 120 | 15 | 135 |
| 2021 May | 142 | 15 | 157 |
| 2021 April | 226 | 19 | 245 |
| 2021 March | 151 | 10 | 161 |
| 2021 February | 88 | 8 | 96 |
| 2021 January | 79 | 11 | 90 |
| 2020 December | 64 | 10 | 74 |
| 2020 November | 45 | 7 | 52 |
| 2020 October | 32 | 8 | 40 |
| 2020 September | 44 | 8 | 52 |
| 2020 August | 48 | 10 | 58 |
| 2020 July | 28 | 8 | 36 |
| 2020 June | 28 | 10 | 38 |
| 2020 May | 34 | 10 | 44 |
| 2020 April | 28 | 3 | 31 |
| 2020 March | 26 | 4 | 30 |
| 2020 February | 22 | 3 | 25 |
| 2020 January | 28 | 6 | 34 |
| 2019 December | 42 | 6 | 48 |
| 2019 November | 39 | 12 | 51 |
| 2019 October | 33 | 3 | 36 |
| 2019 September | 21 | 4 | 25 |
| 2019 August | 20 | 3 | 23 |
| 2019 July | 18 | 17 | 35 |
| 2019 June | 47 | 21 | 68 |
| 2019 May | 121 | 33 | 154 |
| 2019 April | 62 | 29 | 91 |
| 2019 March | 12 | 6 | 18 |
| 2019 February | 13 | 1 | 14 |
| 2019 January | 6 | 3 | 9 |
| 2018 December | 5 | 2 | 7 |
| 2018 November | 10 | 5 | 15 |
| 2018 October | 11 | 5 | 16 |
| 2018 September | 10 | 6 | 16 |
| 2018 August | 8 | 1 | 9 |
| 2018 July | 14 | 2 | 16 |
| 2018 June | 3 | 1 | 4 |
| 2018 May | 9 | 3 | 12 |
| 2018 April | 7 | 0 | 7 |
| 2018 March | 15 | 0 | 15 |
| 2018 February | 4 | 1 | 5 |
| 2018 January | 11 | 0 | 11 |
| 2017 December | 10 | 0 | 10 |
| 2017 November | 10 | 3 | 13 |
| 2017 October | 4 | 1 | 5 |
| 2017 June | 2 | 0 | 2 |
| 2017 May | 10 | 0 | 10 |
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