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The information on this group of patients is very limited. It is unknown if they do or do not have medical indications for treatment or the reasons why they are not receiving treatment.</p><p id="par0010" class="elsevierStylePara elsevierViewall">With the aim of describing the sociodemographic and clinical characteristics of these patients and of evaluating the possibility to start ART, we conducted a cross-sectional survey in 12 hospital units that did follow-ups on patients with HIV in Spain in 2009-2010. The patients included were receiving follow-up attention but no ART at the moment of the last visit. We gathered sociodemographic, clinical and epidemiological information, and potential indications to start treatment, according to the current Gesida/National AIDS Plan recommendations at the moment of the survey (2010).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> The protocol was approved by the Medical Ethics Committee of the Santa Creu i Sant Pau Hospital (Barcelona), and followed the Declaration of Helsinki. The patients gave their informed consent to participate.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The sample contained 1024 patients: From a total of 1024 patients, 865 (84%) were <span class="elsevierStyleItalic">naïve</span> and 159 (16%) had received ART before, but had suspended it. In the group of the naïve patients, the median age was 37 years (interquartile range [RIC]: 30–43 years), 83% were men and the median of time since HIV diagnosis was 2.3 years (RIC: 1–5 years). In the transmission category, 56% of the cases were unprotected sexual intercourse between men, 27% were unprotected heterosexual intercourse and 15% was drug use injection. In the group of naïve patients, 526 (61%) did not have indication to receive ART, according to the therapeutic guidelines of the moment; 111 (13%) had indication and were going to start ART in the following visit, and 228 (26%) had at least one indication, but were not programmed to initiate ART shortly. From the 228 of patients with indication for treatment but did not expect to start, the most frequent reasons of indication to start ART was the HIV/hepatitis C virus (HCV) co-infection, 48% of the cases; elevated viral load (>100,000<span class="elsevierStyleHsp" style=""></span>copies/mL), 24% of the cases, and CD4 counts inferior to established limit at that moment (350 cells/μL), 18% of the cases. Of these 228 patients who had indication but were not programmed to begin treatment, in 199 (87%) of the cases the doctor did not consider the indication of treatment necessary, 21 (9%) of the cases adduced personal reasons and 8 patients (3%) were still in the phase of initial evaluation and deciding on the following steps. Of those 228 patients, 168 had only one indication for treatment; 47 patients had 2 indications and the last 13 had 3–5 indications of treatment (8 did not initiate by medical decision, 4 for personal reasons and 1 for other reasons).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Indication to start ART in all HIV/HCV co-infected patients, regardless of their CD4 level, is based on the evidence that ART reduces progression to cirrhosis, fibrosis and death in the same levels as it does in HCV mono-infected patients. For this reason, it has been stated that early initiation of ART is the best way to reduce death caused by hepatic affectation of the population, even more than it is in the treatment for HCV.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> On the other hand, there is countless evidence that late initiation of ART with low CD4 lymphocyte counts increases the risk of progression to AIDS and death,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4,5</span></a> and that only keeping the level of that indicator high during prolonged periods will it be possible to bring life expectancy of HIV patients near to that of the general population.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion, almost one quarter of the patients being followed up, and who were not receiving ART, could benefit from this treatment depending on their clinical characteristics. Even though in some cases it is the patient themself who prefers not to receive medication, in most of the cases it is the doctor who considers that they do not have the indication to receive it yet.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">Gilead Sciences S. L. contributed to financing the study.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "xack185327" "titulo" => "Acknowledgements" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Domingo Pedrol P, Viciana Fernández P, Castaño M, Ferrer Corbera E. Características de los pacientes con infección por el virus de la inmunodeficiencia humana que no reciben tratamiento antirretroviral en España: estudio PICNIT. Med Clin (Barc). 2015;144:43–44.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">The members of the PICNIT Study Group can be found in the Annex</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0040" class="elsevierStylePara elsevierViewall">Pere Domingo, Teaching Hospital Sant Pau, Barcelona; Piedad Arazo, Teaching Hospital Miguel Servet, Zaragoza; Jose Luis Casado, Teaching Hospital Ramon y Cajal, Madrid; Manuel Castaño, Teaching Hospital Carlos Haya, Malaga; Elena Ferrer, Teaching Hospital Bellvitge, Barcelona; Miguel Angel Goenaga, Teaching Hospital Donostia, San Sebastián; Rafael Granados, Teaching Hospital Dr. Negrín, Palmas de Gran Canaria; Federico Pulido, Teaching Hospital 12 de Octubre, Madrid; Jesus Rodriguez-Baños, Teaching Hospital Virgen Macarena, Seville; Rafael Rubio, Teaching Hospital 12 de Octubre, Madrid; Jose Sanz, Teaching Hospital Príncipe de Asturias, Alcala de Henares; Pompeyo Viciana, Teaching Hospital Virgen del Rocío, Seville.</p>" "etiqueta" => "Annex" "titulo" => "PICNIT Study Group" "identificador" => "sec0010" ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Centro Nacional de Epidemiología, Plan Nacional Sobre el Sida, Ministerio de Sanidad y Política Social. 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Shafran" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/QAI.0b013e31803151c7" "Revista" => array:6 [ "tituloSerie" => "J Acquir Immune Defic Syndr" "fecha" => "2007" "volumen" => "44" "paginaInicial" => "551" "paginaFinal" => "556" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17224846" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of early versus deferred antiretroviral therapy for HIV on survival" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.M. Kitahata" 1 => "S.J. Gange" 2 => "A.G. Abraham" 3 => "B. Merriman" 4 => "M.S. Saag" 5 => "A.C. Justice" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa0807252" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2009" "volumen" => "360" "paginaInicial" => "1815" "paginaFinal" => "1826" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19339714" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.A. Sterne" 1 => "M. May" 2 => "D. Costagliola" 3 => "F. de Wolf" 4 => "A. Phillips" 5 => "R. Harris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(09)60612-7" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2009" "volumen" => "373" "paginaInicial" => "1352" "paginaFinal" => "1363" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19361855" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "HIV-infected adults with a CD4 cell count greater than 500<span class="elsevierStyleHsp" style=""></span>cells/mm<span class="elsevierStyleSup">3</span> on long-term combination antiretroviral therapy reach same mortality rates as the general population" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Lewden" 1 => "G. Chene" 2 => "P. Morlat" 3 => "F. Raffi" 4 => "M. Dupon" 5 => "P. Dellamonica" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/QAI.0b013e318134257a" "Revista" => array:6 [ "tituloSerie" => "J Acquir Immune Defic Syndr" "fecha" => "2007" "volumen" => "46" "paginaInicial" => "72" "paginaFinal" => "77" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17621240" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack185327" "titulo" => "Acknowledgements" "texto" => "<p id="par0035" class="elsevierStylePara elsevierViewall">We thank Ana Maria Caro-Murillo for revision of the manuscript and publishing assistance.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014400000001/v1_201509042040/S2387020615000145/v1_201509042040/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014400000001/v1_201509042040/S2387020615000145/v1_201509042040/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020615000145?idApp=UINPBA00004N" ]
