Comunicaciones orales : VIH y tuberculosis
HIV and tuberculosis
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array:20 [ "pii" => "13051797" "issn" => "02139111" "estado" => "S300" "fechaPublicacion" => "2003-10-01" "documento" => "article" "crossmark" => 0 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Gac Sanit. 2003;17 Supl 2:130-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1867 "formatos" => array:3 [ "EPUB" => 119 "HTML" => 1430 "PDF" => 318 ] ] "itemSiguiente" => array:16 [ "pii" => "13051798" "issn" => "02139111" "estado" => "S300" "fechaPublicacion" => "2003-10-01" "documento" => "article" "crossmark" => 0 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Gac Sanit. 2003;17 Supl 2:132-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2467 "formatos" => array:3 [ "EPUB" => 145 "HTML" => 1926 "PDF" => 396 ] ] "en" => array:8 [ "idiomaDefecto" => true "titulo" => "Comunicaciones orales : Salud reproductiva" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "132" "paginaFinal" => "134" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Reproductive health" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13051798?idApp=WGSE" "url" => "/02139111/00000017000000S2/v0_201302051404/13051798/v0_201302051406/en/main.assets" ] "itemAnterior" => array:16 [ "pii" => "13051796" "issn" => "02139111" "estado" => "S300" "fechaPublicacion" => "2003-10-01" "documento" => "article" "crossmark" => 0 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Gac Sanit. 2003;17 Supl 2:129-30" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2078 "formatos" => array:3 [ "EPUB" => 113 "HTML" => 1598 "PDF" => 367 ] ] "es" => array:8 [ "idiomaDefecto" => true "titulo" => "Comunicaciones orales : Desigualdades sociales II" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "129" "paginaFinal" => "130" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Social inequalities II" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13051796?idApp=WGSE" "url" => "/02139111/00000017000000S2/v0_201302051404/13051796/v0_201302051406/es/main.assets" ] "en" => array:8 [ "idiomaDefecto" => true "titulo" => "Comunicaciones orales : VIH y tuberculosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "130" "paginaFinal" => "132" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "HIV and tuberculosis" ] ] "textoCompleto" => "<p class="elsevierStylePara"> Viernes 3 de Octubre / Friday 3, October<br></br> 11:30:00 a/to 13:30:00</p><p class="elsevierStylePara"> Moderador/Chairperson:<br></br> Ildefonso Hernández Aguado</p><p class="elsevierStylePara"><span class="elsevierStyleBold">271 IMPACT OF HAART AND AGE ON PROGRESSION TO AIDS AND DEATH IN HAEMOPHILICS IN SPAIN</span></p><p class="elsevierStylePara"> Santiago Perez-Hoyos<span class="elsevierStyleSup">1</span>, Julia Del Amo<span class="elsevierStyleSup">2</span>, Inmaculada Ferreros<span class="elsevierStyleSup">1</span>, Manuel Quintana<span class="elsevierStyleSup">3</span>, Jose Miguel Cisneros<span class="elsevierStyleSup">4</span>, Isabel Ruiz <span class="elsevierStyleSup">5</span>, GEMES<span class="elsevierStyleSup">6</span>. En nombre del Grupo: GEMES (Grupo Estudio Multicéntrico Español de Seroconvertores al VIH)</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>Unitat Epidemiología i Estadística, EVES, València. <span class="elsevierStyleSup">2</span>Departamento Salud Pública, Universidad Miguel Hernández, San Juan de Alicante. <span class="elsevierStyleSup">3</span>Hospital La Paz, Madrid. <span class="elsevierStyleSup">4</span>Hospital Virgen del Rocío, Sevilla. <span class="elsevierStyleSup">5</span>Hospital Vall d'Hebrón, Barcelona. <span class="elsevierStyleSup">6</span>Grupo Español Multicéntrico para el Estudio de, Seroconvertores al VIH.</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction:</span> HAART has had profound effects in halting HIV progression in Spain but its impact among haemophilics has not been evaluated. This impact is inevitably confounded by the survival bias introduced by patients who receive treatment and age. The aim of this studye is to describe progression to AIDS an Death over 20 years in HIV positive haemophilics and the impact of HAARt in different age groups.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods:</span> All haemophilics with a diagnosis of HIV infection followed up in three Haemophilia Hospital Units (La Paz in Madrid, Vall d'Hebrón in Barcelone and Virgen del Rocío in Seville) were included in this retrospective cohort within GEMES Project. After imputing date of seroconversion, cumulative risk of AIDS and death was calculated by extended Kaplan-Meier estimates allowing for late entry. Follow up swas divided by calendar periods: before 1988, 1988-89, 1990-1991, 1992-1993, 1994-1995, 1996-1997, 1998-2001, censoring patients at the end of 2001 The incidence ratio of first AIDS event and death from all causes were calculated for each of this periods,. Poisson regression was used to model the incidence rate adjusting for potential confounders as age at seroconversion, type of clotting disorder, severity, ART treatment.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results:</span> 609 patients were identified, 44% were under 15 years old. The majority had type A hameophilia (85%). 371 (61%) people developed AIDS being Pneumocystis Carinii Pneumonia the commonest cause The percentage of AIDS-free subjects after 15 years of HIV infection was higher for those under 15 years (45%) and higher for those over 35% (5%). A reduction of AIDS incidence rate was observed for all age groups after 1996,year of introduction of HAART. No statistically significant interaction was detected between age and calendar period in time to AIDS analyses. 357 (60%) persons died. Marked differences were observed in survival according to age at seroconversion; none of those aged over 35 years old at seroconversion was alive after 20 years since HIV infection compared to 53% of those under 15 years of age. Mortality rate increased overtime for all age groups decreasing very marked after 1996. No statistically significant interaction interaction was detected between age and calendar for time to death analyses.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions:</span> AIDS and death incidence rates are larger than those described for IDUs and Homosexual in Spain though important reductions in HIV disease progression to AIDS and death are also observed from 1998 to 2001 in haemophilics in Spain and can be partly attributed to Highly Active Antiretroviral therapy. Age at and time since seroconversion are powerful predictors of HIV disease progression, together with the type of haemophilia.</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">This work was partially funded through grants from FIPSE and FIS.</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">272 PROGRESSION OF HIV INFECTION AND MORTALITY BY HEPATITIS C INFECTION IN PATIENTS WITH HEMOPHILIA OVER 20 YEARS</span></p><p class="elsevierStylePara"> Alicia Barrasa<span class="elsevierStyleSup">1</span>, Manuel Quintana<span class="elsevierStyleSup">2</span>, Julia Del Amo<span class="elsevierStyleSup">3</span>, Inmaculada Ferreros<span class="elsevierStyleSup">4</span>, Santiago Pérez-Hoyos<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España. <span class="elsevierStyleSup">2</span>Hospital Universitario La Paz, Madrid, España. <span class="elsevierStyleSup"> 3</span>Departamento de Salud Pública, Universidad Miguel Henández, Alicante, España. <span class="elsevierStyleSup">4</span>Escuela Valenciana de Estudios en Salud, Valenica, España.</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objective:</span> Hepatitis C Virus (HCV) infection is an important cause of mortality in HIV-positive hemophiliacs. We describe progression to AIDS, death from HCV end-stage liver disease (ESLD) and from all cause mortality over 20 years.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Method:</span> All HIV- positive hemophiliacs in La Paz University Hospital were included in this cohort study. After imputing date of seroconversion, rates of AIDS, death from ESLD and from all cause mortality was calculated by Poisson Regression using competing risks models. Follow up was divided by calendar periods: before 1988, 1988-89, 1990-1991, 1992-1993, 1994-1995, 1996-1997, 1998-2001, censoring patients at the end of 2001.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results:</span> Among 383 cohort members, global AIDS incidence was 9.7 per 100 person-years, peaking in 1992-93 and dropping by 87% in 1998-2001 compared to before 1988 (IRR 0.13 95%CI: 0.03-0.53). Overall mortality was 7.5 per 100 person-years, was highest from 1992 to 1997, and fell by 66% in 1998-2001 compared to before 1988 (IRR 0.34 95%CI: 0.14-0.81. Eighteen (5%) persons died of ESLD which represented 19% of deaths before 1988, 4% from 1988-89, 1990-91 and 1992-93, 2% in 1994-95, 10% in 1996-97 and 33% in 1998-2001. Overall death rate from ESLD was 0.5 cases per 100 person-years with no statistically significant trend observed overtime.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions:</span> Important reductions in HIV disease progression to AIDS and death have been observed from 1998 to 2001 and can be attributed to Highly Active Antiretroviral therapy. Although no increase in the rate of HCV related deaths can be demonstrated, HCV accounts for an increasing proportion of deaths in the last years.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">273 EFFECTIVENESS OF HAART IN THE RISK OF SPECIFIC FIRST AIDS-DEFINING CONDITION IN SPANISH HIV SEROCONVERTERS COHORTS</span></p><p class="elsevierStylePara"> Santiago Pérez-Hoyos<span class="elsevierStyleSup">1</span>, Inmaculada Ferreros<span class="elsevierStyleSup">1</span>, Julia Del Amo<span class="elsevierStyleSup">2</span>, Jorge Del Romero<span class="elsevierStyleSup">3</span>, Arantza Sanvisens<span class="elsevierStyleSup">4</span>, Patricia Garcia de Olalla<span class="elsevierStyleSup">5</span>, Rafael Guerrero<span class="elsevierStyleSup">6</span>, Manuela Garcia de la Hera<span class="elsevierStyleSup">2</span>, Ildefonso Hernández-Aguado<span class="elsevierStyleSup">2</span>. En nombre del Grupo: GEMES (Grupo Español Multicéntrico Estudio Seroconvertores al VIH).</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>EVES, Escola Valenciana Estudis per a la Salut, València. <span class="elsevierStyleSup">2</span>Dpto. Salud Pública, Universidad Miguel Hernández, San Juan de Alicante. <span class="elsevierStyleSup"> 3</span>Centro Sandoval, Madrid. <span class="elsevierStyleSup">4</span>Hospital Universitario Germans Trias i Pujol, Badalona. <span class="elsevierStyleSup">5</span>Institut Municipal de la Salut, Barcelona. <span class="elsevierStyleSup">6</span>Institucions Penitenciaries de Catalunya, Barcelona.</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objective:</span> Several studies have shown a reduction of AIDS incidence after the introduction of highly active antiretroviral therapy (HAART). The objective of this study was to analyse the effectiveness of HAART in the risk of specific first AIDS defining condition (ADC) among the Spanish HIV seroconverters cohorts from GEMES Study.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods:</span> Data from 1203 individuals, with well-documented HIV seroconversion dates belonging to 5 cohorts recruited from 1980s up to 2000 within GEMES project, were analysed. Time from seroconversion to first ADC or pre-AIDS death was analyse under a competing risk framework. Only ADC with more than ten cases (8 groups) were considered. Risk of AIDS and death were compared in different calendar periods: before 1994, from 1994 to 1996, (reference) and 1996 onwards adjusting for sex, age and exposure category stratifying by cohort. Staggered entry Kaplan-Meier and Cox regression, fitting calendar period as a time-dependent covariate, were used. To cope with competing risks three censoring strategies were used. First specific ADC hazard was estimated censoring other ADC at the time of occurrence. Second, competing risk hazard was estimated censoring other ADC at the end of follow up. Lastly, subjects developing other ADC were dropped out as they are not at risk of developing the specific ADC as their first one.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results:</span> 269 (22.3%) AIDS cases and 62 pre-AIDS death were observed. Tuberculosis(TB), both pulmonary and extrapulmonary were the most frequent ADC (37%) followed by PCP (13%), and oesophageal Candidiasis (9%). Most ADC groups showed a risk reduction for last calendar period (1996 onwards) except for oesophageal candidiasis (RR 1.45 95%CI 0.24-8.85). A great heterogenetiy among the reduction of risk was observed going from a relative risk (RR) of 0.16 (95% CI 0.05-0.46) for PCP, a RR of 0.56 (95% CI 0.34-0.93) for Tuberculosis up to a RR of 0.96 (95% CI 0.44-2.08) for the group "rest of ADC". For Pre-AIDS mortality no significant reduction was observed with a RR of 0.90 (95% IC 0.49-1.67. After fitting a multiple failure-time data excluding pre-AIDS mortality as an endpoint there was still significant effect of calendar period (RR 0.58 95%IC 0.43 - 0.78). Similar results were observed using all censoring strategies.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions:</span> Risk reduction were observed in most ADC after the introduction of HAART therapies in 1996. No risk reduction was observed for pre-AIDS mortality. These reductions were fairly heterogeneous among the specific ADC and were similar using different strategies of censoring to take into account competing risk</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">This work was partially funded through grants from FIPSE and FIS.</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">274 CO-MORBIDITY AND PREDICTORS OF M. TUBERCULOSIS INFECTION AMONG HIV-INFECTED SPANISH SUBJECTS NOT PREVIOUSLY FOLLOWED REGULARLY</span></p><p class="elsevierStylePara"> Mercedes Díez<span class="elsevierStyleSup">1</span>, María José Bleda<span class="elsevierStyleSup">1</span>, Mikel Aldamiz<span class="elsevierStyleSup">2</span>, Miguel Camafort<span class="elsevierStyleSup">3</span>, Concha Cepeda<span class="elsevierStyleSup">4</span>, Asunción Costa<span class="elsevierStyleSup">4</span>, Oscar Ferrero<span class="elsevierStyleSup">5</span>, Paloma Geijo<span class="elsevierStyleSup">6</span>, Jose Antonio Iribarren<span class="elsevierStyleSup">7</span>, et al. En nombre del Grupo: Quimio-TB Study Group</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span>Unidad de Investigación en Tuberculosis, Centro Nacional de Epidemiología/ISCIII, Madrid, España. <span class="elsevierStyleSup">2</span>Servicio de Medicina Interna, Hospital Txagorritxu, Vitoria, España. <span class="elsevierStyleSup">3</span>Servicio de Medicina Interna, Hospital comarcal Mora d'Ebre, Mora d'Ebre, España. <span class="elsevierStyleSup">4</span>Unidad VIH, Hospital Doce de Octubre, Madrid, España. <span class="elsevierStyleSup">5</span>Servicio de Enfermedades Infecciosas, Hospital de Basurto, Bilbao, España. <span class="elsevierStyleSup"> 6</span>Unidad de Enfermedades Infecciosas, Hospital Virgen de la Luz, Cuenca, España. (7) Unidad de Enfermedades Infecciosas, Hospital Donostia, San Sebastian, España.</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objectives:</span> To describe socio-demographic and clinical variables at study entry in a cohort of HIV(+) Spanish subjects not previously followed regularly; and to investigate factors related to infection with Mycobacterium tuberculosis (MTB).</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods:</span> HIV(+) patients not previously followed on a regular basis at a HIV-clinic were prospectively identified between March 2000-February 2003 in the HIV-clinics of 10 Spanish hospitals. Information on socio-demographic variables, risk factors for HIV, clinical variables, TB history, tuberculin skin testing (TST), anergy testing and use of TB preventive therapy were collected from the clinical records. The odds ratio and its 95% confidence interval (OR, 95%CI) was the measure of association. Logistic regression was used for the multivariate analysis.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results:</span> 1142 subjects met the entry criteria. They were mostly male (75.4%), Spanish (87.2%) with a mean (SD) age of 36 (8.4) years and highly unemployed (38.4%). Intravenous drug users (IDU) were the most common HIV risk group (54.3%), followed by heterosexuals (27.5%) and men who have sex with men (MSM) (15.2%). At the initial evaluation median (P5-P95) CD4 was 300 cel/mm3 (16-963), median viral load was 38000 copies (133-487000) and median GPT was 34 units (12-160); almost 7% of the patients were chronic HBs Ag carriers and 55.7% were infected with the hepatitis C virus. A total of 767 (67.2%) subjects were prescribed highly active anti-retroviral therapy (HAART) and 33% were taking some other medication. Anergy was evaluated in 25% of the patients and, contrary to Spanish guidelines, TST was not performed in 116 (10.2%), while 17 subjects either refused testing or never come back to have the test read. At study entry, at least 180 (15.8%) patients recalled a contact with a TB case, and 291 (25.5%) had evidence of infection with MTB: 97 (8.5%) were or have being TB patients and 194 (17%) had a positive TST without signs of disease. In the multivariate analysis evidence of MTB infection was associated with male sex (OR:1.5, 1.0-2.2); age-group 30-39 (OR:1.7, 1.1-2.5) or 40-49 years (OR:1.8, 1.1-3.0); unemployment (OR:1.5, 1.0-2.0); illiteracy (OR:1.9, 1.1-.3.2) or poor education (OR:1.7, 1.1-2.5); homelessness (OR:2.3, 1.3-4.1) or living with family (OR:1.7, 1.0-2.9) as compared to living alone; being IDU (OR:2.0, 1.1-3.5) or heterosexual (OR:1.7, 1.0-3.1) as compared to being MSM; being a contact of a TB case (OR:2, 1.4-2.9); and (negatively) with having CD4<100 (OR:0.6, 0.3-0.9).</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusion:</span> HIV(+) Spanish subjects have a high degree of co-morbidity that makes more difficult to implement TB preventive therapy. Evidence of infection with MTB is positively related to male sex, increasing age, bad social indicators, HIV-infection through IDU or heterosexual sex, and contact with a TB case; and negatively with CD4<100. This later finding suggests that some degree of anergy might be present in this cohort.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">275 MODIFICATIONS TO INITIAL ANTI-TUBERCULOSIS TREATMENT IN A COHORT OF SPANISH TB CASES</span></p><p class="elsevierStylePara"> Mercedes Díez<span class="elsevierStyleSup">1</span>, Asunción Díaz<span class="elsevierStyleSup">1</span>, Jose Antonio Hernández<span class="elsevierStyleSup">1</span>, María José Bleda<span class="elsevierStyleSup">1</span>, Concha Castells<span class="elsevierStyleSup">2</span>, Ángela Domínguez<span class="elsevierStyleSup">3</span>, Ana García-Fulgueiras<span class="elsevierStyleSup">4</span>, Pilar Gayoso<span class="elsevierStyleSup">5</span>, María José López<span class="elsevierStyleSup">6</span>, et al. En nombre del Grupo: MPTR-2 Working Group</p><p class="elsevierStylePara"><span class="elsevierStyleItalic"><span class="elsevierStyleSup">1</span> Unidad de Investigación en Tuberculosis, Centro Nacional de Epidemiología / ISCIII, Madrid, España. <span class="elsevierStyleSup">2</span>Delegación Territorial de Sanidad, Gobierno Vasco, Bilbao, España. <span class="elsevierStyleSup"> 3</span>Dirección General de Salud Pública, Generalitat de Catalunya, Barcelona, España. <span class="elsevierStyleSup"> 4</span>Servicio de Epidemiología, Consejería de Sanidad y Consumo, Murcía, España. <span class="elsevierStyleSup"> 5</span>Complejo Hospitalario Cristal-Piñor, Orense, España. <span class="elsevierStyleSup">6</span>Dirección General de Salud, Gobierno de La Rioja, Logroño, España.</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Objectives:</span> To describe modifications to anti-tuberculosis (TB) treatment and factors associated with them in a cohort of new TB patients identified in six of Spain's Autonomous Regions (AR): Asturias, Catalonia, Galicia, La Rioja, Murcia and Basque Country.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods:</span> In the course of a study aimed at investigating the outcome of anti-TB treatment, information on modifications to initial treatment was collected from the clinical records in a retrospective cohort of new TB cases identified in six Spanish AR from May 1996-April 1997. Cases were followed up until 3 months after the envisaged treatment-completion date. Modification was defined as: a) the inclusion and/or exclusion of one or more drugs different from those initially prescribed; b) a physician's prescribed change in treatment duration that implied at least a three months increase in the initial treatment duration. The odds ratio and its 95% confidence interval (OR, 95%CI) was the measure of association. Logistic regression was used for the multivariate analysis.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results:</span> A total of 4,899 new TB cases were diagnosed during the study period. Out of them, 67 died and in 317 instances the clinical record was lost; thus, the final study population included 4,515 cases. At least one modification to the treatment initially prescribed was recorded in 554 (12.3%) patients, the commonest cause being toxicity (49.1%) followed by unfavourable evolution. Changing some drug was the commonest modification introduced (67.9%). Variations on the proportion of modifications were observed by several variables. In the multivariate analysis modifications increased with male sex (OR: 1.3, 1.1-1.5) foreign nationality (OR: 1.9, 1.2-2.9), intravenous drug use (IDU) (OR: 1.4, 0.9-2.0), use of single-drug formulations (OR: 1.6, 1.2-2.1) and, linearly, with quartiles of age (OR: 1.5 for age group 26-36 years; OR: 2.0 for age group 37-57 years; OR:2.5 for age >57 years). Diabetes was the only variable associated in a negative way with modification (OR: 0.6, 0.4-1.0). An interaction was observed between HIV status and number of drugs used for initial anti-TB treatment: modifications are always more likely among HIV-infected than among HIV-uninfected patients; but while among the HIV-uninfected individuals modifications increase when 4, instead of 3, anti-TB drugs are prescribed for treatment, the opposite is true among the HIV-infected.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusion:</span> Modifications to anti-TB treatment are quite frequent among new TB cases in Spain. The most frequent reason for modification is toxicity and the commonest change is inclusion/exclusion of some drug. Factors associated with modifications are sex, age, nationality, IDU, use of single-drug formulations and (negatively) diabetes. HIV status is a modifier of the effect of number of anti-TB drugs initially prescribed on anti-TB treatment modification.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">276 CHARACTERISTICS OF THE DELAYED DIAGNOSIS OF HIV INFECTION IN CATALONIA</span></p><p class="elsevierStylePara"> Rossie Lugo, Amparo Romaguera, Jordi Casabona, et al. En nombre del Grupo: ReDia Project Collaborative Group</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Centro de Estudios Epidemiológicos sobre el Sida en Cataluña, Hospital Universitario Germans Trias i Pujol, Badalona.</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Background:</span> An early HIV diagnosis offers the benefits of HAART and OI´s prophylaxis, as well as access to receive social support and modify HIV transmission behaviors. A high proportion of people remain having a delayed access to the HIV test. In Catalonia 45% of the AIDS cases had a delayed diagnosis of 12 months between HIV and AIDS diagnosis (1997-2001). The objective of this study (FIPSE-12176p) is to identify factors associated to the delayed diagnosis of HIV infection in Catalonia.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods:</span> The design of the study is transversal and the data collection was carried out through personal interviews and medical records review of HIV infected patients who receive health services in 7 hospitals in Catalonia. The study sample included patients living in Catalonia, older than 13 y/o at diagnosis and first HIV test during 1998-2002. Delayed HIV diagnosis was defined as patients with first CD4+ lymphocytes count <200 x 10<span class="elsevierStyleSup">6</span> cel/l at the moment of HIV diagnosis. The independent variables were: socio-demographics, reasons for being HIV tested and reasons for not being tested before, access to health services, sexual behavior and clinical variables at the moment of HIV diagnosis. Data was collected using a validated questionnaire without personal identifiers. The statistical analysis was performed using the software SPPSS v11.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results:</span> Out of the 329 interviewed cases, 163 (49,1%) had a CD4+ count <200 x 10<span class="elsevierStyleSup">6</span> cel/l at HIV diagnosis. Fifty-four percent (53,8%) of men and 43,9% women (p=0,006) showed a delayed diagnosis (DD). Considering the route of HIV transmission, delayed diagnosis was more frequent among persons infected through heterosexual relations (57,7%), and less among men who have sex with men (46,9%) and IVDU (34,7%) (p<0,05). The most common response to "the reasons for being HIV tested" was "physician's recommendation" (68,1%) and among cases with delayed HIV diagnosis was "being ill" (67,2%).</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions:</span> Preliminary data showed that half of the cases had their first HIV+ test when their immunology stage was already suppressed. HIV-positive cases with sexual relations as route of infection had a lower perception of risk to be HIV infected than IVDU. Most of the patients had their first HIV+ test because of being ill or because of physician's recommendation. Further analysis of the factors related to delayed diagnosis is needed in order to modify prevention and early HIV testing programs in the general population.</p>" "pdfFichero" => "138v17nSupl.2a13051797pdf001.pdf" "tienePdf" => true ] "idiomaDefecto" => "en" "url" => "/02139111/00000017000000S2/v0_201302051404/13051797/v0_201302051406/en/main.assets" "Apartado" => array:4 [ "identificador" => "792" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Congreso" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02139111/00000017000000S2/v0_201302051404/13051797/v0_201302051406/en/138v17nSupl.2a13051797pdf001.pdf?idApp=WGSE&text.app=https://gacetasanitaria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13051797?idApp=WGSE" ]
Información del artículo
ISSN: 02139111Idioma original: Inglés
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