Effects of region of birth, educational level and age on late presentation among men who have sex with men newly diagnosed with HIV in a network of STI/HIV counselling and testing clinics in Spain.

This paper analyses late presentation (LP) of HIV infection, and its determinants, among men who have sex with men (MSM) in Spain, newly diagnosed with HIV (2003-2011) in 15 sexually transmitted infection/HIV counselling and testing clinics. LP was defined as <350 CD4 cells/µL or AIDS. In total, 3,081 MSM were included (2,499 having CD4/AIDS); overall LP was 25.3%. LP was higher in men older than 34 years, those not previously HIV-tested (adjusted odds ratio (aOR):3.1; 95% confidence intervals (CI):2.3-4.2) , and those tested > 12 months before diagnosis (12-24 months (aOR:1.4; 95% CI:1.0-2.0); > 24 months (aOR:2.2; 95% CI:1.7-3.0)). LP was less likely in MSM reporting a known HIV-infected partner as infection source or symptoms compatible with acute retroviral syndrome. 'Region of birth' interacted with 'educational level' and 'steady partner as infection source': only African and Latin-American MSM with low educational level were more likely to present late; Latin-American men attributing their infection to steady partner, but no other MSM, had LP more frequently. In Spain, HIV testing among MSM should be promoted, especially those > 34 years old and migrants with low educational level. The current recommendation that MSM be tested at least once a year is appropriate.

Trends in HIV testing, prevalence among first-time testers, and incidence in most-at-risk populations in Spain: the EPI-VIH Study, 2000 to 2009.

During 2000 to 2009, data on people undergoing HIV testing and on those newly diagnosed with HIV were collected in a network of 20 Spanish clinics specialising in sexually transmitted infections and/or HIV testing and counselling. The number of tests performed, overall and disaggregated by different variables, was obtained. HIV prevalence among first-time testers and HIV incidence among repeat testers were calculated. To evaluate trends, joinpoint regression models were fitted. In total, 236,939 HIV tests were performed for 165,745 individuals. Overall HIV prevalence among persons seeking HIV testing was 2.5% (95% CI: 2.4 to 2.6). Prevalence was highest in male sex workers who had sex with other men (19.0% (95% CI: 16.7 to 21.4)) and was lowest in female sex workers (0.8% (95% CI: 0.7 to 0.9)). Significant trends in prevalence were observed in men who have sex with men (MSM) (increasing) and heterosexual individuals (decreasing). The incidence analysis included 30,679 persons, 64,104 person-years (py) of follow-up and 642 seroconversions. The overall incidence rate (IR) was 1.0/100 py (95% CI: 0.9/100 to 1.1/100). Incidence was significantly higher in men and transgender females than in women (1.8/100 py (95% CI: 1.6 to 1.9), 1.2/100 py (95% CI: 0.5 to 2.8) and 0.1/100 py (95% CI: 0.09 to 0.2) respectively) and increased with age until 35­39 years. IRs in MSM and people who inject drugs were significantly greater than in heterosexual individuals (2.5/100 py (95% CI: 2.3 to 2.7), 1.6/100 py (95% CI: 1.1 to 2.2) and 0.1/100 py (95% CI: 0.09 to 0.2) respectively), and an upward trend was observed in MSM. Our results call for HIV prevention to be reinforced in MSM and transgender women in Spain.

HIV/STI co-infection among men who have sex with men in Spain.

In Spain, neither the HIV nor the STI national surveillance systems collect information on HIV/STI co-infection. However, there are two networks based on HIV/STI clinics which gather this data. We describe HIV prevalence in men who have sex with men (MSM) diagnosed with infectious syphilis and/or gonorrhoea in 15 STI clinics; and concurrent diagnoses of STI in MSM newly diagnosed with HIV in 19 HIV/STI clinics. In total, 572 MSM were diagnosed with infectious syphilis and 580 with gonorrhoea during 2005-2007. HIV prevalence among syphilis and gonorrhoea cases was 29.8% and 15.2% respectively. In the multivariate analysis, HIV/syphilis co-infection was associated with being Latin American; having a history of STI; reporting exclusively anal intercourse; and having sex with casual or several types of partners. HIV and gonorrhoea co-infection was associated with age older than 45 years; having no education or only primary education completed; and having a history of STI. In total, 1,462 HIV infections were newly diagnosed among MSM during 2003-2007. Of these, 31.0% were diagnosed with other STI at the same time. Factors associated with STI co-infection among new HIV cases in MSM were being Latin American; and having sex with casual partners or with both steady and casual partners. In Spain, a considerable proportion of MSM are co-infected with HIV and STI.

Papel de la terapia hormonal sustitutiva, en la prevención y tratamiento de la osteoporosis menopáusica / Role of hormone replacement therapy in the prevention and treatment of menopausal osteoporosis

La terapia hormonal sustitutiva se ha venido utilizando como prevención y tratamiento de la osteoporosis postmenopáusica. En este trabajo se revisan los ensayos publicados recientemente, especialmente los estudios Heart and estrogen/progestin replacement study (HERS) y Women´s Health Initiative (WHI), ensayos aleatorizados controlados de gran extensión. Se concluye que la terapia hormonal sustitutiva tiene un efecto de mejora de los síntomas vasomotores de la menopausia. Tiene un efecto positivo sobre la masa ósea con más intensidad sobre el hueso trabecular, pero este efecto sólo persiste durante el tratamiento hormonal y se recupera el balance negativo del recambio óseo al acabar el tratamiento. Se comprueba un efecto protector sobre las fracturas osteoporóticas (vértebra, fémur) durante el tratamiento en mujeres mayores (>60 años), pero no se comprueba esta acción a largo plazo por lo que su valor como terapia preventiva de la osteoporosis no es apoyada. Al finalizar se dan unas orientaciones que permitan ayudar en la práctica clínica (AU)

[Role of hormone replacement therapy in the prevention and treatment of menopausal osteoporosis]. / Papel de la terapia hormonal sustitutiva, en la prevención y tratamiento de la osteoporosis menopaúsica.

Hormone replacement therapy has been employed for the prevention and treatment of postmenopausal osteoporosis. This paper reviews recently published trials, especially the studies Heart and estrogen/progestin replacement study (HERS) and Womens Health Initiative (WHI), randomized controlled trials of wide scope. The conclusion reached is that hormone replacement therapy has the effect of improving the vasomotor symptoms of menopause. It has a positive effect on the bone mass with more intensity on the trabecular bone, but this effect only persists during the hormonal treatment and the negative balance of bone exchange is recovered when treatment stops. A protective effect is found on osteoporotic fractures (vertebra, femur) during the treatment of older women (above 60 years), but this action is not found in the long term, which is why its value as a preventive therapy for osteoporosis is not supported. Finally, certain guidelines are given that can be helpful in clinical practice.

Diet and the risk of breast cancer in Spain.

A case-control study of the role of diet in the cause of breast cancer was conducted between 1988 and 1991 in Navarra, North Spain; 100 women with breast cancer and 100 hospital controls admitted during the same period were interviewed, using a food frequency-consumption questionnaire. Cases reported significantly lower consumption of fruits, vegetables and fish; relative risk (RR) for persons in the lowest tertile of consumers was: fruits, RR = 3.83, confidence limit (CL) = 9.12-1.66, P = 0.01; vegetables, RR = 1.92, CL = 4.57-0.80, P = 0.09; fish, RR = 0.32, CL = 6.31-0.83, P = 0.05. The risk increased for persons in the highest tertile of processed meat intake, RR = 3.20, P = 0.05. Nutrient intakes for individuals were estimated by multiplying the nutrient content of a selected typical portion size for each specified food item by the frequency that the food was used per month, and adding these estimates for all food items. Cases reported significantly less frequent consumption of vitamin C (ascorbic acid) and monounsaturated fatty acid; after controlling for total calorie intake, the RR was estimated for consumption of vitamin C (RR = 0.40, CL = 0.2-0.9), and monounsaturated fatty acid (RR = 0.30, CL = 0.1-1.08).