Cambios en las características clínico-epidemiológicas de los nuevos casos de infección por el VIH-1 en Castellón (España) y su repercusión en la presentación tardía (1987-2011) / Changes in clinic-epidemiological characteristics of new cases of HIV-1 infection in Castellón (Spain), and its impact on delayed presentation (1987-2011)

OBJETIVO: Describir la evolución de las características clínico-epidemiológicas en una cohorte de pacientes infectados por el VIH-1 en Castellón (España), y su repercusión en la presentación tardía. MÉTODOS: Estudio descriptivo retrospectivo en el que se revisaron datos de la primera visita de pacientes infectados por el VIH-1 que consultaron desde 1987 a 2011. RESULTADOS: Durante el periodo de estudio se produjeron importantes cambios en las características de los 1.001 pacientes que consultaron por primera vez. La edad media pasó de ser de unos 30 años antes de 1996, a situarse alrededor de los 35 tras el periodo 2000-2002. El porcentaje de extranjeros pasó de ser < 2% antes de 1997 a representar el 50% en el periodo 2009-2011, y el de transmisión por drogas parenterales del 92,3% antes de 1988 a < 20% tras el periodo 2003-2005, con un descenso paralelo en la coinfección por VHC. La presentación tardía no experimentó cambios significativos, con una media del 47,1% en el periodo estudiado. Los factores asociados a este retraso en solicitar asistencia fueron: mayor edad, diagnóstico realizado a nivel hospitalario, mayor demora en el tiempo estimado entre infección y diagnóstico serológico, y en el tiempo entre diagnóstico serológico y primera visita. CONCLUSIÓN: En nuestro entorno, la epidemiología del VIH-1 ha cambiado considerablemente desde el inicio de la epidemia. El progresivo retraso en el diagnóstico serológico es una importante causa de la escasa variación en el porcentaje de presentaciones tardías, y evidencia el escaso impacto de las estrategias de diagnóstico precoz

OBJECTIVE: To describe the trend of the clinical and epidemiological characteristics of a cohort of HIV-1 infected patients in Castellón (Spain), and its impact on the delayed presentation. METHODS: Data from HIV-1 infected outpatients presenting for care for the first time between 1987 and 2011 were retrospectively analyzed. RESULTS: There have been significant changes in the characteristics of the 1001 newly presented patients during the period studied. An increase in the mean age was observed (increasing from about 30 years before 1996, to approximately 35 after the 2000-2002 period), as well as an increase in the percentage of immigrants (< 2% before 1997, to 50% in the 2009-2011 period), and a decline in the proportion of intravenous drug use as the main transmission route (changing from being 92.3% before 1988 to below 20% after the 2003-2005 period), together with a decrease in the proportion of hepatitis-C coinfection. The rate of late presentation has not significantly changed, being 47.1% in the period studied. Factors associated with this late presentation were: older age, hospital diagnosis, an increased delay between estimated infection time and diagnosis, and between diagnosis and initial presentation. CONCLUSIONS: The epidemiology of HIV-1 infection in our area has dramatically changed since the beginning of the disease. The increasing delay between estimated infection time and diagnosis is an important cause of the lack of variation in the late presentation rate, and highlights the low impact of early diagnosis strategies

[Changes in clinic-epidemiological characteristics of new cases of HIV-1 infection in Castellón (Spain), and its impact on delayed presentation (1987-2011)]. / Cambios en las características clínico-epidemiológicas de los nuevos casos de infección por el VIH-1 en Castellón (España) y su repercusión en la presentación tardía (1987-2011).

OBJECTIVE: To describe the trend of the clinical and epidemiological characteristics of a cohort of HIV-1 infected patients in Castellón (Spain), and its impact on the delayed presentation. METHODS: Data from HIV-1 infected outpatients presenting for care for the first time between 1987 and 2011 were retrospectively analyzed. RESULTS: There have been significant changes in the characteristics of the 1001 newly presented patients during the period studied. An increase in the mean age was observed (increasing from about 30 years before 1996, to approximately 35 after the 2000-2002 period), as well as an increase in the percentage of immigrants (<2% before 1997, to 50% in the 2009-2011 period), and a decline in the proportion of intravenous drug use as the main transmission route (changing from being 92.3% before 1988 to below 20% after the 2003-2005 period), together with a decrease in the proportion of hepatitis-C coinfection. The rate of late presentation has not significantly changed, being 47.1% in the period studied. Factors associated with this late presentation were: older age, hospital diagnosis, an increased delay between estimated infection time and diagnosis, and between diagnosis and initial presentation. CONCLUSIONS: The epidemiology of HIV-1 infection in our area has dramatically changed since the beginning of the disease. The increasing delay between estimated infection time and diagnosis is an important cause of the lack of variation in the late presentation rate, and highlights the low impact of early diagnosis strategies.

Leucostasis pulmonar como primera manifestación de una leucemia mieloide aguda sin hiperleucocitosis / Pulmonary leukostasis as a first manifestation of an acute myeloid leukemia without hyperleukocitosis

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