[Public health and eradication of infection by the Human Immunodeficiency Virus]. / Salud Pública y erradicación de la infección por el Virus de la Inmunodeficiencia Humana.

The Human Immunodeficiency Virus (HIV) is integrated into the cellular genome remaining active or latent indefinitely. Antiretroviral therapy suppresses viral replication to undetectable levels but does not eradicate the virus. New therapeutic strategies are being developed, such as gene therapy, shock and kill, neutralizing monoclonal antibodies or therapeutic vaccines, which together with biomedical interventions, especially pre-exposure prophylaxis, are generating high optimism among the scientific community as weapons for a viral eradication. However, we do not pay enough attention to human behavior as an essential element to obtain eradication. We need to promote Public Health with the necessary human and economic tools to achieve eradication. The sole development of effective therapeutic strategies will not prevent the human immunodeficiency virus from continuing among us if we do not promote and develop Public Health.

El Virus de la Inmunodeficiencia Humana (VIH) se integra en el genoma celular y permanece activo o latente de manera indefinida. La terapia antirretroviral suprime la replicación viral a niveles indetectables, pero no erradica el virus. Nuevas estrategias terapéuticas se están desarrollando, tales como la terapia génica, el llamado shock and kill, los anticuerpos monoclonales neutralizantes o las vacunas terapéuticas, que sumadas a intervenciones biomédicas (especialmente la profilaxis pre-exposición) están generando un elevado optimismo entre la comunidad científica como armas para la erradicación viral. Sin embargo, no prestamos suficientemente atención al comportamiento humano como elemento imprescindible para obtener la eliminación definitiva. Necesitamos potenciar la Salud Pública con las herramientas humanas y económicas pertinentes para poder alcanzar dicha erradicación. El desarrollo aislado de estrategias terapéuticas eficaces no evitará que el virus de la inmunodeficiencia humana continúe entre nosotros si no impulsamos y desarrollamos la Salud Pública.

Salud Pública y erradicación de la infección por el Virus de la Inmunodeficiencia Humana / Public health and eradication of infection by the Human Immunodeficiency Virus

El Virus de la Inmunodeficiencia Humana (VIH) se integra en el genoma celular y permanece activo o latente de manera indefinida. La terapia antirretroviral suprime la replicación viral a niveles indetectables, pero no erradica el virus. Nuevas estrategias terapéuticas se están desarrollando, tales como la terapia génica, el llamado shock and kill, los anticuerpos monoclonales neutralizantes o las vacunas terapéuticas, que sumadas a intervenciones biomédicas (especialmente la profilaxis pre-exposición) están generando un elevado optimismo entre la comunidad científica como armas para la erradicación viral. Sin embargo, no prestamos suficientemente atención al comportamiento humano como elemento imprescindible para obtener la eliminación definitiva. Necesitamos potenciar la Salud Pública con las herramientas humanas y económicas pertinentes para poder alcanzar dicha erradicación. El desarrollo aislado de estrategias terapéuticas eficaces no evitará que el virus de la inmunodeficiencia humana continúe entre nosotros si no impulsamos y desarrollamos la Salud Pública

The Human Immunodeficiency Virus (HIV) is integrated into the cellular genome remaining active or latent indefinitely. Antiretroviral therapy suppresses viral replication to undetectable levels but does not eradicate the virus. New therapeutic strategies are being developed, such as gene therapy, shock and kill, neutralizing monoclonal antibodies or therapeutic vaccines, which together with biomedical interventions, especially pre-exposure prophylaxis, are generating high optimism among the scientific community as weapons for a viral eradication. However, we do not pay enough attention to human behavior as an essential element to obtain eradication. We need to promote Public Health with the necessary human and economic tools to achieve eradication. The sole development of effective therapeutic strategies will not prevent the human immunodeficiency virus from continuing among us if we do not promote and develop Public Health

A feasibility study for 3 strategies promoting HIV testing in primary health care in Madrid, Spain (ESTVIH project).

RATIONALE AND OBJECTIVES: Late diagnosis of HIV infection is a public health problem. Framed by the international guidelines for improving HIV testing, in 2014, the Spanish Ministry of Health published a guide of recommendations to promote early diagnosis of HIV in health care settings. In the Community of Madrid, in order to implement these recommendations, we defined 3 new HIV testing strategies in primary health care. The objectives of this study were to know the interest of professionals and the acceptability for patients towards these strategies. METHODS: We performed a quasi-experimental study to assess the feasibility of the implementation of new strategies (indicator condition, risk based, and universal offer) to promote early detection of HIV infection in the framework of the ESTVIH project. The centres participating in this project were randomly chosen among centres located in the health areas with the highest incidence of HIV infection. The feasibility was assessed in 6 centres. We considered outcomes by strategy in relation to the participation of professionals (family physician and nursing) and patients. RESULTS: Overall, 56.9% of eligible professionals agreed to take part in the study; however, the percentage of professionals who recruited patients was 25.9%. This percentage was higher in the indicator condition strategy (47.2%, versus 18.5% in the universal offer and 14.3% in the risk-based strategy, P-value < 0.05). The test uptake percentage was greater than 80%, and there were no statistically significant differences between strategies. CONCLUSION: Different strategies promoting HIV testing in primary care had different acceptability among professionals and similar among patients. At the end of the ESTVIH project, these results will be complemented with others related to the contribution of each strategy to improving the early diagnosis of HIV infection.

[Late diagnosis of human immuno deficiency virus infection in the Madrid region (2007-2011)]. / Retraso diagnóstico y enfermedad avanzada en la infección por el virus de la inmunodeficiencia humana en la Comunidad de Madrid (2007-2011).

BACKGROUND: Early HIV infection diagnosis means tremendous benefits both for the individual, in particular, and public health, in general. The aim is to analyze the prevalence of delayed HIV-infection diagnosis in Madrid region and its related factors. METHODS: Descriptive study of HIV-diagnosed patients from January 2007 to September 2011. A study was conducted on all new cases where the CD4+ count was below 200/µl ('presentation with advanced HIV disease', PAD), 350/µl ('late diagnosis', LD) and 500/µl. Descriptive and multivariate analysis by means of logistical regression. RESULTS: 3,347 HIV-diagnoses were reported, with CD4 count data available in 2,896 cases. 29.7% of which were PAD, 48.1% were LD and 67.7%<500 CD4+. Both in Spaniards and foreigners, age and mode of transmission intravenous drug users (IDU) and heterosexual (HTX), were independent variables regarding late presentation. In foreigners, geographical origin was likewise an independent variable. In Spaniards the probability of contracting PAD and LD rise with age and was higher in HTX (OR:3.38 [95%CI:2.29-4.98) and 2.44 (1.67-3.56)] and IDU [OR: 2.41 (1.47-3.94) and 1.89 (1.19-3.01)] than men who have sex with men (MSM). For their part, probability of PAD and LD in foreigners increased with age and was higher in HTX (OR: 2.04 [1.44-2.89) and 2.29 (1.61-3.25)] than MSM and Latin American nationals (OR: 2.56 [1.48-4.42) and 2.29 (1.49-3.51)] and Sub-Saharan Africans (OR: 2.83 [1.52-5.28) and 2.52 (1.48-4.30)] than Western Europeans. CONCLUSIONS: In the Madrid Region a high number of new diagnoses are carried out in patients who should have already been under treatment. What is more some of them also present a significant degree of immuno-depression. Age, mode of transmission and geographical origin are closely related to late presentation.

Retraso diagnóstico y enfermedad avanzada en la infección por el virus de la inmunodeficiencia humana en la Comunidad de Madrid (2007-2011) / Late diagnosis of human immuno deficiency virus infection in the Madrid Region (2007-2011)

Fundamentos: El diagnóstico precoz de la infección por VIH conlleva un beneficio a nivel individual y de salud pública. El objetivo fue determinar la prevalencia de retrasos en el diagnóstico de infección por VIH en la Comunidad de Madrid (CM) y factores asociados. Métodos: Estudio descriptivo de diagnósticos de VIH de enero- 2007 a septiembre-2011. Se estudiaron todos los nuevos diagnósticos con linfocitos CD4+ menores de 200/μl (presentación enfermedad avanzada, PEA), 350/μl (retraso diagnóstico, RD) y 500/μl. Análisis descriptivo y multivariante mediante regresión logística. Resultados: Se notificaron 3.347 casos. Se disponía de cifra de linfocitos CD4+ en 2.896 casos. El 29,7 presentaron PEA, 48,1% RD y 67,7% <500CD4+/μ. Tanto en autóctonos como foráneos, la edad y mecanismo de transmisión (usuarios de drogas inyectadas (UDI) y heterosexual (HTX)) fueron variables independientes relacionadas con el diagnóstico tardío. En foráneos, el área geográfica de origen fue, igualmente, una variable independiente La probabilidad de PEA y RD en españoles aumentó con la edad de diagnóstico y fue mayor en HTX [OR:3,38 (IC95%:2,29-4,98) y 2,44 (1,67-3,56)] y UDI [OR:2,41 (1,47-3,94) y 1,89 (1,19-3,01)] respecto hombres que tienen sexo con hombres (HSH). La probabilidad de PEA y RD en foráneos aumentó con la edad de diagnóstico y fue mayor en HTX (OR:2,04 (1,44-2,89) y 2,29 (1,61-3,25)) respecto HSH y en procedentes de Latinoamérica [OR:2,56 (1,48-4,42) y 2,29 (1,49-3,51)] y África Subsahariana [OR:2,83 (1,52-5,28) y 2,52 (1,48-4,30)] respecto originarios de Europa Occidental. Conclusiones: En la CM un elevado número de nuevos diagnósticos se producen en pacientes susceptibles a tratamiento, parte de ellos además presentan un grado importante de inmunosupresión. La edad, mecanismo de transmisión y país de origen se relacionan con un diagnóstico más tardío(AU)

Background: Early HIV infection diagnosis means tremendous benefits both for the individual, in particular, and public health, in general. The aim is to analyze the prevalence of delayed HIV-infection diagnosis in Madrid region and its related factors. Methods: Descriptive study of HIV-diagnosed patients from January 2007 to September 2011. A study was conducted on all new cases where the CD4+ count was below 200/μl (‘presentation with advanced HIV disease’, PAD), 350/μl (‘late diagnosis’ ,LD) and 500/μl. Descriptive and multivariate analysis by means of logistical regression. Results: 3,347 HIV-diagnoses were reported, with CD4 count data available in 2,896 cases. 29.7%of which were PAD, 48.1%were LD and 67.7%<500 CD4+. Both in Spaniards and foreigners, age and mode of transmission intravenous drug users (IDU) and heterosexual (HTX), were independent variables regarding late presentation. In foreigners, geographical origin was likewise an independent variable. In Spaniards the probability of contracting PAD and LD rise with age and was higher in HTX (OR:3.38 [95%CI:2.29-4.98) and 2.44 (1.67-3.56)] and IDU [OR: 2.41 (1.47-3.94) and 1.89 (1.19-3.01)] than men who have sex with men (MSM). For their part, probability of PAD and LD in foreigners increased with age and was higher in HTX (OR: 2.04 [1.44-2.89) and 2.29 (1.61-3.25)] than MSM and Latin American nationals (OR: 2.56 [1.48-4.42) and 2.29 (1.49-3.51)] and Sub-Saharan Africans (OR: 2.83 [1.52-5.28) and 2.52 (1.48-4.30)] thanWestern Europeans. Conclusions: In the Madrid Region a high number of new diagnoses are carried out in patients who should have already been under treatment. What is more some of them also present a significant degree of immuno-depression. Age, mode of transmission and geographical origin are closely related to late presentation(AU)

[Biodefense: a new challenge for microbiology and public health]. / Biodefensa: un nuevo desafío para la microbiología y la salud pública.

Bioterrorism and the potential use of biological weapons has become an important concern of governments and responsible authorities. An example of this threat occurred in 2001 in the USA, when letters were sent containing spores of the agent that produces anthrax; this resulted in some deaths, and caused panic and negative effects on the world economy. If this small-scale event was able to cause such a huge impact, the repercussions of a massive attack could be catastrophic. In many countries, these events have resulted in the implementation of measures directed toward preventing and responding to bioterrorist threats and acts. As a whole, these measures are known as biodefense. This article briefly analyzes several aspects related to detecting and identifying acts of bioterrorism, and considers the biological agents that are implicated. The microbiological diagnosis that allows identification of the causal agent, a key point for taking suitable control measures, is also included.

Biodefensa: un nuevo desafío para la microbiología y la salud pública / Biodefense: a new challenge for microbiology and public health

El bioterrorismo y el uso potencial de armas biológicas se ha convertido en una preocupación importante de los gobiernos y autoridades competentes. Como ejemplo, el envío de cartas con esporas del agente causante del carbunco en Estados Unidos en 2001 ocasionó varias muertes, causó pánico y tuvo repercusiones negativas en la economía mundial. Si este incidente, a pequeña escala, produjo semejante impacto, los efectos de un ataque masivo podrían ser catastróficos. En muchos países éste fue el punto que marcó el inicio de la toma de medidas encaminadas a prevenir y responder ante amenazas y actos bioterroristas, acciones que, en su conjunto, se conocen como biodefensa. Este artículo pretende analizar someramente algunos aspectos relacionados con la detección e identificación de este tipo de acciones y los agentes biológicos implicados. Se considera el diagnóstico microbiológico que permite la identificación del agente causal, punto clave para la toma de medidas de control adecuadas (AU)

Bioterrorism and the potential use of biological weapons has become an important concern of governments and responsible authorities. An example of this threat occurred in 2001 in the USA, when letters were sent containing spores of the agent that produces anthrax; this resulted in some deaths, and caused panic and negative effects on the world economy. If this small-scale event was able to cause such a huge impact, the repercussions of a massive attack could be catastrophic. In many countries, these events have resulted in the implementation of measures directed toward preventing and responding to bioterrorist threats and acts. As a whole, these measures are known as biodefense. This article briefly analyzes several aspects related to detecting and identifying acts of bioterrorism, and considers the biological agents that are implicated. The microbiological diagnosis that allows identification of the causal agent, a key point for taking suitable control measures, is also included (AU)