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Clinical and Epidemiological Trends and Patterns of Antiretroviral Therapy among HIV+ Patients PISCIS Cohort, Spain
A Jaén*1, J Casabona1, J M Miro2, J M Gatell2, C Tural3, D Podzamczer4, E Ferrer4, S Riera5, F Segura6, L Force7, J Vilaró8, A Masabeu9, I Garcia10, E Dorca11, J Altés12, and PISCIS study group
1CEESCAT, Barcelona, Spain; 2Hosp. Clin., Barcelona, Spain; 3Hosp. Univ. Germans Trias i Pujol, Barcelona, Spain; 4Hosp. de Bellvitge, Barcelona, Spain; 5Hosp. de Son Dureta, Palma de Mallorca, Spain; 6Consorci Sanitari Parc Taulí, Sabadell, Spain; 7Hosp. de Mataró, Mataró, Spain; 8Hosp. Gen. de Vic, Vic, Spain; 9Hosp. de Palamós, Palamós, Spain; 10Hosp. Creu Roja, Hosp. of Llobregat, Spain; 11Hosp. de Manresa, Manresa, Spain; and 12Hosp. Alt Penedès, Vilafranca, Spain
Background: Spain has the
second highest incidence of AIDS in Europe.
After HAART era the natural history of HIV infection have changed. The aim of
this study is to describe the evolution of the epidemiological, clinical and
biological characteristics of HIV+ patients recruited from 1998 in
an ongoing multi-center cohort study.
Methods: The
PISCIS project includes newly attended HIV+
patients (≥16 years) from 10 hospitals from Catalonia and 1 from Balearic
islands. Epidemiological, clinical, biological, and antiretroviral
therapy (ART) data from each
patient is sent to the Coordination
Center every 4 months.
For the purpose of this analysis data was censured at December 2002 and
analysis was done using the Mantel’s X2 test for trend.
Results:
During the study period a total of 4759 patients (75% men, mean age 39)
were recruited, and the mean follow-up was 21months. Of the group, 2591 were
diagnosed during the study period (newly diagnosed patients). Overall, the
percentage of patients that every year are on ART
remains constant around 85%. Patients on 3 or more drug regimens has increased
over time (9% in 1998 to 29% in 2002, p
<0.001), while the proportion of patients using a protease inhibitor (PI) in
triple combination therapies has decreased (82% to 32%, p <0.001). Among newly diagnosed patients, the individuals under
35 years has increased across years (p
<0.0001), being 45% in 2002, and the proportion of men and women have
remained constant. The highest proportion was found within heterosexual
transmission route (76% in women and 29% in men, in 2002) and homo/bisexual
among men (40%). The AIDS defined disease has decreased across the years both,
at the recruitment (from 24% in 1998 to 17% in 2002, p <0.001) and during follow-up (30% to 20%, p <0.001). Among 1963 subjects that had the first CD4 count
within a 6-month period of HIV diagnosis, 44% had a CD4 below 200 c/mm3 in
2002, without differences across the years.
Conclusions: In our
setting ARV regimens have changed according to the recommended protocols, being
combination therapy more frequent and decreasing the use of IP. Over time the
age of newly diagnosed have decreased, and the more frequent route of infection
is heterosexual contacts. Interestingly, the diagnosis delay is high and it did
not change over time. Cohort studies can describe the natural history of HIV
infection, but also they provide important data for health care and
intervention programs improvement.
Keywords: HIV cohort; Epidemiological characteristics; Antiretroviral patterns
