[Requests for HIV tests and their performance in primary health care. Study of the Sentinel Physician Network of Castilla y León in Spain, 1990-1996]

[Elevated risk of HIV infection in homosexual men even after contact with the health system]

OBJECTIVE

To determine the incidence of HIV seroconversion and to evaluate the characteristics associated with a greater risk of seroconversion in homosexual men in the period 2000-2003.

METHODS

We performed a dynamic cohort study of all homosexual men tested for HIV in 20 ambulatory care centers specialized in diagnosing HIV, located in 19 cities in Spain. The characteristics of the men were analyzed and the seroconversion incidence rate was calculated among those who were followed up.

RESULTS

In the period 2000-2003, a total of 10,189 persons-year of follow-up were accumulated and 167 seroconversions were diagnosed with a seroconversion incidence rate of 16.4 per 1,000 persons-year. Most of the seroconversions (63%) occurred in men younger than 30 years old. The seroconversion rate was higher among homosexual men from Latin America and sub-Saharan Africa than among Spanish men.

CONCLUSIONS

In Spain, the risk of HIV transmission among men who have sex with men is still high. Therefore, this population continues to be a high priority group in HIV prevention. A proportion of HIV diagnoses among immigrants concern infections acquired after their arrival to Spain, probably due to conditions of greater social vulnerability. Reinforcing and renewing prevention strategies directed at this population would be timely.

[Prevalence of the HIV infection in patients seen at specialized diagnosis centers in 9 cities in Spain from 1992 to 2001]

OBJECTIVE

To describe the prevalence of HIV infection in persons tested between 1992 and 2001.

DESIGN

Descriptive, cross-sectional epidemiological study.

SETTING

10 ambulatory centers specialized in diagnosing HIV, located in 9 cities in Spain.

PARTICIPANTS

53,183 persons older than 12 years, tested for the first time for HIV.

MAIN MEASURES

Number of persons tested per year, number of persons diagnosed as seropositive for HIV according to sex, age group and category of exposure.

RESULTS

The number of persons tested increased from 4401 in 1992 to 6407 in 2001. Approximately half reported heterosexual risk exposure/exposure through high-risk heterosexual behaviors, excluding prostitution. Intravenous drug users (IVDU) increased from 15.3% in 1992-1993 to 1.4% in 2000-2001, and women prostitutes/female sex workers increased from 6.7% to 25.1%. A total of 2898 persons were diagnosed as having HIV infection; 78% of them were men. The number of diagnoses decreased from a high of 1058 in 1992-1993 to 304 in 2000-2001, and this trend was seen for all categories of exposure except female prostitutes and men with heterosexual risk factors. The prevalence decreased from 14% in 1992 to 2% in 2001. There were decreases in all categories of exposure, especially during the first years of the study, with a tendency to level off. In 2001 the prevalence figures were 23.8% for IVDU, 7.9% for homosexual men and women, 0.8% for female sex workers and 1% for other heterosexual men and women.

CONCLUSIONS

The specialized diagnostic centers play an important role in diagnosing HIV, and this service complements primary care services. Greater efforts are needed in the prevention of HIV infection.

[Evaluation of drug addicts with associated pathology. Clinical and therapeutic aspects of the integral attention]

We review the evaluation and treatment of patients with drug addictions complicated by other acute or chronic diseases from the perspective of the hospital setting. The spectrum of drug addiction's complications is broad and in many instances it is predetermined by the abuse substance and its administration route. Some complications of intravenous drug addiction have dramatically decreased in the last few years as a result of a better knowledge of hygienic customs and after the implementation of some health interventions such as the provision of sterile injectable devices. Two highly prevalent infections --HIV/AIDS and hepatitis C-- remain from the period in which most HIV infections owed to the intravenous use of heroin. Of note, these two infections largely account for the survival and quality of life of those who quit their addiction. On the other hand, it is still common the hospitalization of patients with both alcohol dependence and intercurrent diseases in whom their drug addiction may pass unnoticed. Other common situations include the treatment of acute patients with cocaine addiction and psychiatric comorbidity, patients under methadone therapy and, in general, all those cases in which, in emergency, ordinary hospital wards and specialized units, a wide differential diagnosis is raised when there is a coexistence of signs and symptoms common to an addiction, infection and/or intoxication. An integral vision of drug addiction and its complications, as well as the clinical evaluation of all health problems, is fundamental for the prognosis and treatment of these patients.

[Incidence and clinical characteristics of maculopapular exanthemas of viral aetiology]

OBJECTIVE

To estimate the incidence of maculo-papular viral exanthemas and to describe the epidemiological and clinical patterns.

DESIGN

Observational descriptive study with a sample design.

PARTICIPANTS AND SETTING

154 practitioners from the Castilla y León Sentinel Network with a surveilled population of 23 237 people-year under 15 years old, notified in 2002 the cases of diseases by means of a standard form with the variables and inclusion and exclusion criteria.

MAIN MEASUREMENTS

It was included the maculo-papular exanthemas associated to a presumable systemic virus disease in patients under 15 years old. It was excluded the infectious mononucleose, the chickenpox, and other non viral infections or exanthemas.

RESULTS

368 cases were notified which represent a incidence rate of 158.37 cases per 10 000 (95% CI, 142.31-174.42). The incidence was maximum under four years old, more than 350 per 10 000, decreasing significantly in children over this age. Erythema infectiousum presented the highest rate, followed by exanthema subitum. The exanthemas caused by measles or rubella were insignificants.

CONCLUSIONS

Childhood exanthematous diseases of presumable viral etiology have an important incidence in primary care, although the majorities are banal and self-limited diseases. Clinical characteristics supported the suspicion diagnosis, which was consistent with the observed epidemiological description and expected presentations of each disease. Although serological analysis could diminish the uncertainly on notification and control of diseases submited to especial programs of vaccination and eradication, they would not improve substantially the diagnosis and treatment of these patients.