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Objective: To present surveillance data on advanced disease (AD) and late presentation (LP) of HIV in Spain and their determinants., Methods: We included all new HIV diagnoses notified by the autonomous regions that consistently reported such cases throughout the period 2007-2011. Coverage was 54% of the total Spanish population. Data sources consisted of clinicians, laboratories and medical records. AD was defined as the presence of a CD4 cell count <200cells/μL in the first test after HIV diagnosis, while LP was defined as the presence of a CD4 cell count <350cells/μL after HIV diagnosis. Odds ratios and their 95% confidence intervals (OR, 95% CI) were used as the measure of association. Logistic regressions were fit to identify predictors of AD and LP., Results: A total of 13,021 new HIV diagnoses were included. Among these, data on the outcome variable were available in 87.7%. The median CD4 count at presentation was 363 (interquartile range, 161-565). Overall, 3356 (29.4%) patients met the definition of AD and 5494 (48.1%) were classified as LP. Both AD and LP increased with age and were associated with male sex and infection through drug use or heterosexual contact. All immigrants except western Europeans were more prone to AD and LP. Multivariate models disaggregated by sex showed that the effect of age and region of origin was weaker in women than in men., Conclusions: Despite universal health care coverage in Spain, men, immigrants and people infected through drug use or heterosexual contact seem to be experiencing difficulties in gaining timely access to HIV care., (Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objetive: To describe linkage to care among new HIV diagnoses in Spain; and to estimate factors associated to linkage to care within three months after diagnosis., Methods: The distribution of the time elapsing between the date of HIV diagnosis and the date of first determination of CD4 (considered to be the date of linkage to care) was calculated among new HIV diagnoses in 2010 in the seven Autonomous Regions participating, where data on date of CD4 count was available. Linkage to care was considered «correct» if done within three months after diagnosis. Factors associated to correct linkage to care were estimated using logistic regression., Results: A total of 1769 new HIV diagnoses were included. Of them, 83.1% had evidence of linkage to care within a year, and 75.7% were linked within three months after diagnosis. Being an injectable drug user (IDU) was the only factor inversely associated with linkage to care within 3 months (OR = 0.3; 95% CI: 0.2-0.6)., Conclusion: In Spain linkage to care after HIV diagnosis is good, but there is still room for improvement, especially among IDUs., (Copyright © 2013 Elsevier España, S.L. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Objective: To describe the incidence of new HIV diagnoses and its trend in Spain., Methods: All new HIV diagnoses notified to the case-registries of 15 autonomous regions (64% of the total Spanish population) in 2009 were analyzed. To evaluate trends from 2004 to 2009, data from only nine regions were available. Clinical-epidemiological data were obtained from the notification forms. Distributions of new HIV diagnoses and late diagnoses according to several variables were performed. The Poisson distribution was used to evaluate trends., Results: In 2009, 2264 new HIV diagnoses were notified, mostly in men (80%). The median age at diagnosis was 36 years (interquartile range 29-43) and 37.6% of affected individuals were immigrants, mostly from Latin-America and sub-Saharan Africa. The most common transmission category (42.5%) was men who have sex with men (MSM) followed by the heterosexual and parenteral modes of transmission (34.5% and 8.1%, respectively). The median CD4 count at diagnosis was 347 (interquartile range: 152-555), and CD4 count was <350 in 50.2% of patients. From 2004 to 2009, the mean incidence rate of new HIV diagnoses was 91.14 per million inhabitants; an increasing trend for rates in MSM, as well as a decreasing trend for the parenteral mode of transmission, were observed., Conclusions: In Spain, the epidemiology of HIV infection has changed since the mid-1990s. Currently, the most frequent transmission category is sexual transmission, particularly among MSM, and immigrants are an important part of the epidemic. Heterogeneous trends for the three main transmission categories were observed from 2004 to 2009., (Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objective: Among the most severe complications caused by the influenza A virus H1N1 pandemic is the Acute Respiratory Distress Syndrome (ARDS). The main objective of this study was to assess mortality after applying a strict protocol of ventilatory management and to describe the clinical characteristics of the patients., Design: A prospective cohort study., Setting: Intensive care unit (ICU) of the Hospital Enrique Garcés of the City of Quito., Patients: Patients admitted to the ICU with a diagnosis of severe pneumonia, ARDS, and high suspicion of influenza A H1N1., Primary Variables of Interest: Demographic variables, severity, diagnostic scores of community-acquired pneumonia, ventilator management protocol and mortality at 28 days, as principal effect of the study, were collected., Results: 24 patients were studied, 100% with a diagnosis of ARDS, mean age 41.1 (+/-14.8). Severe viral pneumonia predominated in these patients, mean APACHE was 18, average PaO(2)/FiO(2) on admission was 74.9, 100% had multisystemic involvement. A total of 91.3% received oseltamivir 150 mg w/12h for 14 days, the mean time between onset of symptoms and antiviral administration was 6.74 days. Intra-ICU mortality was 16.6%, and 28 days was 16.6%., Conclusions: After applying a strict management protocol for ventilatory management, mortality in this patient group was 16.6. We also stress that obesity and early renal failure were independent risk factors for mortality., (Copyright (c) 2009 Elsevier España, S.L. y SEMICYUC. All rights reserved.)