A low-cost, sustainable, second generation system for surveillance of people living with HIV in Spain: 10-year trends in behavioural and clinical indicators, 2002 to 2011
Diez M., Diaz A., Garriga C., Pons M., Ten A., Marcos H., Gutiérrez G., Moreno S., González-García J., Barrios AM., Arponen S., García MT., Royo MC., Toledo J., González G., Aranguren R., Izquierdo A., Viloria LJ., Elizalde L., Martínez E., Castrillejo D., López I., Redondo C., Cano A., Egido M., Gracia MP., Letona S., Arazo P., Martínez R., Tuya MJ., Suárez R., Costales J., Garcia-Alcalde ML., Escribano D., Rodríguez M., Vázquez MT., Asensi V., González A., Fernández P., García E., Payeras A., Riera M., Cantarero R., Rodríguez E., Gómez JL., Colino ME., Cárdenas MA., Linares M., Pueyo V., Fariñas MC., Teira R., Carrascosa M., Beato JL., Portillo H., Barbera JR., López de la Osa A., Pereda C., Geijo P., Rodríguez M., Cuadra F., Marcos F., Garcinuño MA., Lorenzo JF., Cancelo P., Sánchez M., Carro JA., Bahamonde A., Sánchez J., Alba A., Cordero M., Elizaga J., del Valle M., Bachiller P., Hinojosa C., Gamazo F., Chocarro A., Gonzalez L., Vera A., Galán M., Gutiérrez MC., Medina M., Martín C., Alonso J., Oteo JA., Sanz J., Barrios AM., Fabregat JF., Ryan P., Miralles P., Peñalver R., Pulido F., Losa JE., Estrada V., Martin P., Perez JL., Portillo A., Serrano R., Fernández A., Toledo C., García JA.
A second-generation surveillance system of people infected with human immunodeficiency virus (HIV) has been implemented in Spain. Behavioural and clinical data were collected between 2002 and 2011 through an annual one-day, cross-sectional survey in public hospitals, including all in- and outpatients receiving HIV-related care on the survey day. Mean age increased over time (from 38.7 years in 2002 to 43.8 years in 2011) and 68.4% of the 7,205 subjects were male. The proportion of migrants increased from 6.1% to 15.9%, while people who inject or used to inject drugs (PWID and Ex-PWID) decreased and men who have sex with men (MSM) and heterosexuals increased. Unprotected intercourse at last sex increased among MSM and PWID/Ex-PWID. Patients receiving antiretroviral treatment increased significantly from 76.0% to 88.2% as did those with CD4 T-cell counts ≥350 (from 48.2% to 66.9%) and viral copies <200 (from 47.0% to 85.2%). HIV-infected people with hepatitis C virus RNA decreased from 36.0% in 2004 to 29.9% in 2011, while those with HBsAg remained stable at around 4.4%. Implementation of a low-cost, sustainable system for second-generation surveillance in people living with HIV is feasible. In Spain, the information obtained has helped to define and refine public health policy and document treatment effectiveness.