S. Benet Garrabé 1 , G. Verdejo Muñoz 2 , L.J. Garcia-Fraile Fraile 3 , A.C. Silva Klug 4 1 Hospital Universitari Germans Trias i Pujol, Badalona 2 Hospital Clínico Lozano Blesa, Zaragoza 3 Hospital U La Princesa, Madrid 4 Hospital Universitari de Bellvitge, Barcelona HIV/AIDS SITUATION IN SPAIN THE HIV/AIDS EPIDEMIC IN SPAIN DELAY ON HIV DIAGNOSIS NEW HIV INFECTIONS IN SPAIN (2015) 10 new cases per day 3.428 new HIV diagnosis in 2015 497 new AIDS diagnosis in 2015 140.700 people living with HIV 85.720 total AIDS diagnosis 85,9% 14,1% 36 years old GENDER HIV TRANSMISSION ORIGIN 53,6% 0% 25,4% 2,8% MSM Mother-to-child Heterosexual Injection drug use Spain Other countries 69,7% 30,3% 46,5% <200 CD4 27,1% 200-349 CD4 19,4% <350 CD4 Sevilla Mardrid Barcelona BCN Checkpoint Adhara Apoyo Positivo Community centers for early diagnosis of STD 54,5% of women 45,3% of men 38,4% of 54,4% of 60% of MSM Heterosexual Injection drug users < < < Heterosexual 63,1% of New HIV/AIDS diagnosis in Spain according to gender, age, mechanism of HIV transmission and origin. Despite MSM represent the higher volume of new HIV infections, they have a lower delayed HIV diagnosis ratio. In Spain, there are three community centers that together with healthcare centers promote early diagnosis of STD on MSM. CHANGES IN THE NATURAL HISTORY OF HIV In 2015, 46,5% of new HIV infected people presented a delayed HIV diagnosis. THE HIV TREATMENT CASCADE CLINICAL MANAGEMENT 100% 82% 76% 81% People living with HIV HIV diagnosed On cART Virally supressed 50% An estimated 50% people living with HIV in Spain are virally supressed. Aging Antiretroviral drug toxicity Coinfection HCV, HPV, syphilis Drug-drug interactions Comorbidities cardiovascular, bone, kidney, neurocognitive, neoplasia Early detection of anal cancer Anoscopy, anal-rectal cytology Multidisciplinary attention AIDS RELATED DISEASES 0 10 20 30 Extrapulmonary cryptococcosis HIV-related encephalopathy Bacterial pneumonia Progressive multifocal leukoencephalopathy Cytomegalovirus Cerebral toxoplasmosis No hodgkin lymphoma wasting syndrome Kaposi's sarcoma Esophageal candidiasis Tuberculosis P. jirovecii pneumonia % HIV/HCV COINFECTION MORTALITY CAUSES IN HIV INFECTED INDIVIDUALS A multidisciplinary attention is offered to HIV infected patients, with special care to other STD and anal cancer detection. P. jirovecii pneumonia is the most frequent AIDS related disease (27%), followed by tu- berculosis (21,4%) and esophageal candi- diasis (13,2%). 2000 2005 2010 2015 0 3 6 9 12 Rate per 100.000 population Gonorrhea Syphilis TRENDS IN SEXUALLY TRANSMITTED DISEASES The incidence of gonorrhea and syphilis in the HIV population has in- creased 4-fold over the last 10 years. The incidence of HIV/HCV coinfection has dropped significantly due to the appearance of new antiviral drugs and the reduction of injection drug users. 4X 497 7494 New HIV/AIDS cases 2015 1995 1981 Number of HIV/AIDS deaths 5857 2015 1995 1981 633 1,4/100.000 inhabitants 513 120 HAART Since 1997, with the begining of HAART there was a marked decline in the number of new HIV/AIDS diagnosis and the number of HIV/ AIDS related deaths. TDF/FTC + RAL or TAF/FTC + RAL TDF/FTC + DTG or TAF/FTC + DTG ABC/3TC + DTG TAF/FTC + EVG/COBI TDF/FTC + RPV TDF/FTC + DRV/r TDF/FTC + EVG/COBI Preferred combinations Alternatives The rate of new HIV diagnosis decreases over time among drug injection users and heterosexual trans- mission, but remains stable for MSM until 2014. EVOLUTION OF NEW HIV DIAGNOSIS ACCORDING TO THE MECHANISM OF TRANSMISSION 2009 2011 2013 2015 0 500 1000 1500 2000 Number of cases Drug injection users Heterosexual MSM Overall, AIDS associated diseases, non-AIDS-defining malingnancies and liver disease are the main causes of mortality in HIV infected individuals. (Alejos B. et al. Medicine (Baltimore); sep 2016). AIDS associated diseases Non-AIDS-defining malignancies Liver disease Non-AIDS infections Cardiovascular diseases Pulmonary diseases Drug abuse Suicide External causes Other (Vigilancia epidemiológica del VIH y SIDA en España. Ministerio de Sanidad, Asuntos Sociales e Igualdad, Junio 2016) (Vigilancia epidemiológica del VIH y SIDA en España. Ministerio de Sanidad, Asuntos Sociales e Igualdad, Junio 2016) (Vigilancia epidemiológica del VIH y SIDA en España. Ministerio de Sanidad, Asuntos Sociales e Igualdad, Junio 2016) (Gourlay A. et al. CID; June 2017)