02.07.01. Investigación y comunicación científica

Trends in Hepatitis C Virus Infection Prevalence Among People With HIV in Spain Over 2 Decades (2002-2023)

Tue, 17 Mar 2026 00:00:00 GMT

Trends in Hepatitis C Virus Infection Prevalence Among People With HIV in Spain Over 2 Decades (2002-2023) Berenguer, Juan; Fanciulli, Chiara; Arcos, María M; Vivancos, María J; Domingo, Pere; Hernando, Asunción; Barrado, Julia; Ryan, Pablo; Navarro, Jordi; Palacios, Rosario; Morano, Luis E; Iribarren, José A; Martínez, Rosa; Galindo, María J; de Los Santos, Ignacio; López-Cruz, Ian; Rivero, Antonio; Pérez-Latorre, Leire; Giner, Livia; Fariñas, María C; García, Coral; Montero-Alonso, Marta; Ferrero, Óscar L; Villoslada, Aroa; Soler-González, Josefa F; Sanz, José; Rodríguez, Sergio; Losa, Juan E; Bernal-Morell, Enrique; Veloso, Sergio; Pérez-Martínez, Laura; Mateos, Fernando; Arbonés, Laia; Franch, Raquel; Corps, Diana; Martín, Cristina; Alonso-García, Gerardo; Clavero-Olmos, Marta; Silvariño, Rafael; Teira, Ramón; Belinchón, Olga; de Miguel, Marta; Jarrín, Inmaculada; González-García, Juan BACKGROUND: Hepatitis C virus (HCV) has significantly impacted people with human immunodeficiency virus (HIV). Harm reduction programs, changing transmission patterns, and direct-acting antivirals (DAAs) have profoundly altered HIV/HCV coinfection trends. This study evaluates HCV prevalence among people with HIV in Spain over 2 decades. METHODS: We conducted 9 cross-sectional studies (2002-2023) in 39-43 centers. Sampled individuals were randomly sampled from people with HIV actively followed up at these centers, with proportional allocation. Main outcomes included the prevalence of anti-HCV antibody and active HCV infection (HCV RNA--positive result). RESULTS: The reference population ranged from 31 800 to 47 006, with sample sizes of 1260-1867. HIV transmission patterns shifted from 2002 to 2023, with injection drug use decreasing from 55% to 21% and the proportion of men who have sex with men increasing from 17% to 46%. HCV seroprevalence fell from 60.8% to 27.4%, and active infection from 46.3% to 0.9%. In the DAA era (2015-2023), active HCV infection dropped by 100% in heterosexuals, 94% in people who inject drugs, and 71% in men who have sex with men. Treatment uptake increased from 23% in 2002 to 99% by 2023 with all-oral DAAs. The prevalence of cirrhosis among active HCV cases peaked at 23.1% in 2015 but fell to 0% by 2021. Among those achieving sustained virologic response, cirrhosis prevalence was 20.4% in 2023. CONCLUSIONS: HIV/HCV coinfection has drastically declined in Spain, with active HCV infection prevalence <1% since 2021. DAAs were pivotal in this achievement. However, cirrhosis remains a concern among those with sustained virologic response. Ongoing surveillance and prevention efforts are essential to sustain these gains and address residual risks.

Genotyping not required for sustained effectiveness of long-acting cabotegravir plus rilpivirine: evidence from the RELATIVITY cohort

Wed, 01 Apr 2026 00:00:00 GMT

Genotyping not required for sustained effectiveness of long-acting cabotegravir plus rilpivirine: evidence from the RELATIVITY cohort Buzón-Martín, Luis; Bernardino, José-Ignacio; Galindo-Puerto, María-José; Martín-Torres, Juan; Alemán-Valls, María-Remedios; Torralba-González-de-Suso, Miguel; Díaz-de-Santiago, Alberto; Fanjul, Francisco; Rodríguez, Adrián; Cabello-Úbeda, Alfonso; Pedrero-Tome, Roberto; Crusells-Canales, María-José; Calzado-Isbert, Sonia; Aguilera-García, María; Hidalgo-Tenorio, Carmen; Morano, Luis; Vinuesa-García, David; de-Andres-David, Carlos; Bernal-Morell, Enrique; Martínez-Álvarez, Rosa-María; Cabello-Clotet, Noemi; Tiraboschi, Juan; Gimeno-García, Alejandra; Vivancos, María-Jesús; Troya, Jesus OBJECTIVES: Long-acting injectable cabotegravir and rilpivirine (LAI CAB+RPV) provides an alternative to daily therapy for people with HIV (PWH) with virologic suppression. Although genotypic testing is recommended before switching, its real-world clinical value is unclear. We assessed outcomes after switching to LAI CAB+RPV with or without available genotypes in the Spanish RELATIVITY cohort. DESIGN: RELATIVITY is a multicenter, ambispective cohort study assessing the effectiveness and safety of LAI CAB+RPV in adults with HIV across 58 centers in Spain. METHODS: Posthoc analysis of 3146 participants, focusing on the availability of genotypic resistance data before switching. RESULTS: Of the 3146 participants, 53.5% ( n = 1682) did not have genotypes available. The median follow-up was 13.3 months [interquartile range (IQR) 8.6, 18.9] in the no-genotype group and 14.9 months (IQR 9.0, 19.2) in the genotype group ( P = 0.003). Both groups maintained high virological suppression rates (>93%) up to the 23rd month of follow-up, with no significant differences observed in virological or immunological outcomes. Virologic failure rates (0.5% vs. 1.0%; P = 0.476) and permanent discontinuation rates (6.1% vs. 6.6%; P = 0.804) were similar. Of the 20 participants with virologic failure, 12 had genotype data. After resuming oral antiretroviral therapy, 8 of those with and 4 of those without the genotype achieved undetectable viral loads. Adherence to injection schedules and changes in body mass index were comparable. CONCLUSIONS: In this large real-world cohort, the absence of genotypic data did not affect LAI CAB+RPV effectiveness in virologically suppressed PWH. Limitations, including ambispective design, short follow-up, and low non-B subtype prevalence, may limit generalizability.

Expert Opinion and Evidence-Based Review on Maintenance Therapy Step-Down in Patients With Severe Asthma Controlled With Biologics.

Wed, 01 Apr 2026 00:00:00 GMT

Expert Opinion and Evidence-Based Review on Maintenance Therapy Step-Down in Patients With Severe Asthma Controlled With Biologics. Plaza, Vicente; Soto-Campos, Gregorio; Miralles-López, Juan-Carlos; Padilla-Galo, Alicia; Martínez-Moragon, Eva; Rodríguez, Fernando; Mosteiro, Mar; Ausin, Pilar; Cebollero, Pilar; Quirce, Santiago; Almonacid, Carlos INTRODUCTION: Severe asthma (SA) management requires a comprehensive, individualized approach with continuous pharmacological treatment adjustments. In SA patients controlled with biologics, decisions on how to adjust maintenance therapy remain a clinical challenge, as current guidelines provide only general recommendations but lack specific practical guidance on how to implement step-down strategies. MATERIAL AND METHODS: A literature review about maintenance therapy step-down in SA patients was conducted, complemented by five regional expert meetings across Spain. A total of 87 allergists and pulmonologists from referral hospitals discussed four clinical questions: whether step-down is a potential therapeutic goal, the minimum clinical conditions required to initiate tapering, the duration of disease control needed, and the preferred sequence of therapy reduction. Quantitative insights were captured through televoting, complemented by structured discussions. RESULTS: Experts agreed that maintenance therapy step-down can be considered a potential therapeutic objective in patients with SA who achieve sustained control with biologics. Key conditions identified to start it included absence of exacerbations, nonuse of oral corticosteroids, adequate symptom control and preserved lung function for at least 6 or 12 months. A stepwise sequence for stepping-down maintenance therapy was established, prioritizing withdrawal of leukotriene receptor antagonists and high-to-low-dose reduction of inhaled corticosteroids, and finally withdrawal of long-acting beta-agonists, while maintaining low-dose inhaled corticosteroids. CONCLUSIONS: Expert perspectives, together with clinical trial and real-world evidence, support a gradual, individualized approach guided by objective markers and close monitoring. The algorithm proposed will provide clinicians with a structured, evidence-informed framework to guide the safe and effective reduction of SA maintenance therapy in real-world practice.

Prescription Trends and Clinical Decision-Making in Neuropathic Pain Pharmacological Treatment: Results From a Cross-Sectional Survey by the Spanish Pain Society

Sun, 01 Mar 2026 00:00:00 GMT

Prescription Trends and Clinical Decision-Making in Neuropathic Pain Pharmacological Treatment: Results From a Cross-Sectional Survey by the Spanish Pain Society Huerta, Miguel-A; Mayo-moldes, Monica; García, Miguel-M; García-Parra, Beliu; Matute, Merce; López-tofino, Yolanda; Paniagua, Nancy; Hernández-secorun, Mar; Soler, Dolors; Salmerón, Marcos; Taylor, Julian; Verdu, Enrique; Valencia-Arqués, José-Antonio; Pico, Silvia; Díaz-Alejo, Clara; Katsuki, Masahito; Serrano-afonso, Ancor; Ruiz-cantero, M-Carmen BACKGROUND: Neuropathic pain (NP) is a complex chronic condition with limited therapeutic effectiveness. Despite multiple drug classes and international guidelines, real-world adherence remains inconsistent, and data on prescribing practices among pain specialists is scarce. METHODS: We conducted a nationwide cross-sectional survey among members of the Spanish Pain Society in May 2025. A structured 62-item questionnaire assessed prescribing habits, decision-making criteria, guideline adherence, dosage patterns, and the recognition and management of tolerance. Sociodemographic and professional data were also collected. RESULTS: A total of 220 pain specialists (52% female) completed the survey; 28% had over 20 years of clinical experience. Satisfaction with current pharmacological options was modest, with 52% reporting dissatisfaction or indifference. Prescribing was mainly guided by clinical experience (43%) and guideline recommendations (36%). Gabapentin (45%) and pregabalin (40%) were the most frequent first-line choices, followed by tricyclic antidepressants (amitriptyline; 9%), duloxetine (5%) and venlafaxine (1%). Tramadol dominated second-line use (65%), followed by capsaicin (22%) or lidocaine (5%) patches. Half of the participants reported tolerance, typically after 3-12 months, managed mainly by dose escalation or switching drug classes. Dosage practices for gabapentinoids and antidepressants showed marked heterogeneity, with frequent deviations from recommended titration protocols. CONCLUSIONS: NP management in Spain shows variability and partial alignment with international guidelines. Gabapentinoids, tricyclic antidepressants and duloxetine remain preferred treatments, but reliance on personal experience and awareness of tolerance hinder evidence-based practice. Quantifying Spanish pain specialists' views on tolerance supports calls for national consensus, better dosing education and further research to harmonise care and improve outcomes. SIGNIFICANCE: This nationwide survey provides the first systematic assessment of neuropathic pain management in Spain, revealing marked variability, only partial adherence to international guidelines, and persistent reliance on clinical experience over evidence. It confirms gabapentinoids, tricyclic antidepressants and duloxetine as preferred treatments, identifies continued tramadol use despite conflicting recommendations, and quantifies for the first time clinicians' perception and management of tolerance. These findings fill a major evidence gap and directly inform future national consensus, educational initiatives and clinical practice improvement.