Impacto de la inmigración en la epidemia del VIH en Madrid perspectivas epidemiológica, clínica y molecular

Resumen

HIV-1 diagnosis among immigrants residing in Spain is increasing. This fact is changing the current situation of the HIV epidemic in Madrid and affecting both traditional and molecular epidemiology. The Community of Madrid represents a challenge for the control of HIV epidemic in Spain given its high HIV prevalence and increasing proportion of immigrant people. In this Thesis, different studies focusing on the impact at diverse levels of the presence of HIV-positive immigrants in Madrid are presented. A combination of molecular, phylogenetic and demographic approaches was used. According to the results, HIV-infected patients in this cohort in Madrid presented very different profiles according to their geographical origin. Subjects from sub-Saharan Africa showed a more advanced immunodeficiency, co-existence of parasitic diseases, and a HIV-1 infection caused by a large diversity of non-B and recombinant variants. They also presented an increasing prevalence of transmitted drug resistance among those who remained untreated. In addition, the mutational pattern differed across groups, reflecting the influence of the treatment strategies in their countries of origin. On the other hand, autochthonous and Latin American HIV-positive populations were more similar, showing both of them decreasing rates of transmitted drug resistance. Nevertheless, these factors did not seem to have an influence on the antiretroviral treatment effectiveness. HIV transmission networks were also described, showing that one out of five HIV-infected patients was epidemically linked. The probability of inclusion in these networks was high for Spaniards and Latin Americans but quite low for sub-Saharan Africans. This determined also different trends for the HIV transmission across viral variants. The increasing presence of diverse HIV variants, especially recombinants, impaired the performance of different computational tools widely used in clinical settings, since they misinterpreted the great variability that HIV-1 clades naturally present. In summary, different approaches for the study of HIV sequences generated routinely are powerful and very valuable tools that, together with epidemiological and clinical surveillance, can reveal crucial knowledge for designing prevention campaigns aimed for vulnerable collectives in the fight against HIV/AIDS such as immigrant people.