The first nationally representative cross-sectional HIV drug resistance (HIVDR) survey was conducted in Uruguay in 2018–2019 among adults diagnosed with HIV and initiating or reinitiating antiretroviral therapy (ART). Protease, reverse transcriptase, and integrase genes of HIV-1 were sequenced. A total of 206 participants were enrolled in the survey; 63.2% were men, 85.7% were >25 years of age, and 35.6% reported previous exposure to antiretroviral (ARV) drugs. The prevalence of HIVDR to efavirenz or nevirapine was significantly higher (OR: 1.82, p < 0.001) in adults with previous ARV drug exposure (20.3%, 95% CI: 18.7–22.0%) compared to adults without previous ARV drug exposure (12.3%, 11.0–13.8%). HIVDR to any nucleoside reverse transcriptase inhibitors was 10.3% (9.4–11.2%). HIVDR to ritonavir-boosted protease inhibitors was 1.5% (1.1–2.1%); resistance to ritonavir-boosted darunavir was 0.9% (0.4–2.1%) among adults without previous ARV drug exposure and it was not observed among adults with previous ARV drug exposure. Resistance to integrase inhibitors was 12.7% (11.7–13.8%), yet HIVDR to dolutegravir, bictegravir, and cabotegravir was not observed. The high level (>10%) of HIVDR to efavirenz highlights the need to accelerate the transition to the WHO-recommended dolutegravir-based ART. Access to dolutegravir-based ART should be prioritised for people reporting previous ARV drug exposure.

Introduction: as gay men and men who have sex with men (MSM) constitute a population with a greater incidence of HIV, UNAIDS recommends regular surveillance by means of surveys that provide information that allows reporting prevention indicators. The implementation of these studies is limited in our context given the high complexity and costs of traditional methodologies. Objectives: to generate updated information about HIV prevention, with an emphasis on condom use and to implement screening tests in gay/MSM population between 15 and 49 years old in Uruguay, using an innovative methodological strategy. Method: transversal, analytical study by means of a web-based survey available between October and December 2019. Results: 693 men were included in the study, 67% from Montevideo and 67% of which had university studies. 17% of them had been forced to have sex in the past, 20% had suffered abuse because of their sexual orientation and 68.4% concealed their sex-affective orientation to some extent. 57.2% used condoms in their last casual anal sexual relationship, what evidences a decrease with regard to 2012 (67.6%), whereas a growing tendency in the HIV test coverage (66%) was observed, when compared to previous studies. HIV positivity rate was 13.3%. The multivariate analysis revealed a lower probability of condom use was associated to: a stable partner in the last year, gay self-identification, HIV test in the last year and having the HPV vaccine. The greater likelihood of use was associated to: participating in informative activities, having sex with people with STD/ HIV. The lowest probability of having an HIV test was associated to a stable partner and the highest was associated to knowing where they could get tested for HIV and also knowing about the post-exposure prophylaxis. When considering those who knew about the pre-exposure prophylaxis (375), 46.1% was willing to receive it and 1.3% had agreed to it. Conclusions: the continuation of discrimination and violence towards gay men and MSM needs more effective right promoting actions. We need to integrate into prevention biomedical innovations that complement and leverage one another. The web-based survey was effective in terms of recruiting, although there were bias in the selection, what results challenging to improve the methodological strategy.

Introducción: por ser los varones gais y los hombres que tienen sexo con hombres (HSH) una población con mayor incidencia de virus de inmunodeficiencia humana (VIH), ONUSIDA recomienda el monitoreo periódico mediante encuestas que releven información para reportar indicadores de prevención. La implementación de estos estudios en nuestro medio es limitada debido a la complejidad y costos de las metodologías tradicionales. Objetivo: generar información actualizada sobre prevención del VIH, con énfasis en uso de condón y realización de pruebas de tamizaje en gais/HSH de 15 a 49 años en Uruguay, implementando una estrategia metodológica innovadora. Material y método: estudio de corte transversal y analítico, en base a una encuesta online disponible entre octubre y diciembre de 2019. Resultados: se incluyeron 693 varones, 67% de Montevideo y 67% con nivel educativo terciario. Un 17% fue forzado a mantener relaciones sexuales alguna vez, 20% sufrió maltrato por su orientación y 68,4% ocultaba su orientación sexoafectiva en algún grado. Un 57,2% usó condón en la última relación sexual anal casual, observándose un descenso respecto al año 2012 (67,6%), mientras que la tendencia en la cobertura de prueba de VIH (66%) fue creciente comparada con estudios previos. La proporción de positividad de VIH fue de 13,3%. El análisis multivariado mostró que la menor probabilidad de uso de condón se asocia a: pareja estable en el último año, autoidentificación gay, prueba de VIH en el último año y vacunación para virus papiloma humano. La mayor probabilidad de uso se asoció a: participación en actividades de información, relaciones sexuales con personas con ITS/VIH. La menor probabilidad de realización de prueba de VIH se asoció con pareja estable y la mayor con el conocimiento de lugares de acceso a prueba y conocimiento de la profilaxis posexposición. Entre quienes conocían la profilaxis preexposición (375), 46,1% estaba dispuesto a recibirla y 1,3% había accedido. Conclusiones: la persistencia de situaciones de discriminación y violencia hacia varones gais/HSH necesita acciones más efectivas de promoción de derechos. Es necesario integrar innovaciones biomédicas en prevención que se complementen y potencien para el control de la epidemia. El uso de una encuesta en línea fue eficiente en el reclutamiento, aunque con sesgos en la selección, lo que desafía a mejorar esta estrategia metodológica.

Introduction: Early diagnosis of HIV and early and continuos antirretroviral treatment constitute key strategies to avoid dying of aids. After a steady increase, HIV-related mortality has remained stable since 2005, although the expected reduction has not occurred. A study was conducted in order to characterize the clinical and epidemiological profile of the population that died of AIDS in Uruguay in 2014 and to assess the distribution of deaths in the continuum of care cascade”. Method: Retrospective and observational study, based on information kept in files containing death certificates and medical histories of people who were 18 years old or older and died of AIDS in 2014. Results: We had access to 124 records of the 175 deaths, finding that 105 corresponded to HIV-related deaths, 77% of them came from the public subsector and 68% of them being men. Most of them were young adults (43.711.6 years old) and lived in vulnerable conditions (47.1% had used drugs; 15.4% were homeless or in prison; 37.5% benefited from social plans). In 71.4% of cases diagnosis was late and 37.1% died within the first year of diagnosis. 60% died without having consulted the health system or continued treatment (11.4% failed to seek health assistance, 48.6% interrupted treatment). Conclusions: The increased proportion of patients who died without having sought health assistance or follow up in the health system within a population of social vulnerability evidences the need to adopt comprehensive strategies that have been proved successful to increase access and continuation of treament.

Introducción: el diagnóstico precoz del virus de la inmunodeficiencia humana y el acceso a un tratamiento antirretroviral temprano y continuado son estrategias clave para evitar el fallecimiento por sida. En Uruguay, desde el año 2005, luego de un ascenso continuo, se observa una estabilización de la mortalidad por sida, no presentando el descenso previsto. Se realizó un estudio con el objetivo de caracterizar el perfil clínico-epidemiológico de la población fallecida por sida en 2014 en Uruguay y valorar la distribución de las muertes en la cascada de continuo de atención. Método: retrospectivo y observacional, en base a información de registros en certificados de defunción e historias clínicas de personas de edad igual o mayor a 18 años fallecidas por sida durante el año 2014. Resultados: de los 175 fallecidos, se accedió a 124 registros, correspondiendo a 105 las muertes por sida; 77% del subsector público y 68% varones. Se caracterizó por ser una población de adultos jóvenes (43,7±11,6 años) y con condiciones de vulnerabilidad (alguna vez consumo de drogas 47,1%; situación de calle y privación de libertad 15,4%; 37,5% beneficiarios de planes sociales). El 71,4% presentó diagnóstico tardío y el 37,1% falleció en el primer año del diagnóstico. El 60% falleció sin haber logrado contacto o continuidad en la atención (11,4% previnculación, 48,6% sin retención en cuidados). Conclusiones: la elevada proporción de pacientes fallecidos sin haber establecido vinculación y seguimiento en el sistema de salud, en una población con rasgos de vulnerabilidad social, evidencia la necesidad de adoptar estrategias integrales probadas para mejorar el acceso y la continuidad de la atención.

Introduction: early diagnosis of HIV and early and continuos antirretroviral treatment constitute key strategies to avoid dying of AIDS. After a steady increase, HIV-related mortality has remained stable since 2005, although the expected reduction has not occurred. A study was conducted in order to characterize the clinical and epidemiological profile of the population that died of AIDS in Uruguay in 2014 and to assess the distribution of deaths in the continuum of care cascade. Method: retrospective and observational study, based on information kept in files containing death certificates and medical histories of people who were 18 years old or older and died of AIDS in 2014. Results: we had access to 124 records of the 175 deaths, finding that 105 corresponded to HIV-related deaths, 77% of them came from the public subsector and 68% of them being men. Most of them were young adults (43.7 +/- 11.6 years old) and lived in vulnerable conditions (47.1% had used drugs; 15.4% were homeless or in prison; 37.5% benefited from social plans). In 71.4% of cases diagnosis was late and 37.1% died within the first year of diagnosis. 60% died without having consulted the health system or continued treatment (11.4% failed to seek health assistance, 48.6% interrupted treatment). Conclusions: the increased proportion of patients who died without having sought health assistance or follow up in the health system within a population of social vulnerability evidences the need to adopt comprehensive strategies that have been proved successful to increase access and continuation of treament.