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Migration crisis in Venezuela and its impact on HIV in other countries: the case of Colombia.
Annals of Clinical Microbiology and Antimicrobials ( IF 5.7 ) Pub Date : 2019-03-08 , DOI: 10.1186/s12941-019-0310-4
Alfonso J Rodríguez-Morales 1 , D Katterine Bonilla-Aldana 1, 2 , Miguel Morales 3 , José A Suárez 4 , Ernesto Martínez-Buitrago 5
Affiliation  

During the last few years, there has been a large migration flux of Venezuelan citizens and refugees. This is a consequence of the current political instability and the economic crisis in that country. Such a situation is leading the migration to countries in South, Central and North America, as well as to Europe, among other regions of the world. This forced displacement is leading also to the importation of infectious diseases as has been recently reported [1,2,3]. Malaria and other vector-borne diseases [4, 5], tuberculosis, vaccine-preventable diseases [3, 6], among others, such as sexually transmitted diseases and Human Immunodeficiency Virus (HIV) infection. The most direct consequences in public health are to countries of the Americas, which are receiving the massive flux of migration from Venezuela, e.g. Colombia.

Colombia is an example to discuss and enhance the message of the negative consequences of the massive migration from Venezuela and the impact on HIV in a near country. Using and analyzing data from the surveillance system of Colombia, during 2017 (SIVIGILA, https://www.ins.gov.co/Paginas/sistemas-de-informacion.aspx), we explored the incidence of new cases of HIV imported from other countries, particularly including Venezuela.

In 2017, Colombia reported 13,310 new cases of HIV, with 108 of them imported from other countries (0.8%) [7]. From those imported cases, 83.3% of them (90) were from Venezuela (Table 1). Colombia received newly diagnosed HIV people from 12 other countries. The most affected territory, as expected, was Norte de Santander department, in the border with Venezuela (Fig. 1), followed by the capital of the country, Bogota, and La Guajira department, which is also an international border territory. Norte de Santander reported only 388 autochthonous which means a relation of 1 imported case of Venezuela per 12.9 autochthonous in that territory (Table 1).

Table 1 Distribution of imported cases of HIV in Colombia, 2017, according to origin countries and receiving departments of the country
Full size table
Fig. 1
figure1

a Departments of Colombia receiving imported cases of HIV infection from Venezuela, 2017. b Trends in the number of people living with HIV in Colombia, 1990–2017, based on estimates of UNAIDS

Full size image

Countries emerging from a conflict or humanitarian crisis often face conditions that facilitate the spread of HIV, including significant population movements, lack of social and health services in their countries and gender-based violence that leads to these problems. Moving to border countries, where the partnership with humanitarian and assistance organizations is essential to ensure that HIV is adequately addressed in those territories receiving HIV people [8, 9].

During 2017, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that 150,000 adults and children were living with HIV in Colombia, whilst estimated for 2016 there were 120,000 in Venezuela, among whom only 59% were accessing antiretroviral therapy (ART) (only 71,210 people on ART), with only 7% with a low viral load [2, 10]. Over the past decade in Colombia, the number of people living with HIV/AIDS has been stable (Fig. 1) [11]. However, in Venezuela, more than 79,000 people living with HIV stopped receiving antiretrovirals since 2017 and the number of deaths increased from 1800 in 2014 to possibly more than 5000 in 2018. Even more, 154,000 people may be living with HIV in Venezuela, although there are no prevalence and incidence studies with significant coverage [2, 10]. Since 2016, access to ART fell alarmingly, especially due to government lack of funding for it, until it almost disappeared in 2017 and 2018, when international purchases were interrupted leading to approximately 58,000 people with HIV without access to treatment. Given the lack of tests and reagents for it, would impact in a decrease of diagnoses and HIV detection and notification. The impact of such situation even has led to the illegal marketing of ART.

Probably all of it is additionally pressing migration from people of Venezuela with HIV to other countries, including Colombia. In this country, as expected, border territories, such as Norte de Santander and La Guajira, among others, have been significantly impacted by forced migration from Venezuela. A previous report indicated that the number of migrants from Venezuela, significantly increased in the first months of 2017 [12], which is consistent with our findings for this department, but also with impact in other territories of Colombia. Preliminary data of 2018, show that Colombia reported 14,411 new HIV cases during the year, with 135 cases imported from other countries during the first semester of the year, of them 89.6% were from Venezuela, then we can anticipate that at least the number of imported cases in Colombia have doubled for the whole year, most of them from Venezuela.

As has been recently stated by others [3, 6, 10, 13,14,15], Venezuela is in the midst of an emerging public health crisis, resulting from the collapse of its healthcare system and the re-emergence of previously controlled infectious diseases [14, 16], including HIV, now being receiving in Colombia, Peru as well as in other countries especially in the region of the Americas [1]. On September 27, 2018, the United Nations Human Rights Council adopted a resolution on Venezuela signaling the gravity of the human rights situation and the growing concern by governments worldwide about the country’s humanitarian crisis, including aspects such as malnutrition and the upsurge of preventable diseases. International health organizations [6], including UNAIDS, faces an enormous challenge in attending, without interference, to the complex emergency that affects Venezuela but also migrants, with HIV infection and AIDS. The findings of HIV imported cases from Venezuela in Peru as well as in Colombia, probably are similar in other countries in the Americas, particularly Panama, Ecuador, Peru, Chile, among others, were a significant flux of Venezuelan migrants is occurring, needing more analyses about it. Unpublished data from the Hospital Santo Tomas of Panama City (the largest healthcare center of the Ministry of Health of Panama with 632 beds), show that during 2016–2018, from 2439 new patients diagnosed at the HIV Clinic, 13.5% (329) of them were migrants from Venezuela. In the context of a large shortage of ART, non-rational use practices are reported that have a considerable risk of generating drug resistance and compromising the effectiveness of the treatment, in addition to the risk that the resistance is transmitted and spread to the population level, which is a huge problem, even greater associated with the migration of patients with HIV, who are transmitting a virus with a high probability of resistance to first-line ART in countries with low primary resistance rates, such as Colombia.

With all of the above, it is necessary and a priority that the governments of the countries with the greatest influx of Venezuelan migrants, particularly Colombia, define public health policies in search of evaluating the strategies of detection and prevention of the infection for HIV in this population. Also, specific protocols are necessary to approach and treat patients from Venezuela, given the difficulty of having data from the previous clinical history of them and the unfavorable conditions generated by the abandonment of therapy or late diagnosis.

These protocols must be originated in a combined effort between governments, scientific societies and international supporting organizations, to issue recommendations aimed at providing free testing to refugees, linking those diagnosed or known positive to health care and treat them according to their medical treatment history, if available, guided by resistance testing results or, as a programmatic option, with a regimen that poses low likelihood to be affected by primary or selected resistance associated mutations, such as those based on integrase inhibitors or darunavir/ritonavir, any of both in combination with tenofovir and emtricitabine or lamivudine.

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AJR-M: conceptualization, data curation, formal analysis, methodology, writing—original draft, writing—review and editing. DKB-A and MM: writing—review and editing. JAS: data curation, formal analysis, methodology, writing—review and editing. EM-B: writing—review and editing (based on CRediT authorship contribution statement). All authors read and approved the final manuscript.

Acknowledgements

Ana Belen Arauz and Felix Díaz from the Hospital Santo Tomas, Panama, for providing the frequency of HIV Venezuelans diagnosed with at their HIV Clinic during 2016–2018.

Competing interests

The authors declare that they have no competing interests.

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Affiliations

  1. Annals of Clinical Microbiology and Antimicrobials, Public Health and Infection Research and Incubator Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
    • Alfonso J. Rodríguez-Morales
    •  & D. Katterine Bonilla-Aldana
  2. Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia
    • D. Katterine Bonilla-Aldana
  3. Infectious Diseases Organization, Taller Venezolano de VIH, Caracas, DC, Venezuela
    • Miguel Morales
  4. Investigador SNI Senacyt Panamá, Clinical Research Deparment, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama
    • José A. Suárez
  5. Infectious Diseases, Department of Internal Medicine, Universidad del Valle, Santiago de Cali, Colombia
    • Ernesto Martínez-Buitrago
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Correspondence to Alfonso J. Rodríguez-Morales.

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Rodríguez-Morales, A.J., Bonilla-Aldana, D.K., Morales, M. et al. Migration crisis in Venezuela and its impact on HIV in other countries: the case of Colombia. Ann Clin Microbiol Antimicrob 18, 9 (2019). https://doi.org/10.1186/s12941-019-0310-4

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中文翻译：
委内瑞拉的移民危机及其对其他国家的艾滋病毒的影响：哥伦比亚的情况。

在过去的几年中，委内瑞拉公民和难民大量涌入。这是该国当前政治动荡和经济危机的结果。这种情况正导致向世界其他地区的南美洲，中美洲和北美洲以及欧洲国家迁移。正如最近报道的[1,2,3]，这种强迫流离失所也导致了传染病的输入。疟疾和其他媒介传播疾病[4，5]，结核病，疫苗可预防疾病[3，6]等，例如性传播疾病和人类免疫缺陷病毒（HIV）感染。对公共健康最直接的影响是对美洲国家的影响，这些国家正从委内瑞拉等哥伦比亚接受大量移民。

哥伦比亚是讨论和加强委内瑞拉大规模移民的负面后果以及对附近国家艾滋病毒的影响的一个例子。我们使用并分析了2017年哥伦比亚监测系统中的数据（SIVIGILA，https://www.ins.gov.co/Paginas/sistemas-de-informacion.aspx），我们调查了从哥伦比亚进口的新HIV病例的发生率其他国家，特别是委内瑞拉。

2017年，哥伦比亚报告了13,310例新的HIV感染病例，其中108例是从其他国家进口的（0.8％）[7]。在这些进口病例中，有83.3％（90）来自委内瑞拉（表1）。哥伦比亚从其他12个国家/地区接受了新诊断的艾滋病毒感染者。正如预期的那样，受影响最大的地区是与委内瑞拉接壤的北桑坦德省（图1），其次是该国首都波哥大和瓜瓜拉省，这也是一个国际边境地区。北桑坦德银行仅报告了388例当地人，这意味着该领土上每12.9例当地人中有1例委内瑞拉输入病例（表1）。

表1按来源国和接收国分列的哥伦比亚2017年艾滋病毒进口病例分布
全尺寸表
图。1
图1

a哥伦比亚各部门从委内瑞拉接收进口的艾滋病毒感染病例，2017年。b根据联合国艾滋病规划署的估计，1990- 2017年哥伦比亚艾滋病毒感染人数趋势

全尺寸图片

摆脱冲突或人道主义危机的国家通常面临促进艾滋病毒传播的条件，包括大量人口流动，本国缺乏社会和卫生服务以及导致这些问题的基于性别的暴力。移居边境国家，与人道主义和援助组织建立伙伴关系对于确保在接收艾滋病毒的人的领土上充分解决艾滋病毒至关重要[8，9]。

2017年，联合国艾滋病毒/艾滋病联合规划署（UNAIDS）估计哥伦比亚有15万名成人和儿童感染了艾滋病毒，而2016年委内瑞拉估计有12万名艾滋病毒携带者，其中只有59％的人接受抗逆转录病毒疗法（ART） （ART上只有71,210人），只有7％的病毒载量低[2，10]。在过去的十年中，哥伦比亚的艾滋病毒/艾滋病感染者人数一直稳定（图1）[11]。但是，在委内瑞拉，自2017年以来，有79,000例艾滋病毒感染者停止接受抗逆转录病毒药物，死亡人数从2014年的1800人增加到2018年的5000多人。委内瑞拉可能有154,000人感染艾滋病毒，尽管那里尚无覆盖率很高的患病率和发病率研究[2，10]。自2016年以来，获得ART的人数惊人地减少了，特别是由于政府缺乏资金，直到2017年和2018年几乎消失了，当时国际采购中断，导致约5.8万艾滋病毒感染者无法获得治疗。鉴于缺乏针对它的测试和试剂，将影响诊断和艾滋病毒检测与通报的减少。这种情况的影响甚至导致了ART的非法销售。

可能所有这些都进一步迫使从感染艾滋病毒的委内瑞拉人迁移到包括哥伦比亚在内的其他国家。如所预期的那样，在该国，北部地区的桑坦德和拉瓜希拉等边境领土受到了委内瑞拉的强迫移民的严重影响。先前的报告指出，从委内瑞拉移民的人数在2017年前几个月显着增加[12]，这与我们对该部门的调查结果相符，但也影响了哥伦比亚的其他地区。2018年的初步数据显示，哥伦比亚在这一年中报告了14,411例新的HIV病例，其中在今年上半年从其他国家/地区进口了135例，其中89.6％来自委内瑞拉，

正如其他人最近所指出的[3、6、10、13、14、15]，委内瑞拉正处于新兴的公共卫生危机之中，这是由于其医疗体系崩溃和先前控制的传染病重新出现所致。哥伦比亚，秘鲁以及其他国家，尤其是美洲地区正在接受包括艾滋病毒在内的疾病[14、16]。2018年9月27日，联合国人权理事会通过了一项关于委内瑞拉的决议，表明人权状况的严重性以及全世界各国政府对该国的人道主义危机日益关注，包括营养不良和可预防疾病的增加等方面。包括联合国艾滋病规划署在内的国际卫生组织[6]在参加会议，不受干预，不仅影响委内瑞拉而且影响移民的复杂紧急情况，感染了艾滋病毒和艾滋病。从秘鲁和哥伦比亚的委内瑞拉进口的艾滋病毒病例的发现，在美洲其他国家，特别是在巴拿马，厄瓜多尔，秘鲁，智利等国家，可能是相似的，因为正在发生大量委内瑞拉移民，需要更多分析。巴拿马城圣托马斯医院（巴拿马卫生部最大的医疗中心，有632张病床）的未发表数据显示，2016-2018年期间，在HIV诊所诊断出的2439名新患者中，有13.5％（329）他们是委内瑞拉的移民。在严重缺乏抗逆转录病毒疗法的情况下，据报道，非合理使用做法具有产生耐药性和损害治疗效果的巨大风险，

综上所述，委内瑞拉移民涌入最多的国家，尤其是哥伦比亚的各国政府，有必要制定一项公共卫生政策，以评估在这一方面检测和预防艾滋病毒感染的战略，这是必要且优先的。人口。同样，鉴于难以获得委内瑞拉患者的既往临床病史数据以及因放弃治疗或晚期诊断而产生的不利情况，要治疗和治疗委内瑞拉患者，必须有特殊的治疗方案。

这些协议必须源自政府，科学团体和国际支持组织的共同努力，以发布旨在为难民提供免费测试的建议，将诊断或已知为阳性的人与医疗保健联系起来，并根据他们的医疗史对其进行治疗（如果有）可在耐药性测试结果的指导下使用，或者作为一种程序选择，采用受原发性或选定性耐药相关突变影响的可能性很小的方案，例如基于整合酶抑制剂或darunavir / ritonavir的突变，两者均与替诺福韦和恩曲他滨或拉米夫定。

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下载参考

AJR-M：概念化，数据策划，形式分析，方法论，写作（原始草案），写作-审查和编辑。DKB-A和MM：编写-审查和编辑。JAS：数据策划，形式分析，方法论，写作-审查和编辑。EM-B：写作-审核和编辑（基于CRediT作者贡献声明）。所有作者阅读并认可的终稿。

致谢

巴拿马圣托马斯医院的Ana Belen Arauz和FelixDíaz提供了2016-2018年在其HIV诊所诊断出的委内瑞拉艾滋病毒感染者的频率。

利益争夺

作者宣称他们没有竞争利益。

发行人须知

对于出版的地图和机构隶属关系中的管辖权主张，Springer Nature保持中立。

隶属关系

  1. 临床微生物学和抗菌药物年鉴，公共卫生与感染研究和孵化器小组，Tecnológicade Pereira大学，佩雷拉，哥伦比亚里萨拉尔达
    • 阿方索·罗德里格斯·莫拉雷斯
    •  和D.Katterine Bonilla-Aldana
  2. 哥伦比亚里约热内卢大学-拉斯佩里拉分校
    • D.凯特琳·博尼利亚-阿尔达纳
  3. 委内瑞拉加拉加斯市塔拉委内瑞拉诺德VIH传染病组织
    • 米格尔·莫拉莱斯（Miguel Morales）
  4. SNI SenacytPanamá调查员，巴拿马巴拿马城Conmemorativo Gorgas de Estudios de la Salud临床研究所
    • 何塞·苏亚雷斯
  5. 哥伦比亚圣地亚哥卡利大学，瓦莱大学内科，传染病
    • 埃内斯托·马丁内斯·布特拉格
s
  1. Alfonso J.Rodríguez-Morales查看作者出版物您也可以在以下位置搜索该作者
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通讯作者

对应于Alfonso J.Rodríguez-Morales。

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引用本文

Rodríguez-Morales，AJ，Bonilla-Aldana，DK，Morales，M.等。委内瑞拉的移民危机及其对其他国家的艾滋病毒的影响：哥伦比亚的情况。安临床微生物学Antimicrob 18， 9（2019）。https://doi.org/10.1186/s12941-019-0310-4

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  • DOI ：https ：//doi.org/10.1186/s12941-019-0310-4
更新日期：2020-04-22
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