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Ayerdi O, Benito R, Ortega D, Aguilera A, Montiel N, Pintos I, Díaz de Santiago A, Baza B, Soriano V, de Mendoza C. HTLV infection in persons with sexually transmitted diseases in Spain. Front Immunol 2023; 14:1277793. [PMID: 38143748 PMCID: PMC10740202 DOI: 10.3389/fimmu.2023.1277793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/13/2023] [Indexed: 12/26/2023] Open
Abstract
Background HTLV-1 infection is a neglected disease, despite estimates of 10 million people infected worldwide and producing life-threatening illnesses in 10% of carriers. Sexual transmission is the main route of contagion. However, HTLV-1 is not listed among sexually transmitted infections (STIs). Methods Serum from all consecutive individuals who had attended six STI clinics across Spain during the last 12 months were tested for HTLV antibodies using a commercial enzyme immunoassay (EIA). Reactive samples were confirmed by immunoblot. Results A total of 2,524 samples were examined. The majority (1,936; 76.7%) belonged to men, of whom 676 (34.9%) were men who have sex with men (MSM) receiving HIV pre-exposure prophylaxis. Although native Spaniards predominated (1,470; 58.2%), up to 593 (23.5%) came from Latin America and 139 (5.5%) were African. A total of 26 individuals were initially EIA reactive and immunoblot confirmed 5 as HTLV-1 and 7 as HTLV-2. All but one HTLV-1+ case came from Latin America. Three were men and two were women. Among Latin Americans, the HTLV-1 seroprevalence was 0.67%. In contrast, all seven HTLV-2+ were native Spaniards and former injection drug users, and all but one were HIV+. Conclusion The rate of HTLV infection among individuals with STIs in Spain is 0.5%, which is greater than in the general population. These results support the introduction of universal HTLV screening in persons who attend clinics for STIs.
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Affiliation(s)
- Oskar Ayerdi
- Sexually transmitted Infections Clinic, Centro Sanitario Sandoval, Madrid, Spain
| | - Rafael Benito
- Microbiology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Diego Ortega
- Microbiology Department, Hospital Miguel Servet, Zaragoza, Spain
| | - Antonio Aguilera
- Microbiology Department, University of Santiago, Santiago de Compostela, Spain
| | - Natalia Montiel
- Microbiology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Ilduara Pintos
- Internal Medicine Laboratory, Puerta de Hierro University Hospital and Research Foundation-IDIPHISA, Madrid, Spain
| | - Alberto Díaz de Santiago
- Internal Medicine Laboratory, Puerta de Hierro University Hospital and Research Foundation-IDIPHISA, Madrid, Spain
| | - Begoña Baza
- Sexually transmitted Infections Clinic, Centro Sanitario Sandoval, Madrid, Spain
| | - Vicente Soriano
- Public Health Unit, UNIR Health Sciences School and Medical Center, Madrid, Spain
| | - Carmen de Mendoza
- Internal Medicine Laboratory, Puerta de Hierro University Hospital and Research Foundation-IDIPHISA, Madrid, Spain
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Melo Bandeira L, Moreira Puga MA, Croda J, Pompílio MA, Amianti C, Rocha de Rezende G, Coimbra Motta-Castro AR. Human T-Lymphotropic Virus-1/2 Infection in Central Brazil Prisons: A Multicenter Study. Front Microbiol 2022; 12:740245. [PMID: 35126323 PMCID: PMC8815966 DOI: 10.3389/fmicb.2021.740245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/20/2021] [Indexed: 01/12/2023] Open
Abstract
Human T-lymphotropic virus (HTLV) infection is endemic in some group populations. Prisoners are at high risk of acquiring HTLV infection mainly due to the environment of closed penal institutions, socioeconomic conditions, and risk behaviors. This study aimed to investigate the prevalence, the occurrence of new cases of HTLV infection after a 1-year follow-up, and circulating subtypes of HTLV-1 among prisoners from twelve closed prisons in Mato Grosso do Sul state, Central Brazil. A total of 1,507 prisoners were randomly enrolled in the cross-sectional study. Out of the 1,507 participants, 1,000 prisoners, susceptible to HTLV infection, were included in the prospective cohort study. In the cross-sectional study, serological evidence of HTLV infection was 0.4% (CI 95%: 0.1-0.7), tested for anti-HTLV antibodies by enzyme-linked immunosorbent assay (ELISA). Three samples were positive for HTLV-1, two samples were positive for HTLV-2, and 1 sample was indeterminate by the Western blot method. The presence of HTLV proviral DNA was detected in all positive samples by amplification of the HTLV tax gene through nested-PCR. Phylogenetic analysis showed that HTLV-1 samples belonged to the Cosmopolitan subtype Transcontinental subgroup. From a cohort of 1,000 individuals, no new case of HTLV infection was detected. Although the prevalence rate of HTLV infection found in this study was similar to that observed in the Brazilian general population, the lack of access to preventive interventions and harm reduction measures all contribute to increasing the risk of HTLV transmission and acquisition among this key and vulnerable population.
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Affiliation(s)
- Larissa Melo Bandeira
- Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- *Correspondence: Larissa Melo Bandeira,
| | | | - Julio Croda
- Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- Fiocruz Mato Grosso do Sul, Fundação Oswaldo Cruz, Ministério da Saúde, Campo Grande, Brazil
| | | | | | | | - Ana Rita Coimbra Motta-Castro
- Federal University of Mato Grosso do Sul, Campo Grande, Brazil
- Fiocruz Mato Grosso do Sul, Fundação Oswaldo Cruz, Ministério da Saúde, Campo Grande, Brazil
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3
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Pereira FM, Ramos PIP, Lirio M, Mercês Atta A, Silva de Oliveira I, Nascimento FCV, Silva MC, Galvão-Castro B, Rios Grassi MF. Evaluation of the Inflammatory Cytokines and IL-10 Network in Individuals Co-infected With Human T-Cell Lymphotropic Virus and Hepatitis C Virus (HTLV/HCV). Front Microbiol 2021; 12:632695. [PMID: 33717024 PMCID: PMC7953037 DOI: 10.3389/fmicb.2021.632695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/08/2021] [Indexed: 02/05/2023] Open
Abstract
Background Co-infection between the human T-cell lymphotropic virus (HTLV) and the hepatitis C virus (HCV) can modify the natural history of HCV infection. The aim of this study was to describe the inflammatory cytokines and IL-10 network in patients co-infected with HTLV and HCV viruses in Bahia, Brazil. Methods Samples from 31 HTLV/HCV co-infected individuals and 27 HCV monoinfected individuals were evaluated. IFN-γ, TNF-α, IL-10, IL-8, and IL-1 cytokines were quantified by ELISA. Clinical, laboratory data were obtained from patient records. Serum levels of the cytokines were log10-transformed and data mining was performed using Z-score statistics and correlation analysis. Results Co-infected individuals presented a tendency toward higher production of INF-γ compared to the HCV monoinfected group. Regarding cytokine pairs, there was a positive correlation (P-value < 0.05) between IL-1 and IL-8 in the HTLV/HCV co-infected group and uninfected controls, and two correlations in the HCV mono-infected group IL-8 – IL10 and IL- INF-γ – IL-10 pairs. There was no significant difference between the groups for the other parameters analyzed. Conclusion The results presented herein indicated that HTLV/HCV co-infection was associated with a trend in IFN-γ production while HCV-infected individuals presented a positive correlation with both inflammatory cytokines (IL-8 and IFN-γ) and the regulatory cytokine IL-10.
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Affiliation(s)
- Felicidade Mota Pereira
- Laboratório Avançado de Saúde Pública, Fundação Oswaldo Cruz, Salvador, Brazil.,Laboratório Central de Saúde Pública Prof. Gonçalo Moniz - Secretaria da Saúde do Estado da Bahia, Salvador, Brazil
| | - Pablo Ivan Pereira Ramos
- Centro de Integração de Dados e Conhecimentos para Saúde - CIDACS, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Monique Lirio
- Laboratório Avançado de Saúde Pública, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Ajax Mercês Atta
- Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | | | | | - Maria Fernanda Rios Grassi
- Laboratório Avançado de Saúde Pública, Fundação Oswaldo Cruz, Salvador, Brazil.,Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
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Distribution of Human T-Lymphotropic Virus (HTLV) and Hepatitis C Co-infection in Bahia, Brazil. PLoS One 2020; 15:e0223087. [PMID: 32692782 PMCID: PMC7373273 DOI: 10.1371/journal.pone.0223087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 06/29/2020] [Indexed: 02/07/2023] Open
Abstract
Both Human T-lymphotropic virus type 1 (HTLV-1) and hepatitis C virus (HCV) are endemic in Brazil. In Salvador, the capital of the state of Bahia, 2% and 1.5% of the general population is infected with HTLV-1 or HCV. This study aimed to estimate the prevalence and the distribution of HTLV/HCV coinfection in Bahia. This cross-sectional study was conducted at the Central Laboratory of Public Health for the state of Bahia (LACEN-BA). All samples in the LACEN database submitted to serological testing for anti-HCV (chemiluminescence) and anti-HTLV-1/2 (chemiluminescence/ELISA and Western blot) from 2004 to 2013 were included. Infection rate was expressed as the number of infected individuals per 100,000 inhabitants in a given municipality; municipalities were grouped by microregion for further analysis. A total of 120,192 samples originating from 358 of the 417 municipalities in Bahia (85.8%) were evaluated. The overall HCV coinfection rate in HTLV-positive was 14.31% [2.8 (ranging from 0.4 to 8.0) per 100,000 inhabitants.] Twenty-one (5%) of the municipalities reported at least one case of HTLV/HCV coinfection. Most cases (87%) were concentrated in three microregions (Salvador: 79%, Ilhéus/Itabuna: 5%, Porto Seguro: 3%). Coinfection occurred more frequently in males (51%) with a mean age of 59 [(IQR): 46–59] years. HTLV/HCV coinfection in the state of Bahia was more frequently found among males living in the microregions of Salvador, Ilhéus/Itabuna and Porto Seguro, all of which are known to be endemic for HTLV infection.
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Oliveira-Filho AB, Araújo APS, Souza APC, Gomes CM, Silva-Oliveira GC, Martins LC, Fischer B, Machado LFA, Vallinoto ACR, Ishak R, Lemos JAR, Kupek E. Human T-lymphotropic virus 1 and 2 among people who used illicit drugs in the state of Pará, northern Brazil. Sci Rep 2019; 9:14750. [PMID: 31611600 PMCID: PMC6791863 DOI: 10.1038/s41598-019-51383-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/28/2019] [Indexed: 11/09/2022] Open
Abstract
People who used illicit drugs (PWUDs) represent an important population group for acquisition and viral dispersion. In Brazil, high rates of the human T lymphotropic virus 1 (HTLV-1) and 2 (HTLV-2) have been reported in epidemiological studies. However, the epidemiological scenario of HTLV-1/2 infections in PWUDs is still poorly understood. Thus, this cross-sectional study determined the prevalence, frequency of subtypes and factors associated with HTLV-1/2 infections among PWUDs in the Brazilian state of Pará, an area considered endemic for this virus and with poor health services. Among 826 PWUDs, 53 (6.4%) presented anti-HTLV-1/2 antibodies by EIA and 44 (5.3%) presented proviral DNA by PCR. HTLV-1 and HTLV-2 were detected in 25 (3.0%) and 19 (2.3%) PWUDs, respectively. Subtypes 1a (25/44), transcontinental (23/44) and Japanese subgroups (2/44), 2b (6/44) and 2c (13/44) were identified. Involvement in illicit/criminal activity, daily use of illicit drugs, illicit drug use over 12 years, unprotected sex with other PWUDs, changes in genitalia (including ulcers and wounds), and more than 12 sexual partners were associated with HTLV-1/2 in PWUDs. This high prevalence and intense circulation of subtypes and subgroups of HTLV-1/2 is very worrying, and indicate the need for urgent actions for its control, prevention and treatment.
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Affiliation(s)
- Aldemir B Oliveira-Filho
- Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança, PA, Brazil.
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.
| | - Ana Paula S Araújo
- Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança, PA, Brazil
- Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antonio Maria Zaccaria, Universidade Federal do Pará, Bragança, PA, Brazil
| | - Andreia Polliana C Souza
- Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança, PA, Brazil
- Residência Multiprofissional em Saúde da Mulher e da Criança, Hospital Santo Antonio Maria Zaccaria, Universidade Federal do Pará, Bragança, PA, Brazil
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, PA, Brazil
| | - Camila M Gomes
- Instituto de Estudos Costeiros, Universidade Federal do Pará, Bragança, PA, Brazil
| | | | - Luísa C Martins
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, PA, Brazil
| | - Benedikt Fischer
- Faculty of Medical and Health Sciences, University of Auckland, Grafton, AK, New Zealand
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | - Ricardo Ishak
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brazil
| | - José Alexandre R Lemos
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brazil
- Centro de Hemoterapia e Hematologia do Pará, Belém, PA, Brazil
| | - Emil Kupek
- Departamento de Saúde Pública, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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No significant HTLV seroprevalence in German people who inject drugs. PLoS One 2017; 12:e0183496. [PMID: 28829831 PMCID: PMC5567501 DOI: 10.1371/journal.pone.0183496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/04/2017] [Indexed: 12/28/2022] Open
Abstract
Background Although human T-lymphotropic virus (HTLV) is transmitted via the same routes as human immunodeficiency virus (HIV), its worldwide seroprevalence differs drastically because HTLV is transmitted mainly via infected cells rather than free virus. The sharing of needles and other equipment places people who inject drugs (PWID) at particularly high-risk for such blood-borne diseases. Methods To validate the methodology used to process and analyze the dried blood spots (DBS) utilized in the study, dried serum spots (DSS) with dilutions of sera from known HTLV infected individuals were analyzed by ELISA and Western blot. DBS collected between 2011 and 2015 from 2,077 PWID in eight German cities recruited by respondent-driven sampling were tested for HTLV-specific antibodies. Results The validation demonstrated that the use of DSS allowed identification of samples with even low titers of HTLV-specific antibodies, although a confirmatory Western blot with an additional venous blood sample would often be required. Despite numerous HIV and HCV positive individuals being identified within the study population, none tested positive for HTLV. Conclusion While the HIV and HCV prevalences in German PWID are comparable to those in other European countries, the very low prevalence of HTLV reflects the situation in the general population.
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Innovations in health and demographic surveillance systems to establish the causal impacts of HIV policies. Curr Opin HIV AIDS 2016; 10:483-94. [PMID: 26371462 DOI: 10.1097/coh.0000000000000203] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Health and demographic surveillance systems (HDSS), in conjunction with HIV treatment cohorts, have made important contributions to our understanding of the impact of HIV treatment and treatment-related interventions in sub-Saharan Africa. The purpose of this review is to describe and discuss innovations in data collection and data linkage that will create new opportunities to establish the impacts of HIV treatment, as well as policies affecting the treatment cascade, on population health and economic and social outcomes. RECENT FINDINGS Novel approaches to routine collection of biomarkers, behavioural data, spatial data, social network information, migration events and mobile phone records can significantly strengthen the potential of HDSS to generate exposure and outcome data for causal analysis of HIV treatment impact and policies affecting the HIV treatment cascade. Additionally, by linking HDSS data to health service administration, education and welfare service records, researchers can substantially broaden opportunities to establish how HIV treatment affects health and economic outcomes when delivered through public sector health systems and at scale. SUMMARY As the HIV treatment scaleup in sub-Saharan Africa enters its second decade, it is becoming increasingly important to understand the long-term causal impacts of large-scale HIV treatment and related policies on broader population health outcomes, such as noncommunicable diseases, as well as on economic and social outcomes, such as family welfare and children's educational attainment. By collecting novel data and linking existing data to public sector records, HDSS can create near-unique opportunities to contribute to this research agenda.
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Jõgeda EL, Avi R, Pauskar M, Kallas E, Karki T, Des Jarlais D, Uusküla A, Lutsar I, Huik K. Human T-lymphotropic virus types 1 and 2 are rare among intravenous drug users in Eastern Europe. INFECTION GENETICS AND EVOLUTION 2016; 43:83-5. [PMID: 27223634 DOI: 10.1016/j.meegid.2016.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/02/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND In Europe, human T-lymphotropic virus (HTLV) type 2 mainly occurs among intravenous drug users (IDUs) with prevalence up to 15% and HTLV-1 among general population with prevalence <1%. However, there is no data regarding the prevalence of HTLV-1 or HTLV-2 in Eastern European IDUs population where HIV prevalence is relatively high. We aimed to determine the prevalence and genotypes of HTLV-1/HTLV-2 among IDUs and healthy volunteers in Estonia. METHODS The study included 345 IDUs and 138 healthy volunteers. The presence of HTLV-1/HTLV-2 was determined by nested PCR; positive and negative controls were used in every PCR run. RESULTS The analysed IDUs resembled the IDUs of HIV epidemic in Estonia: mainly male (79%) with median age of 30years (interquartile range [IQR] 25-34), and prolonged duration of intravenous drug usage (11years; IQR 7-14). The prevalence exposure to blood-borne viral infections was high - 50% were HIV positive, 88% hepatitis C positive, 67% hepatitis B positive. Of IDUs, 64% reported receptive needle sharing in the past and 18% at least once a month during last six months. None of the IDUs carried HTLV-1 but there was a case of HTLV-2 (prevalence 0.3%; 95% CI 0.1-1.6). All healthy volunteers were HTLV-1 and HTLV-2 PCR negative. CONCLUSION This is the first study investigating the prevalence of HTLV-1/HTLV-2 among high risk population and healthy volunteers in Eastern European region. Our results suggest that despite other widely spread blood-borne infections (e.g. HIV, HBV, HCV) HTLV-1 and HTLV-2 are rare among IDUs in Estonia.
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Affiliation(s)
- Ene-Ly Jõgeda
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia(1).
| | - Radko Avi
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia(1)
| | - Merit Pauskar
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia(1)
| | - Eveli Kallas
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia(1)
| | - Tõnis Karki
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia(1)
| | | | - Anneli Uusküla
- Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Irja Lutsar
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia(1)
| | - Kristi Huik
- Department of Microbiology, Faculty of Medicine, University of Tartu, Tartu, Estonia(1)
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Castro E, Roger E. Hepatitis C virus/human T lymphotropic virus 1/2 co-infection: Regional burden and virological outcomes in people who inject drugs. World J Virol 2016; 5:68-72. [PMID: 27175351 PMCID: PMC4861872 DOI: 10.5501/wjv.v5.i2.68] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 01/09/2016] [Accepted: 01/31/2016] [Indexed: 02/05/2023] Open
Abstract
This review analyses current data concerning co-infection with hepatitis C virus (HCV) and human T lymphotropic virus (HTLV)-1/2 in people who inject drugs (PWID), with a particular focus on disease burden and global implications for virological outcome. In addition, the available treatment options for HTLV-1/2 are summarized and the ongoing and likely future research challenges are discussed. The data in this review was obtained from 34 articles on HCV/HTLV-1/2 co-infection in PWID retrieved from the PubMed literature database and published between 1997 and 2015. Despite unavailable estimates of the burden of HCV/HTLV-1/2 co-infection in general, the epidemiologic constellation of HTLV-1/2 shows high incidence in PWID with history of migration, incarceration, and other blood-borne infectious diseases such as HCV or human immunodeficiency virus. The most recent research data strongly suggest that HTLV-1 co-infection can influence HCV viral load, HCV sustained virological response to α-interferon treatment, and HCV-related liver disease progression. In short, outcome of HCV infection is worse in the context of HTLV-1 co-infection, yet more studies are needed to gain accurate estimations of the burden of HCV/HTLV-1/2 co-infections. Moreover, in the current era of new direct-acting antiviral treatments for HCV and proven HTLV-1/2 treatment options, prospective clinical and treatment studies should be carried out, with particular focus on the PWID patient population, with the aim of improving virological outcomes.
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Vallejo F, Barrio G, Brugal MT, Pulido J, Toro C, Sordo L, Espelt A, Bravo MJ. High hepatitis C virus prevalence and incidence in a community cohort of young heroin injectors in a context of extensive harm reduction programmes. J Epidemiol Community Health 2015; 69:599-603. [PMID: 25870164 DOI: 10.1136/jech-2014-205070] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 03/20/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cohort studies on hepatitis C virus (HCV) among drug injectors are scarcer than studies on HIV. Combined harm reduction interventions (HRIs) can prevent HCV infection. Spain has a medium-high coverage of HRIs. METHODS 513 young heroin users who injected drugs in the past 12 months (recent injectors) were street-recruited in 2001-2003 and followed until 2006 in three Spanish cities; 137 were anti-HCV seronegative, 77 of whom had ≥1 follow-up visit. Dried blood spots were tested for anti-HCV. HCV incidence and predictors of infection were estimated using Poisson models. RESULTS At baseline, 73% were anti-HCV positive. Overall incidence (n=77) of HCV seroconversion was 39.8/100 person-years (py) (95% CI 28.7 to 53.8). Excluding non-injectors during follow-up from the analysis (n=57), HCV incidence was 52.9/100 py (95% CI 37.4 to 72.5). Injecting at least weekly (incidence rate ratio (IRR)=5.2 (95% CI 2.5 to 11.1)) and having ≥2 sexual partners (IRR=2.2 (95% CI 1.1 to 4.7)) were independent predictors of HCV seroconversion; drug-injection history <2 years was marginally associated (IRR=2.4 (95% CI 0.9 to 4.7)). HCV incidence may have been underestimated due to differential attrition. CONCLUSIONS Despite fairly high HRI coverage among Spanish drug injectors, a distressingly high incidence of HCV in a context of high HCV prevalence was found among young heroin injectors.
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Affiliation(s)
- Fernando Vallejo
- National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain Consortium for Biomedical Research in Epidemiology and Public Health, (CIBERESP), Madrid, Spain
| | - Gregorio Barrio
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
| | - M Teresa Brugal
- Consortium for Biomedical Research in Epidemiology and Public Health, (CIBERESP), Madrid, Spain Public Health Agency, Barcelona, Spain Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Jose Pulido
- National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain Consortium for Biomedical Research in Epidemiology and Public Health, (CIBERESP), Madrid, Spain
| | - Carlos Toro
- Service of Microbiology, La Paz-Cantoblanco-Carlos III University Hospital, Madrid, Spain
| | - Luis Sordo
- National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain Consortium for Biomedical Research in Epidemiology and Public Health, (CIBERESP), Madrid, Spain
| | - Albert Espelt
- Public Health Agency, Barcelona, Spain Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain Departament de Psicobiologia i Metodologia en Ciències de la Salut, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - María J Bravo
- National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain Consortium for Biomedical Research in Epidemiology and Public Health, (CIBERESP), Madrid, Spain
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Zimmermann R, Marcus U, Schäffer D, Leicht A, Wenz B, Nielsen S, Santos-Hövener C, Ross RS, Stambouli O, Ratsch BA, Bannert N, Bock CT, Kücherer C, Hamouda O. A multicentre sero-behavioural survey for hepatitis B and C, HIV and HTLV among people who inject drugs in Germany using respondent driven sampling. BMC Public Health 2014; 14:845. [PMID: 25124485 PMCID: PMC4247126 DOI: 10.1186/1471-2458-14-845] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/25/2014] [Indexed: 01/03/2023] Open
Abstract
Background People who inject drugs are at high risk for hepatitis B, hepatitis C and HIV. HTLV was reported by neighboring countries to be prevalent in this population, but the situation for Germany is unclear. To generate seroprevalence and related behavioural data and to enhance prevention efforts against these infections for drug users in Germany, a multicentre sero- and behavioural survey was initiated. People who inject drugs are not well reached by services for testing and counselling for blood-borne infections in Germany. An interventional part of the study is intended to prove feasibility and acceptance of testing and counselling in low-threshold drop-in settings. Methods/Design Between May 2011 and March 2015, eligible participants (persons having injected drugs within the last 12 months, aged 16 years+, and living in the study city) are recruited by respondent driven sampling, using low-threshold drop-in facilities as study-sites in eight German cities with large drug scenes. Calculated sample size is 2,033 participants. Capillary blood samples collected as dried blood spots are anonymously tested for serological and molecular markers of hepatitis B and C, HIV, and HTLV I and II. A detailed face-to-face-interview about hepatitis- and HIV-related knowledge, former testing, imprisonment, sexual and injecting risk behaviour is conducted with participants. Staff is trained to offer pre- and post-test-counselling of blood-borne infections and HIV rapid testing to participants. Discussion We chose respondent driven sampling for recruitment of participants to improve representativeness of results. Persons, who are not reached by the facility where the study is conducted, are aimed to be included by recruitment through their personal social network of injecting drug users. To reduce differential biases in the questions on knowledge of transmission and prevention of infections, we present true statements on hepatitis B, C and HIV, their possible routes of transmission and measures of prevention to participants. Participants are told that the statements are true and are asked to answer if they knew this fact already or if it is new to them. In case of knowledge gaps they are offered free targeted counselling as well as free HIV rapid testing and post-test counselling of HIV and hepatitis test results.
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Affiliation(s)
- Ruth Zimmermann
- Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany.
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Lehmann S, Delaby C, Vialaret J, Ducos J, Hirtz C. Current and future use of "dried blood spot" analyses in clinical chemistry. Clin Chem Lab Med 2014; 51:1897-909. [PMID: 23740687 DOI: 10.1515/cclm-2013-0228] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 04/19/2013] [Indexed: 11/15/2022]
Abstract
The analysis of blood spotted and dried on a matrix (i.e., "dried blood spot" or DBS) has been used since the 1960s in clinical chemistry; mostly for neonatal screening. Since then, many clinical analytes, including nucleic acids, small molecules and lipids, have been successfully measured using DBS. Although this pre-analytical approach represents an interesting alternative to classical venous blood sampling, its routine use is limited. Here, we review the application of DBS technology in clinical chemistry, and evaluate its future role supported by new analytical methods such as mass spectrometry.
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Malm K, Ekermo B, Hillgren K, Britton S, Fredlund H, Andersson S. Prevalence of human T-lymphotropic virus type 1 and 2 infection in Sweden. ACTA ACUST UNITED AC 2012; 44:852-9. [DOI: 10.3109/00365548.2012.689847] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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Treviño A, Benito R, Caballero E, Ramos JM, Parra P, Roc L, Eiros JM, Aguilera A, García J, Cifuentes C, Marcaida G, Rodríguez C, Trigo M, Arroyo LA, de Mendoza C, de Lejarazu RO, Soriano V. HTLV infection among foreign pregnant women living in Spain. J Clin Virol 2011; 52:119-22. [PMID: 21782504 DOI: 10.1016/j.jcv.2011.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 05/23/2011] [Accepted: 06/24/2011] [Indexed: 12/25/2022]
Abstract
BACKGROUND The overall seroprevalence of HTLV infection among pregnant women in Spain is below 0.02% and accordingly universal antenatal screening is not recommended. However, as the number of immigrants has significantly increased during the last decade, this population might warrant specific considerations. OBJECTIVE To evaluate the seroprevalence of HTLV infection among immigrant pregnant women living in Spain. METHODS From January 2009 to December 2010 a cross-sectional study was carried out in all foreign pregnant women attended at 14 Spanish clinics. All were tested for HTLV antibodies using a commercial enzyme-immunoassay, being reactive samples confirmed by Western blot or PCR. RESULTS A total of 3337 foreign pregnant women were examined. Their origin was as follows: Latin America 1579 (47%), North Africa 507 (16%), East Europe 606 (18%), Sub-Saharan Africa 316 (9%), North America and West Europe 116 (3.5%) and Asia and Australia 163 (5%). A total of 7 samples were confirmed as HTLV positive, of which 6 were HTLV-1 and 1 HTLV-2. HTLV-1 infection was found in 5 women coming from Latin America and 1 from Morocco. The only woman with HTLV-2 came from Ghana. The overall HTLV seroprevalence was 0.2%, being 0.3% among Latin Americans and 0.2% among Africans. It was absent among women coming from other regions. CONCLUSIONS The seroprevalence of HTLV infection among foreign pregnant women in Spain is 0.2%, being all cases found in immigrants from Latin America and Africa. Given the benefit of preventing vertical transmission, antenatal screening should be recommended in pregnant women coming from these regions.
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Affiliation(s)
- Ana Treviño
- Infectious Diseases Department, Hospital Carlos III, Calle Sinesio Delgado 10, Madrid, Spain.
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15
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Treviño A, García J, de Mendoza C, Benito R, Aguilera A, Ortíz de Lejarazu R, Ramos JM, Trigo M, Eirós JM, Rodríguez-Iglesias M, Torres A, Calderón E, Hernandez A, Gomez C, Marcaida G, Soriano V. Prevalence of HTLV-1/2 infections in Spain: A cross-sectional hospital-based survey. AIDS Res Hum Retroviruses 2010; 26:861-4. [PMID: 20672999 DOI: 10.1089/aid.2009.0234] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The presence of antibodies to human T-lymphotropic virus (HTLV) types 1 and 2 was examined in 5742 sera belonging to consecutive adult outpatients attended during June 2008 at 13 different hospitals across Spain. Overall, 58.8% were female. Foreigners represented 8% of the study population. Seven individuals were seropositive for HTLV-2 (overall prevalence 0.12%). No cases of HTLV-1 infection were found. All HTLV-2(+) subjects were Spanish natives, of whom six were coinfected with HIV-1 and five with hepatitis C virus (HCV). Moreover, all but one of the HTLV-2(+) subjects had been intravenous drug users. In summary, this cross-sectional survey suggests that the rate of HTLV infection in Spain is low, and is mostly represented by HTLV-2. Infected individuals are generally Spanish natives with a prior history of intravenous drug use and are coinfected with HIV-1 and/or HCV.
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Affiliation(s)
- Ana Treviño
- Infectious Diseases Department, Hospital Carlos III, Madrid, Spain
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16
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[HIV-2 and HTLV-1/2 infections in Spain]. Med Clin (Barc) 2010; 135:67-9. [PMID: 19560171 DOI: 10.1016/j.medcli.2009.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 04/24/2009] [Indexed: 11/23/2022]
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Milagres FAP, Duarte MIS, Viso AT, Segurado AC. Hepatitis C virus and human T-lymphotropic virus coinfection: epidemiological, clinical, laboratory and histopathological features. Rev Soc Bras Med Trop 2010; 42:363-8. [PMID: 19802468 DOI: 10.1590/s0037-86822009000400001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 07/20/2009] [Indexed: 11/21/2022] Open
Abstract
Twenty-four hepatitis C virus patients coinfected with human T-lymphotropic virus type 1 were compared with six coinfected with HTLV-2 and 55 with HCV alone, regarding clinical, epidemiological, laboratory and histopathological data. Fischer's discriminant analysis was applied to define functions capable of differentiating between the study groups (HCV, HCV/HTLV-1 and HCV/HTLV-2). The discriminant accuracy was evaluated by cross-validation. Alcohol consumption, use of intravenous drugs or inhaled cocaine and sexual partnership with intravenous drug users were more frequent in the HCV/HTLV-2 group, whereas patients in the HCV group more often reported abdominal pain or a sexual partner with hepatitis. Coinfected patients presented higher platelet counts, but aminotransferase and gamma-glutamyl transpeptidase levels were higher among HCV-infected subjects. No significant difference between the groups was seen regarding liver histopathological findings. Through discriminant analysis, classification functions were defined, including sex, age group, intravenous drug use and sexual partner with hepatitis. Cross-validation revealed high discriminant accuracy for the HCV group.
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Cardoso DF, Souza FVD, Fonseca LAM, Duarte AJDS, Casseb J. Influence of human t-cell lymphotropic virus type 1 (HTLV-1) Infection on laboratory parameters of patients with chronic hepatitis C virus. Rev Inst Med Trop Sao Paulo 2009; 51:325-9. [DOI: 10.1590/s0036-46652009000600003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 10/07/2009] [Indexed: 12/19/2022] Open
Abstract
Hepatitis C virus (HCV) and human T-cell lymphotropic virus type 1 (HTLV-1) share routes of transmission and some individuals have dual infection. Although some studies point to a worse prognosis of hepatitis C virus in patients co-infected with HTLV-1, the interaction between these two infections is poorly understood. This study evaluated the influence of HTLV-1 infection on laboratory parameters in chronic HCV patients. Twelve HTLV-1/HCV-coinfected patients were compared to 23 patients infected only with HCV, in regard to demographic data, risk factors for viral acquisition, HCV genotype, presence of cirrhosis, T CD4+ and CD8+ cell counts and liver function tests. There was no difference in regard to age, gender, alcohol consumption, smoking habits, HCV genotype or presence of cirrhosis between the groups. Intravenous drug use was the most common risk factor among individuals co-infected with HTLV-1. These patients showed higher TCD8+ counts (p = 0.0159) and significantly lower median values of AST and ALT (p = 0.0437 and 0.0159, respectively). In conclusion, we have shown that HCV/HTLV-1 co-infected patients differs in laboratorial parameters involving both liver and immunological patterns. The meaning of these interactions in the natural history of these infections is a matter that deserves further studies.
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Toro C, Soriano V. Actualización sobre las infecciones por el virus de la inmunodeficiencia humana de tipo 2 y por los virus linfotrópico humano de tipo 1 y de tipo 2 en España. Enferm Infecc Microbiol Clin 2009; 27:377-9. [DOI: 10.1016/j.eimc.2008.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Accepted: 10/10/2008] [Indexed: 11/28/2022]
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Treviño A, Aguilera A, Caballero E, Toro C, Eiros JM, de Lejarazu RO, Rodríguez-Calviño JJ, Tuset C, Gómez-Hernando C, Rodríguez-Iglesias M, Ramos JM, Rodríguez-Díaz JC, Benito R, Trigo M, García-Campello M, Calderón E, Garcia J, Rodríguez C, Soriano V. Seroprevalence of HTLV-1/2 infection among native and immigrant pregnant women in Spain. AIDS Res Hum Retroviruses 2009; 25:551-4. [PMID: 19544594 DOI: 10.1089/aid.2008.0268] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HTLV-1=2 antenatal screening is not mandatory in European countries. The rapid increase in immigrants coming from areas endemic for HTLV-1 infection has compelled a review of this policy in Spain. From February 2006 to December 2007, a cross-sectional study was carried out in all pregnant women attended at 10 different Spanish hospitals. An enzyme immunoassay (EIA) was used to test serum HTLV-1=2 antibodies; reactive samples were further confirmed by Western blot and=or polymerase chain reaction. A total of 20,518 pregnant women were examined, of whom 18,266 (89%) were native Spaniards. Overall, 946 (4.6%) of the immigrants came from HTLV-1 endemic areas (mainly Central and South America and sub-Saharan Africa). Four samples were EIA seroreactive for HTLV-1=2, two of them in women infected with HTLV-1 coming from endemic areas. The other two women were infected with HTLV-2; one was an immigrant from Bolivia and another was a native Spaniard who admitted prior injection drug use and was HIV-1 positive. The overall HTLV-1=2 seroprevalence was 0.19 per 1000 (95% CI: 0.05-0.49=1000). For HTLV-1, the seroprevalence was 2.11 per 1000 (95% CI: 0.26-7.62=1000) in pregnant women from endemic areas. The seroprevalence of HTLV-1=2 infection is below 0.02% among pregnant women in Spain, and therefore universal screening for HTLV-1=2 infection in antenatal clinics is not warranted. However, HTLV-1=2 screening could be considered in pregnant women coming from endemic areas, in whom the rate of infection is nearly 1000-fold higher than in native Spaniards and are the only group infected with the more pathogenic HTLV-1.
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Affiliation(s)
- Ana Treviño
- Department of Infectious Diseases, Hospital Carlos III, Madrid
| | - Antonio Aguilera
- Department of Microbiology, Hospital Conxo, Santiago de Compostela, Spain
| | | | - Carlos Toro
- Department of Infectious Diseases, Hospital Carlos III, Madrid
| | - José M. Eiros
- Department of Microbiology, Hospital Clínico Universitario, Valladolid, Spain
| | | | | | - Concepción Tuset
- Department of Immunology, Hospital General Universitario, Valencia, Spain
| | - César Gómez-Hernando
- Department of Microbiology, Complejo Hospitalario Virgen de la Salud, Toledo, Spain
| | | | | | | | - Rafael Benito
- Department of Microbiology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Matilde Trigo
- Department of Microbiology, Complejo Hospitalario, Pontevedra, Spain
| | | | - Enrique Calderón
- CIBER in Epidemiology and Public Health Hospital Universitario Virgen del Rocio Seville, Spain
| | - Juan Garcia
- Department of Microbiology, Hospital Cristal-Piñor, Orense, Spain
| | | | - Vincent Soriano
- Department of Infectious Diseases, Hospital Carlos III, Madrid
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Herrero MJ, Domingo-Salvany A, Torrens M, Brugal MT. Psychiatric comorbidity in young cocaine users: induced versus independent disorders. Addiction 2008; 103:284-93. [PMID: 18199307 DOI: 10.1111/j.1360-0443.2007.02076.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To examine the psychiatric status of young cocaine users using a validated instrument for the evaluation of psychiatric comorbidity, emphasizing the distinction between independent and induced psychiatric conditions. DESIGN Cross-sectional study. SETTING Barcelona, Spain. PARTICIPANTS A cohort of 139 young (18-30 years) adult current regular cocaine users. MEASUREMENTS The Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV, which produces diagnoses according to DSM-IV criteria, including Axis II antisocial and borderline personality disorders). FINDINGS Nearly 42.5% of the subjects presented psychiatric comorbidity. The most common Axis I diagnoses were mood disorders (26.6%) and anxiety disorders (13%). Increasing age, having ever received treatment for drug use and freebase cocaine use were associated with substance-induced disorders diagnoses relative to primary Axis I disorders. CONCLUSIONS This study has shown a relatively high prevalence of psychiatric comorbidity in cocaine users recruited in non-clinical settings. Future studies examining potential differential factors associated with primary versus substance-induced disorders are necessary to optimize the implementation of more suitable approaching programmes for young regular cocaine users.
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Affiliation(s)
- M Jesús Herrero
- Health Services Research Unit (IMIM-Hospital del Mar), Barcelona, Spain
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22
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Toro C, Aguilera A, Caballero E, Tuset C, Alvarez P, García-Campello M, Rodríguez-Iglesias M, de Lejarazu RO, Eiros J, Rodriguez C, del Romero J, Benito R, Calderón E, Santana O, Amor A, Gómez-Hernando C, García J, Soriano V. Hospital-based surveillance for HTLV-1/2 infections in Spain. AIDS Res Hum Retroviruses 2007; 23:1075-7. [PMID: 17919100 DOI: 10.1089/aid.2006.0192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In Western countries, HTLV-1 infection is recognized mainly among foreigners coming from endemic areas. In contrast, HTLV-2 is found predominantly in native intravenous drug users (IDUs). Spain has experienced a large wave of immigration, which could have influenced the current prevalence and distribution of HTLV-1 and HTLV-2 infection. A 1-day cross-sectional survey was carried out in May 2005 in 13 hospitals distributed across Spain. A total of 2873 outpatient subjects were screened for HTLV-1/2 antibodies. Although the majority of the study population consisted of native Spaniards, 206 (7.2%) were immigrants. Two cases of HTLV-1 and one of HTLV-2 infection were found (overall prevalence, 0.1%). The two individuals with HTLV-1 were immigrants from endemic areas and the single case of HTLV-2 infection was a former Spaniard IDU coinfected with HIV-1. In summary, the current prevalence of HTLV-1/2 infection in Spain is low, with no evidence of spread beyond the classical risk groups. However, a rapidly growing population of immigrants from HTLV-1-endemic areas in Spain could modify this pattern and periodic surveillance studies including both natives and immigrants are warranted.
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Affiliation(s)
- Carlos Toro
- Service of Infectious Diseases, Hospital Carlos III, Madrid, Spain
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Toro C, Soriano V. Infección por el virus de la inmunodeficiencia humana tipo 2 y virus linfotrópicos humanos tipos 1 y 2 en España. Med Clin (Barc) 2007; 129:14-6. [PMID: 17570181 DOI: 10.1157/13106692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Zunt JR, Tapia K, Thiede H, Lee R, Hagan H. HTLV-2 infection in injection drug users in King County, Washington. ACTA ACUST UNITED AC 2006; 38:654-63. [PMID: 16857611 PMCID: PMC2683846 DOI: 10.1080/00365540600617009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Human T-cell lymphotropic virus type 2 (HTLV-2) is endemic in injection drug users (IDU), and native American populations in the Americas. Transmission is associated with high-risk injection and sexual practices. A cohort of 2561 IDU in King County, Washington completed 2 study visits over 1 y. HTLV-2 infection was detected in 190 (7.4%) of 2561 IDU, and 13 (7.8 cases per 1000 person-y) incident infections occurred during the study. Prevalent infection was associated with female gender, non-white race, longer duration as IDU, having a tattoo, combined injection of heroin and cocaine, and with serologic evidence of hepatitis B and C infection. Seroconversion was more common in women, and was associated with African American race, heterosexual identity and longer duration as IDU. In conclusion, increased risk of HTLV-2 infection was associated with non-white race, and injection drug of choice, suggesting injection networks may play an important role in transmission of HTLV-2. The high correlation of HTLV-2 infection with HCV infection suggests the major route of transmission in IDU is via injection practices. Additional studies are needed to examine the clinical manifestations of HTLV-2 infection, as well as the clinical and virological manifestations of HTLV-2/HCV coinfection.
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Affiliation(s)
- Joseph R Zunt
- Department of Neurology, University of Washington School of Medicine, Seattle, USA.
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Small D, Drucker E. Policy makers ignoring science and scientists ignoring policy: the medical ethical challenges of heroin treatment. Harm Reduct J 2006; 3:16. [PMID: 16670010 PMCID: PMC1557662 DOI: 10.1186/1477-7517-3-16] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Accepted: 05/02/2006] [Indexed: 11/10/2022] Open
Abstract
A decade of research in Switzerland, The Netherlands, Germany, and Spain now constitutes a massive body of work supporting the use of heroin treatment for the most difficult patients addicted to opiates. These trials concur on this method's safety and efficacy and are now serving as a prelude to the institution of heroin treatment in clinical practice throughout Europe. While the different sampling and research protocols for heroin treatment in these studies were important to the academic claims about specific results and conclusions that could be drawn from each study, the overall outcomes were quite clear--and uniformly positive. They all find that the use of prescribed pharmaceutical heroin does exactly what it is intended to do: it reaches a treatment refractory group of addicts by engaging them in a positive healthcare relationship with a physician, it reduces their criminal activity, improves their health status, and increases their social tenure through more stable housing, employment, and contact with family. The Canadian trial (NAOMI), now underway for over a year, but not yet completed, now faces a dilemma about what to do with its patients who have successfully completed 12 months of heroin and must be withdrawn from heroin and transferred to other treatments in accordance with the research protocol approved by Government of Canada, federal granting body and host institutions. The problem is that the principal criterion for acceptance to NAOMI was their history of repeated failure in these very same treatment programs to which they will now be referred. The existence of the results from abroad (some of which were not yet available when NAOMI was designed and initiated) now raises a very important question for Canada: is it ethical to continue to prohibit the medical use of heroin treatment that has already been shown to be feasible and effective in numerous medical studies throughout the world? And while this is being worked out, is it acceptable to require patients who have been successfully treated with heroin in Canada, to be forced to move back to less effective treatments (treatments that failed to be efficacious in the past)? This essay discusses this dilemma and places it in the broader context of ethics, science, and health policy. It makes the case for continuation of the current successful patients in heroin treatment and the institution of heroin treatment to all Canadian patients living with active addictions who qualify.
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Affiliation(s)
- Dan Small
- PHS Community Services Society, 20 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
- Department of Anthropology and Sociology, University of British Columbia, Vancouver, BC, V6T 1Z1, Canada
| | - Ernest Drucker
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx NY 10467, USA
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