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Ryan P, Valencia J, Cuevas G, Amigot-Sanchez R, Martínez I, Lazarus JV, Pérez-García F, Resino S. Decrease in active hepatitis C infection among people who use drugs in Madrid, Spain, 2017 to 2023: a retrospective study. Euro Surveill 2024; 29:2300712. [PMID: 39027941 PMCID: PMC11258947 DOI: 10.2807/1560-7917.es.2024.29.29.2300712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/24/2024] [Indexed: 07/20/2024] Open
Abstract
BackgroundPeople who use drugs (PWUD) are a key target population to reduce the burden of hepatitis C virus (HCV) infection.AimTo assess risk factors and temporal trends of active HCV infection in PWUD in Madrid, Spain.MethodsWe conducted a retrospective study between 2017 and 2023, including 2,264 PWUD visiting a mobile screening unit. Data about epidemiology, substance use and sexual risk behaviour were obtained through a 92-item questionnaire. HCV was detected by antibody test, followed by RNA test. The primary outcome variable was active HCV infection prevalence, calculated considering all individuals who underwent RNA testing and analysed by logistic regression adjusted by the main risk factors.ResultsOf all participants, 685 tested positive for anti-HCV antibodies, and 605 underwent RNA testing; 314 had active HCV infection, and 218 initiated treatment. People who inject drugs (PWID) were identified as the main risk group. The active HCV infection rate showed a significant downward trend between 2017 and 2023 in the entire study population (23.4% to 6.0%), among PWID (41.0% to 15.0%) and PWUD without injecting drug use (7.0% to 1.3%) (p < 0.001 for all). These downward trends were confirmed by adjusted logistic regression for the entire study population (adjusted odds ratio (aOR): 0.78), PWID (aOR: 0.78), and PWUD non-IDU (aOR: 0.78).ConclusionsOur study demonstrates a significant reduction in active HCV infection prevalence among PWUD, particularly in PWID, which suggests that efforts in the prevention and treatment of HCV in Madrid, Spain, have had an impact on the control of HCV infection.
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Affiliation(s)
- Pablo Ryan
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Hospital Universitario Infanta Leonor, Madrid, Spain
- Universidad Complutense de Madrid (UCM), Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Jorge Valencia
- Unidad de Reducción de Daños 'SMASD', Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Rafael Amigot-Sanchez
- Unidad de Infección e Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Isidoro Martínez
- Unidad de Infección e Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jeffrey V Lazarus
- CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, United States
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Felipe Pérez-García
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, Madrid, Spain
- Universidad de Alcalá, Facultad de Medicina, Departamento de Biomedicina y Biotecnología, Madrid, Spain
| | - Salvador Resino
- Unidad de Infección e Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Ryan P, Valencia J, Cuevas G, Torres-Macho J, Troya J, Pueyo Á, José Muñoz-Gómez M, Muñoz-Rivas N, Vázquez-Morón S, Martinez I, Lazarus JV, Resino S. Detection of active hepatitis C in a single visit and linkage to care among marginalized people using a mobile unit in Madrid, Spain. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103424. [PMID: 34429222 DOI: 10.1016/j.drugpo.2021.103424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/22/2021] [Accepted: 08/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The burden of hepatitis C virus (HCV) infection among marginalized people in Spain is high, despite the fact that HCV prevalence has decreased in recent years. We aimed to assess the effectiveness of a simplified point-of-care (PoC) model for screening for active HCV infection via a mobile unit and subsequent linkage to care with the assistance of navigators. METHODS We carried out a prospective study on 2001 participants from Madrid, Spain. A nurse and a navigator/educator screened for hepatitis C in a mobile unit, using the OraQuick HCV Rapid Antibody Test and Xpert HCV VL Fingerstick assay. Participants with active HCV were referred to the hospital the same day with a navigator for evaluation and treatment of HCV. RESULTS Overall, 1621 (81%) participants had not been exposed to HCV, 380 (18.9%) were positive for HCV antibodies, and 136 (6.8%) had active hepatitis C. Among the latter, 134 (98.5%) received the HCV screening results, 133 (97.8%) had an appointment at the hospital, 126 (92.8%) were seen by a physician once they were at the hospital, and 105 (77.2%) started HCV treatment. Being over 50 years old and a person who uses drugs, particularly people who inject drugs (PWID), was directly associated with active hepatitis C (p<0.05). PWID were the only patients with HCV reinfection (4.3% in people without recent injecting drug use and 5.9% in people with recent injecting drug use). Among PWID, no income and daily alcohol intake were also directly associated with active hepatitis C. People with recent injecting drug use showed the lowest rates of attendance at the hospital (91.8%) and starting HCV treatment (70.4%). CONCLUSION HCV screening using a two-step PoC-based strategy and its linkage to care was extremely efficient for identifying and treating marginalized people with active hepatitis C, thanks to the use of a mobile unit with personnel and technical equipment, an interdisciplinary team, and collaboration between institutions.
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Affiliation(s)
- Pablo Ryan
- University Hospital Infanta Leonor, Madrid, Spain; Complutense University of Madrid (UCM), Madrid, Spain; Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
| | - Jorge Valencia
- University Hospital Infanta Leonor, Madrid, Spain; Harm Reduction Unit "SMASD", Madrid, Spain
| | | | - Juan Torres-Macho
- University Hospital Infanta Leonor, Madrid, Spain; Complutense University of Madrid (UCM), Madrid, Spain
| | - Jesús Troya
- University Hospital Infanta Leonor, Madrid, Spain
| | - Ángel Pueyo
- Foundation for Biomedical Research and Innovation of University Hospital Infanta Leonor and University Hospital Southeast, Madrid, Spain; Heath Science PhD Program. UCAM Universidad Católica San Antonio de Murcia. 30107 Guadalupe de Maciascoque, Murcia, Spain
| | - María José Muñoz-Gómez
- Viral Infection and Immunity Unit, National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain
| | | | - Sonia Vázquez-Morón
- Viral Infection and Immunity Unit, National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain
| | - Isidoro Martinez
- Viral Infection and Immunity Unit, National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Salvador Resino
- Viral Infection and Immunity Unit, National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain.
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Estirado Gómez A, Justo Gil S, Limia A, Avellón A, Arce Arnáez A, González-Rubio R, Diaz A, Del Amo J. Prevalence and undiagnosed fraction of hepatitis C infection in 2018 in Spain: results from a national population-based survey. Eur J Public Health 2021; 31:1117-1122. [PMID: 34392348 DOI: 10.1093/eurpub/ckab069] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A national strategy against hepatitis C virus (HCV) was implemented in Spain in 2015 with the aim of reducing associated morbidity and mortality. In order to improve our understanding of the epidemiology of HCV, we analysed the prevalence of HCV antibodies and active infection overall and by age and sex in the general population aged 20-80 years. We also aimed to report the undiagnosed fraction. METHODS A national population-based seroprevalence survey was conducted in 2017-2018. A representative sample from the general population was selected using two-stage sampling. The prevalence of total HCV antibodies and of HCV RNA was calculated using inverse probability weighting based on bootstrapping. RESULTS Overall, we approached 17 496 persons; 9103 agreed to participate and met the eligibility criteria and 7675 were aged 20-80. We obtained a prevalence of HCV antibodies of 0.85% [95% confidence interval (CI): 0.64-1.08%] and of active infection of 0.22% (95% CI: 0.12-0.32%). The prevalence of active HCV infection was highest in men aged 50-59 (0.86%; 95% CI: 0.28-1.57%) and in men aged 60-69 years (0.72%; 95% CI: 0.27-1.28%). Prevalence was below 0.20% in the remaining age groups. The undiagnosed fraction for active HCV infection was 29.4%. CONCLUSION This study shows that prevalence of HCV in the general population in Spain is low and reflects the impact of scaling up treatment with direct acting antivirals, together with other prevention strategies, from 2015 onwards. The data reported can guide subsequent public health actions.
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Affiliation(s)
- Alicia Estirado Gómez
- Health Information, General Secretariat for Digital Health, Information and Innovation, Ministry of Health, Madrid, Spain
| | - Soledad Justo Gil
- Health Promotion, Prevention and Quality, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Aurora Limia
- Health Promotion, Prevention and Quality, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Ana Avellón
- National Center for Microbiology, Institute of Health Carlos III, CIBERESP, Madrid, Spain
| | - Araceli Arce Arnáez
- Health Information, General Secretariat for Digital Health, Information and Innovation, Ministry of Health, Madrid, Spain
| | - Raquel González-Rubio
- National Plan against HIV & STIs & Viral Hepatitis & TB, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Asunción Diaz
- National Plan against HIV & STIs & Viral Hepatitis & TB, General Directorate of Public Health, Ministry of Health, Madrid, Spain.,HIV, HCV & STI Surveillance, National Center for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Julia Del Amo
- National Plan against HIV & STIs & Viral Hepatitis & TB, General Directorate of Public Health, Ministry of Health, Madrid, Spain
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Burgui C, Martín C, Aguinaga A, Pérez-García A, Ezpeleta C, Castilla J. Prevalence and detection of undiagnosed active hepatitis C virus infections in Navarre, Spain, 2017-2019. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:28-34. [PMID: 33207891 DOI: 10.17235/reed.2020.7000/2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND undiagnosed active hepatitis C virus (HCV) infection remains an obstacle towards its eradication. This study aimed to estimate the prevalence of HCV infection and to describe the diagnostic advances in Navarre, Spain. METHODS HCV-infection diagnostic performance was analyzed in Navarre's primary and specialized health care between 2017 and 2019. The prevalence of undiagnosed infections was estimated for patients with programmed surgeries unrelated to HCV infection, who underwent a routine HCV antibody (anti-HCV) determination. HCV-RNA (viral load) was quantified in anti-HCV positive cases. The prevalence was standardized according to the sex and age distribution in the general population. RESULTS from the 63,405 subjects examined for anti-HCV, 84 (five per 100,000 person-years) were diagnosed with an active infection. In Primary Health Care, 20,363 patients were analyzed and 47 active infections were detected, i.e. one case for every 433 people tested, implying 56 % of all identified active infections. On the other hand, 9,399 surgical patients were analyzed and 120 anti-HCV positive cases were detected (adjusted prevalence: 1.47 %; 95 % CI: 1.24-1.52). A positive viral load had been determined at any time in 66 cases (0.61 %), of which five were undiagnosed active infections (adjusted prevalence: 0.04 %; 95 % CI: 0.01-0.11). Preoperative screening allowed the detection of one undiagnosed infection per 795 people analyzed aged between 45 and 64 years. CONCLUSIONS Primary Health Care efficiently contributes to the detection of undiagnosed HCV active infections. This may be speeded up by performing population screening, targeting subjects between 45 and 64 years of age.
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Affiliation(s)
- Cristina Burgui
- Epidemiología, Instituto de Salud Pública de Navarra, España
| | - Carmen Martín
- Microbiología Clínica, Complejo Hospitalario de Navarra
| | | | | | | | - Jesús Castilla
- Epidemiología, Instituto de Salud Pública y Laboral de Navarra, España
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Reyes-Urueña J, Celly A, Moreno S, Majó X, Colom J, Casabona J. Hepatitis C virus: Testing rate and attrition at linkage to specialized care, Catalonia, Spain 2011-2016. J Viral Hepat 2021; 28:288-299. [PMID: 33098176 DOI: 10.1111/jvh.13427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/22/2020] [Accepted: 10/09/2020] [Indexed: 01/11/2023]
Abstract
Hepatitis C virus (HCV) screening through primary care providers (PCP) might increase linkage to specialized care. This study aimed to calculate HCV testing rate and prevalence of anti-HCV according to socio-demographic factors in primary care in Catalonia, Spain, from 2011 to 2016, and to identify the rate and determinants of attrition at linkage to specialized care. Patient data from 274 primary care centres (3414 PCP) were analysed, including socio-demographic information, morbidity, laboratory tests and treatments (1-Jan-2011 to 31-Dec-2016). Both descriptive and inferential statistics were used to examine HCV testing rate, HCV seroprevalence and rate of attrition at linkage to specialized care. In the study period, there were 839 072 people tested for HCV infection and 21 156 with first-time positive anti-HCV test results. Rate of HCV testing was 143.54/103 pop (95% CI: 143.26-143.83). Women had higher HCV testing rate (158.65/103 women [95% CI: 158.24-159.07]), compared to men (128.10/103 men [95% CI: 127.72-128.49]). The highest HCV testing rate was among people aged 25-34 (284.11/103 pop [CIs: 283.10-285.12]). The anti-HCV seroprevalence was 3.62/103 pop (CIs: 3.57-3.67). The highest prevalence was found among men (4.20/103 men [CIs: 4.12-4.27]), people aged 45-54 (7.19/103 pop [CIs: 7.01-7.37]), people aged 75-84 (7.26/103 pop [CIs: 6.99-7.53]), Spanish (3.68/103 [CIs: 3.61-3.75]), European and Northern Americans (5.64/103 [CIs: 5.33-5.96]) and Asians (9.78/103 [CIs: 9.21-10.35]). From those who had a positive anti-HCV result, 49.8% (N = 10 528) were not linked to specialized care. Appropriate clinical care pathways and referral systems need to be established to ensure optimal linkage to specialized care for people newly diagnosed with HCV in primary care.
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Affiliation(s)
- Juliana Reyes-Urueña
- Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Badalona, Spain.,Institut d'Investigació Germans Trias i Pujol (IGTP), Spain
| | - Ana Celly
- Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain.,Institut d'Investigació Germans Trias i Pujol (IGTP), Spain.,Departament de Pediatria, d'Obstetricia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Sergio Moreno
- Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain.,Institut d'Investigació Germans Trias i Pujol (IGTP), Spain
| | - Xavier Majó
- Programa de prevenció, control i atenció al virus d'immunodeficiència humana (VIH), les infeccions de transmissió sexual (ITS) i les hepatitis víriques (HV), (PCVIHV), Public Health Agency of Catalonia, Barcelona, Spain
| | - Joan Colom
- Programa de prevenció, control i atenció al virus d'immunodeficiència humana (VIH), les infeccions de transmissió sexual (ITS) i les hepatitis víriques (HV), (PCVIHV), Public Health Agency of Catalonia, Barcelona, Spain
| | - Jordi Casabona
- Dept Salut, Generalitat de Catalunya, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Badalona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Badalona, Spain.,Institut d'Investigació Germans Trias i Pujol (IGTP), Spain.,Departament de Pediatria, d'Obstetricia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Rodríguez-Tajes S, Domínguez Á, Carrión JA, Buti M, Quer JC, Morillas RM, López C, Torras X, Baliellas C, Vergara M, Forner M, Zaragoza N, Salò J, Rigau J, Caballeria L, Mariño Z, Janè M, Colom J, Forns X, Lens S. Significant decrease in the prevalence of hepatitis C infection after the introduction of direct acting antivirals. J Gastroenterol Hepatol 2020; 35:1570-1578. [PMID: 31957902 DOI: 10.1111/jgh.14984] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/20/2019] [Accepted: 01/11/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Accurate information on the epidemiology of hepatitis C and B infection is mandatory to establish a national/regional plan. We aim to update the prevalence of hepatitis C and B infection in Catalonia using point-of-care tests to analyze the risk factors related and to implement a linkage-to-care circuit. METHODS This is a community-based study. A random list of adult individuals was retrieved from censuses of primary care centers. Point-of-care tests for anti-hepatitis C virus (HCV) and HBV surface antigen (HBsAg) and a questionnaire for risk factor assessment were performed. Positive results were validated and a circuit for linkage-to-care was established. RESULTS A total of 3328 individuals were included. The anti-HCV and HBsAg overall prevalence were lower than expected [1.02%, 95% confidence interval (CI) 0.65-1.39; and 0.52%, 95% CI 0.26-0.77, respectively]. Anti-HCV positive subjects were mostly (88%) autochthonous. The prevalence increased with age; only 12% were under age 40. The associated risk factors were drug use, blood transfusion, relative with HCV, and diabetes. Notably, the prevalence of active infection was only 0.49% (95% CI 0.23-0.74), 40% less than previously reported, reflecting the impact of direct acting antiviral therapy. Differently, HBsAg positive subjects were mostly foreign migrants (53%) with no other risk factors. Despite the implementation of a linkage-to-care circuit, one third of HBsAg positive subjects were lost. CONCLUSIONS The prevalence of HCV infection was lower than previously reported, showing a strong impact of direct acting antiviral therapy in the last years. Because of hepatitis B universal vaccination, HBV infection in Catalonia is mainly associated with migrant population. Linkage-to-care in patients with hepatitis B was challenging and warrants additional efforts.
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Affiliation(s)
- Sergio Rodríguez-Tajes
- Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain.,Societat Catalana de Digestologia, Barcelona, Spain
| | - Ángela Domínguez
- Medicine Department, University of Barcelona and CIBERESP, Barcelona, Spain
| | - Jose Antonio Carrión
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital del Mar, Barcelona, Spain
| | - María Buti
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Department of Internal Medicine, Hospital Universitario Vall d'Hebron and CIBEREHD, Barcelona, Spain
| | - Joan Carles Quer
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - Rosa M Morillas
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital Germans Trias i Pujol, IGTP, CIBEREHD, Autonomous University of Barcelona, Barcelona, Spain
| | - Carme López
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital Josep Trueta, Girona, Spain
| | - Xavier Torras
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital Santa Creu iSant Pau and CIBEREHD, Barcelona, Spain
| | - Carme Baliellas
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital Bellvitge, Barcelona, Spain
| | - Merche Vergara
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital Parc Taulí, Sabadell, Spain
| | - Montse Forner
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital Mutua de Terrassa, Terrassa, Spain
| | - Natividad Zaragoza
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital Arnau Vilanova, Lleida, Spain
| | - Joan Salò
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital de Vic, Vic, Spain
| | - Joaquim Rigau
- Societat Catalana de Digestologia, Barcelona, Spain.,Liver Unit, Hospital Granollers, Granollers, Spain
| | - Llorenç Caballeria
- Societat Catalana de Digestologia, Barcelona, Spain.,Unidad de Apoyo a la Investigación (USR) Metropolitana Nord, Instituto Universitario de Investigación en Atención Primaria (IDIAP) Jordi Gol, Mataró, Spain
| | - Zoe Mariño
- Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain.,Societat Catalana de Digestologia, Barcelona, Spain
| | - Mireia Janè
- Program for the Prevention, Control and Care of HIV, Sexually Transmitted Infections and Viral Hepatitis, Public Health Agency of Catalonia, Barcelona, Spain
| | - Joan Colom
- Program for the Prevention, Control and Care of HIV, Sexually Transmitted Infections and Viral Hepatitis, Public Health Agency of Catalonia, Barcelona, Spain
| | - Xavier Forns
- Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain.,Societat Catalana de Digestologia, Barcelona, Spain
| | - Sabela Lens
- Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain.,Societat Catalana de Digestologia, Barcelona, Spain
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Calleja Panero JL, Lens García S, Fernández Bermejo M, Crespo J. Definition of the profiles of hepatitis C virus patients based on the identification of risky practices in Spain. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:731-737. [PMID: 31526012 DOI: 10.17235/reed.2019.6169/2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The absolute number of patients infected with the hepatitis C virus and its prevalence in Spain according to risk practices are not precise. The objective of the study was to estimate the current direct-action antiviral candidates, according to risky practices. The exposed population was determined according to each risky practice and age, based on the data obtained in two epidemiological studies and other bibliographic sources. The overall prevalence of positive serology for the Hepatitis C virus according to the analyzed data was 1.1% (41% with an active infection). The most at-risk group are intravenous drug users (60,368-82,454). It is estimated that between 37,387 to 51,065 patients would be infected via sexual transmission, between 55,505 and 75,812 patients following a blood transfusion and around 18,528 to 25,307 patients by socio-family transmission. According to these data, more than half (55-79%) of the subjects with risky practices would have significant fibrosis (≥ F2). It is estimated that more than half a million people have a positive serology for the Hepatitis C virus and 144,191 to 227,773 antiviral treatments are expected in the coming years. The identification of people with risky practices is key to increase the percentage of diagnosed cases.
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Affiliation(s)
| | | | | | - Javier Crespo
- Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander., España
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Prevalence of HCV infection in a health area of Madrid (Spain): The first step towards microelimination. Enferm Infecc Microbiol Clin 2019; 38:317-322. [PMID: 31818498 DOI: 10.1016/j.eimc.2019.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/15/2019] [Accepted: 10/18/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To estimate the prevalence of HCV infection in the general population of a health area through an intervention in Primary Care, differentiating between new diagnoses and infections previously diagnosed but not treated. METHODS Participants were selected through a risk assessment questionnaire, with all those who gave at least one affirmative answer and all those over 50 years of age undergoing a rapid test. Positive tests were confirmed in the lab by determination of anti-HCV antibodies by chemiluminescent microparticle immunoassay and determination of viraemia. RESULTS Of the 7,991 participants, 36.2% presented a positive HCV risk questionnaire. 4,717 tests were performed, finding an anti-HCV percentage of 0.65% in the screened population, with 0.46% of active infections. Among the individuals with a positive test result, 51.9% had a known prior diagnosis but had not received treatment, because they were not aware of it or were not linked to the health system, and 19.2% had a positive result for the first time. The prevalence of hidden infection was higher in men, those over 50 years of age and people from Eastern Europe. CONCLUSION We found a prevalence of active infections higher than recently described nationwide, and a higher percentage of newly diagnosed infections than recent similar studies in other areas. These differences justify the need to perform local assessments of the prevalence of HCV infection in each of the health areas where it is planned to implement and monitor a microelimination programme.
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Barokar J, McCutchan A, Deutsch R, Tang B, Cherner M, Bharti AR. Neurocognitive impairment is worse in HIV/HCV-coinfected individuals with liver dysfunction. J Neurovirol 2019; 25:792-799. [PMID: 31281947 PMCID: PMC6923581 DOI: 10.1007/s13365-019-00767-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/09/2019] [Accepted: 05/21/2019] [Indexed: 01/09/2023]
Abstract
Infections with HIV and hepatitis C virus (HCV) can individually and jointly contribute to neurocognitive impairment (NCI). Rates of NCI in HIV/HCV-coinfected persons range from 40 to 63% but its correlates have not been described. In this study, we examined HIV/HCV-coinfected adults on antiretroviral therapy (ART) with undetectable HIV RNA in blood (n = 412) who were assessed using a comprehensive neuropsychological test battery. Demographics, host and viral biomarkers, and markers of liver dysfunction were compared between impaired (n = 198) and unimpaired (n = 214) participants using logistic regression. The cohort was predominantly middle-aged men, half of whom (48%) had NCI. The odds of NCI increased by almost two-fold when serum albumin was < 4 g/dL, 1.7-fold when alanine aminotransferase (ALT) levels were > 50 IU/L, and 2.2-fold with every unit increase in log10 AST to Platelet Ratio Index (APRI). These readily available clinical biomarkers of NCI measure hepatic injury and/or dysfunction, suggesting a mechanism for the effects of HCV infection on NCI. They may identify patients at increased risk of NCI who could be prioritized for early initiation of HCV treatment to protect or improve cognition.
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Affiliation(s)
- Jyoti Barokar
- Department of Psychiatry, University of California, San Diego, USA
| | - Allen McCutchan
- Department of Medicine, University of California, San Diego, USA
| | - Reena Deutsch
- Department of Psychiatry, University of California, San Diego, USA
| | - Bin Tang
- Department of Psychiatry, University of California, San Diego, USA
| | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego, USA
| | - Ajay R. Bharti
- Department of Medicine, University of California, San Diego, USA
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10
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Manuel Sousa J, Vergara M, Pulido F, Sánchez Antolín G, Hijona L, Carnicer F, Rincón D, Salmerón J, Mateos-Muñoz B, Jou A, Polo-Lorduy B, Rubín Á, Escarda A, Aguilar P, Aldámiz-Echevarría T, García-Buey L, Carrión JA, Hernández-Guerra M, Chimeno-Hernández S, Espinosa N, Morillas RM, Andrade RJ, Delgado M, Gallego A, Magaz M, Moreno-Planas JM, Estébanez Á, Rico M, Menéndez F, Sampedro B, Morano L, Izquierdo S, Zozaya JM, Rodríguez M, Morán-Sánchez S, Lorente S, Martín-Granizo I, Von-Wichmann MÁ, Delgado M, Manzanares A. Real-world evidence of the effectiveness of ombitasvir-paritaprevir/r ± dasabuvir ± ribavirin in patients monoinfected with chronic hepatitis C or coinfected with human immunodeficiency virus-1 in Spain. PLoS One 2019; 14:e0225061. [PMID: 31714950 PMCID: PMC6850697 DOI: 10.1371/journal.pone.0225061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/27/2019] [Indexed: 12/27/2022] Open
Abstract
Aim We describe the effectiveness and safety of the interferon-free regimen ombitasvir/paritaprevir/ritonavir plus dasabuvir with or without ribavirin (OBV/PTV/r ± DSV ± RBV) in a nationwide representative sample of the hepatitis C virus (HCV) monoinfected and human immunodeficiency virus-1/hepatitis C virus (HIV/HCV) coinfected population in Spain. Material and methods Data were collected from patients infected with HCV genotypes 1 or 4, with or without HIV-1 coinfection, treated with OBV/PTV/r ± DSV ± RBV at 61 Spanish sites within the initial implementation year of the first government-driven “National HCV plan.” Effectiveness was assessed by sustained virologic response at post-treatment week 12 (SVR12) and compared between monoinfected and coinfected patients using a non-inferiority margin of 5% and a 90% confidence interval (CI). Sociodemographic and clinical characteristics or patients and adverse events (AEs) were also recorded. Results Overall, 2,408 patients were included in the intention-to-treat analysis: 386 (16%) were patients with HIV/HCV. Patient selection reflected the real distribution of patients treated in each participating region in Spain. From the total population, 96.6% (95% CI, 95.8–97.3%) achieved SVR12. Noninferiority of SVR12 in coinfected patients was met, with a difference between monoinfected and coinfected patients of −2.2% (90% CI, −4.5% - 0.2%). Only genotype 4 was associated with non-response to OBV/PTV/r ± DSV ± RBV treatment (p<0.001) in the multivariate analysis. Overall, 286 patients (11.9%) presented AEs potentially related to OBV/PTV/r ± DSV, whereas 347 (29.0%) presented AEs potentially related to ribavirin and 61 (5.1%) interrupted ribavirin. Conclusions Our results confirm that OBV/PTV/r ± DSV ± RBV is effective and generally well tolerated in a representative sample of the HCV monoinfected and HCV/HIV coinfected population in Spain within the experience of a national strategic plan to tackle HCV.
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Affiliation(s)
- José Manuel Sousa
- Hepatology Department, Hospital Universitario Virgen del Rocío, Sevilla, Sevilla, Spain
| | - Mercedes Vergara
- Hepatology Unit, Digestive Disease Department, Parc Taulí Sabadell Hospital Universitari, Sabadell, Barcelona, Spain, CIBERehd, Instituto Carlos III, Madrid, Spain
| | - Federico Pulido
- HIV Unit, Hospital Universitario 12 de Octubre, imas12, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Gloria Sánchez Antolín
- Hepatology Department, Hospital Universitario Río Hortega, Valladolid, Valladolid, Spain
| | - Lander Hijona
- Hepatology Department, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, Spain
| | - Fernando Carnicer
- Hepatology Department, Hospital General Universitario de Alicante, Alicante, Alicante, Spain
| | - Diego Rincón
- Hepatology Department, Hospital General Universitario Gregorio Marañón, CIBERehd and (UCM), Madrid, Spain
| | - Javier Salmerón
- Hepatology Department, Complejo Hospitalario Universitario de Granada, Granada, Granada, Spain
| | | | - Antoni Jou
- HIV Clinical Unit, Internal Medicine Department and Fundació de la Lluita contra la SIDA, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Benjamín Polo-Lorduy
- Hepatology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ángel Rubín
- Hepatology Department, Hospital Universitario y Politécnico de La Fe, Valencia, Valencia, Spain
| | - Ana Escarda
- Hepatology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Patricia Aguilar
- Digestive System Clinical Unit, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía/Córdoba University, Córdoba, Spain
| | - Teresa Aldámiz-Echevarría
- Infectious Diseases-HIV, Hospital General Universitario Gregorio Marañón (IiSGM), Madrid, Madrid, Spain
| | - Luisa García-Buey
- Hepatology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - José A. Carrión
- Liver Section, Gastroenterology Department, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), UAB (Universitat Autonoma de Barcelona) Barcelona, Spain
| | - Manuel Hernández-Guerra
- Hepatology Department, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | | | - Nuria Espinosa
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC,Sevilla, Spain
| | - Rosa Mª Morillas
- Liver Section, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, IGTP, Badalona, Barcelona, Spain, and CIBEREHD
| | - Raúl J. Andrade
- Unidad de Gestión Clínica de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Málaga, Spain
| | - Manuel Delgado
- Hepatology Department, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Adolfo Gallego
- Hepatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Barcelona, Spain
| | - Marta Magaz
- Hepatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Ángel Estébanez
- Hepatology Department, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Mikel Rico
- Infectious Diseases Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Fernando Menéndez
- Hepatology Department, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
| | - Blanca Sampedro
- Hepatology Department, Hospital Galdakao, Galdakao, Vizcaya, Spain
| | - Luís Morano
- Infectious Diseases Unit, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Sonia Izquierdo
- Hepatology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - José Manuel Zozaya
- Hepatology Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Manuel Rodríguez
- Liver Unit, Division of Gastroenterology & Hepatology. Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Senador Morán-Sánchez
- Hepatology Department, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - Sara Lorente
- Hepatology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Zaragoza, Spain
| | - Ignacio Martín-Granizo
- Department of Gastroenterology, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | | | - Marcial Delgado
- Infectious Diseases Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
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11
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To-Figueras J. Association between hepatitis C virus and porphyria cutanea tarda. Mol Genet Metab 2019; 128:282-287. [PMID: 31097365 DOI: 10.1016/j.ymgme.2019.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 01/05/2023]
Abstract
Porphyria cutanea tarda (PCT) arises from a deficiency of uroporphyrinogen decarboxylase (UROD) in the liver. Several exogenous risk factors are associated with the acquired form of the disease. In Southern Europe, PCT is strongly linked to hepatitis C virus (HCV) infection to the point that a high prevalence of viral infection in some geographic areas generated an increase of PCT cases as a complication. In spite of the association, PCT is a rare complication of HCV infection, thus suggesting the existence of susceptibility factors operating in only some patients. Investigation of liver specimens of PCT patients showed iron accumulation, which albeit moderate, was higher in comparison with HCV-infected patients without PCT. Measurements of hepcidin in serum of HCV-infected patients with and without PCT and calculation of hepcidin/ferritin ratio were compatible with the hypothesis that HCV induced inadequate response of hepcidin to iron accumulation. Administration of direct-acting antivirals (DAA) to HCV-infected patients with active PCT showed that eradication of the virus was followed by resolution of PCT and rapid disappearance of urinary porphyrins. This suggests a direct participation of the virus in the oxidative mechanism leading to UROD inhibition. If clinical evolution of HCV- PCT-patients is placed within a time-frame, rapid PCT resolution by DAA is in striking contrast with a long-delay (in most cases of decades) between viral infection and appearance of overt porphyria. This could be explained if HCV infection (a): enhanced an oxidative environment in the vicinity of UROD and (b): facilitated iron accumulation through hepdicin down-regulation. Thus, only when iron accumulation reached a threshold, inhibition of UROD attained a critical level. However, the enigma is why only a minority of HCV-infected patients develop PCT. If additional risk factors (i.e. alcohol abuse) are not concurring, it should be concluded that modifier genes or epigenetic mechanisms related to iron homeostasis, facilitate iron progressive accumulation in only a minority susceptible patients.
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Affiliation(s)
- Jordi To-Figueras
- Biochemistry and Molecular Genetics Unit, Hospital Clinic of Barcelona, University of Barcelona, Spain.
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12
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Revuelto Artigas T, Zaragoza Velasco N, Gómez Arbones X, Vidal Ballester T, Piñol Felis C, Reñe Espinet J, Betriu Bars A. Chronic hepatitis C infection: An independent risk factor for subclinical atheromatosis. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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13
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Matsushita H, Takaki A. Alcohol and hepatocellular carcinoma. BMJ Open Gastroenterol 2019; 6:e000260. [PMID: 31139422 PMCID: PMC6505979 DOI: 10.1136/bmjgast-2018-000260] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/04/2019] [Accepted: 01/12/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Alcohol is classified as a Group 1 carcinogen by the International Agency for Research on Cancer because it induces hepatocellular carcinoma (among other cancers) in humans. An excessive alcohol intake may result in fatty liver, acute/chronic hepatitis, and cirrhosis and eventually lead to hepatocellular carcinoma. It has been reported that alcohol abuse increases the relative risk of hepatocellular carcinoma by 3- to 10-fold. AIM AND METHODS To clarify the known mechanisms of alcohol-related carcinogenesis, we searched Pubmed using the terms alcohol and immune mechanism, alcohol and cancer, and immune mechanism and cancer and summarized the articles as a qualitative review. RESULTS From a clinical perspective, it is well known that alcohol interacts with other factors, such as smoking, viral hepatitis, and diabetes, leading to an increased risk of hepatocellular carcinoma. There are several possible mechanisms through which alcohol may induce liver carcinogenicity, including the mutagenic effects of acetaldehyde and the production of ROS due to the excessive hepatic deposition of iron. Furthermore, it has been reported that alcohol accelerates hepatitis C virus-induced liver tumorigenesis through TLR4 signaling. Despite intense investigations to elucidate the mechanisms, they remain poorly understood. CONCLUSION This review summarizes the recent findings of clinical and pathological studies that have investigated the carcinogenic effects of alcohol in the liver.
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Affiliation(s)
- Hiroshi Matsushita
- Department of Gastroenterology and Hepatology, Okayama University, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Akinobu Takaki
- Department of Gastroenterology and Hepatology, Okayama University, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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14
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Hepatitis C virus infection in Spain: Challenges in the track to elimination. Enferm Infecc Microbiol Clin 2019; 37:219-221. [DOI: 10.1016/j.eimc.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 01/08/2023]
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15
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Revuelto Artigas T, Zaragoza Velasco N, Gómez Arbones X, Vidal Ballester T, Piñol Felis C, Reñe Espinet JM, Betriu Bars A. Chronic hepatitis C infection: An independent risk factor for subclinical atheromatosis. Rev Clin Esp 2019; 219:293-302. [PMID: 30773286 DOI: 10.1016/j.rce.2018.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/27/2018] [Accepted: 12/04/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND The association between subclinical atheromatosis and chronic hepatitis C virus (HCV) infection is unknown but is relevant now that antivirals are improving the survival of patients with the infection. OBJECTIVES To determine whether HCV is an independent risk factor for subclinical atheromatosis and to analyse the changes in lipid profiles according to viral RNA levels and hepatic fibrosis. PATIENTS AND METHODS We conducted an observational, cross-sectional study that included 102 HCV-positive patients and 102 HCV-negative patients with parity in terms of sex and age, with no history of cardiovascular or kidney disease or diabetes. Atheromatosis (the presence of atheromatous plaques) and the carotid intima-media thickness (CIMT) were assessed using ultrasonography of the carotid and femoral arteries. RESULTS There was a greater presence of atheromatosis in any vascular territory in HCV-positive patients than in the patients without infection (58.8% vs. 28.4%, p<.0001). In the multivariate analysis, the factors significantly associated with atheromatosis included HCV infection (OR, 14.37 [5.5-37.3]; p<.001), age (OR, 1.12 [1.1-1.2]; p<.001), male sex (OR, 4.32 [1.9-9.5]; p<.001) and the triglyceride/HDL cholesterol coefficient (TG/HDL-indirect indicator of insulin resistance) (OR, 1.34 [1.1-1.6]; p=.007). The HCV-positive patients with atheromatous plaques had a higher TG/HDL coefficient but no significant differences in terms of the viral load or degree of hepatic fibrosis and with a 'low risk' lipid profile. CONCLUSIONS HCV infection is an independent risk factor for subclinical atheromatosis. Systemic arterial ultrasonography for this population improves the cardiovascular risk assessment beyond lipid profile abnormalities and the risk calculation using SCORE tables.
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Affiliation(s)
- T Revuelto Artigas
- Servicio de Aparato Digestivo, Hospital Universitario Santa María, Lleida, España; Servicio de Aparato Digestivo, Hospital Universitario Arnau de Vilanova, Lleida, España; Unidad de Detección y Tratamiento de Enfermedades Aterotrombóticas (UDETMA), Hospital Universitario Arnau de Vilanova (Grupo de Investigación Translacional Vascular y Renal, IRBLleida), Lleida, España; Instituto de Investigación Biomédica, Lleida, España.
| | - N Zaragoza Velasco
- Servicio de Aparato Digestivo, Hospital Universitario Arnau de Vilanova, Lleida, España; Unidad de Detección y Tratamiento de Enfermedades Aterotrombóticas (UDETMA), Hospital Universitario Arnau de Vilanova (Grupo de Investigación Translacional Vascular y Renal, IRBLleida), Lleida, España; Instituto de Investigación Biomédica, Lleida, España
| | - X Gómez Arbones
- Instituto de Investigación Biomédica, Lleida, España; Universidad de Lleida (UdL), Lleida, España
| | - T Vidal Ballester
- Unidad de Detección y Tratamiento de Enfermedades Aterotrombóticas (UDETMA), Hospital Universitario Arnau de Vilanova (Grupo de Investigación Translacional Vascular y Renal, IRBLleida), Lleida, España
| | - C Piñol Felis
- Instituto de Investigación Biomédica, Lleida, España; Universidad de Lleida (UdL), Lleida, España
| | - J M Reñe Espinet
- Servicio de Aparato Digestivo, Hospital Universitario Arnau de Vilanova, Lleida, España; Instituto de Investigación Biomédica, Lleida, España; Universidad de Lleida (UdL), Lleida, España
| | - A Betriu Bars
- Unidad de Detección y Tratamiento de Enfermedades Aterotrombóticas (UDETMA), Hospital Universitario Arnau de Vilanova (Grupo de Investigación Translacional Vascular y Renal, IRBLleida), Lleida, España; Instituto de Investigación Biomédica, Lleida, España
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16
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Juanbeltz R, Pérez-García A, Aguinaga A, Martínez-Baz I, Casado I, Burgui C, Goñi-Esarte S, Repáraz J, Zozaya JM, San Miguel R, Ezpeleta C, Castilla J. Progress in the elimination of hepatitis C virus infection: A population-based cohort study in Spain. PLoS One 2018; 13:e0208554. [PMID: 30513107 PMCID: PMC6279228 DOI: 10.1371/journal.pone.0208554] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/18/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The World Health Organization set targets to eliminate hepatitis C virus (HCV) infection through detection and treatment of all cases by 2030. This study aimed to describe the progress and difficulties in the elimination of HCV infection in Navarra, Spain. METHODS Using electronic healthcare databases, we performed a population-based prospective cohort study to describe changes in the prevalence of diagnosed active HCV infection at the beginning of 2015 and the end of 2017, the rate of new diagnoses and the rate of post-treatment viral clearance (PTVC) during this period. RESULTS At the beginning of 2015 there were 1503 patients diagnosed with positive HCV-RNA, 2.4 per 1000 inhabitants, and at the end of 2017 the prevalence had decreased by 47%. In the study period, 333 (18 per 100,000 person-years) new positive HCV-RNA cases were detected, but only 76 (23%; 4.2 per 100,000 person-years) did not have anti-HCV antibodies previously detected. Prevalent cases and new diagnoses of active infection were more frequent in men, people born in 1950-1979, HIV-infected patients and in those with lower income levels. Among patients with HCV-RNA, 984 achieved PTVC (22.7 per 100 person-years). PTVC was less frequent in patients born before 1940, in immigrants and in patients with lower income levels. CONCLUSIONS The prevalence of diagnosed active HCV infection has dropped by almost half over three years, because the number of patients with PTVC was much higher than the number of new diagnoses. Interventions specifically targeted at population groups with less favourable trends may be necessary.
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Affiliation(s)
- Regina Juanbeltz
- Instituto de Salud Pública de Navarra—IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública, Pamplona, Spain
| | - Alejandra Pérez-García
- CIBER Epidemiología y Salud Pública, Pamplona, Spain
- Department of Clinical Microbiology, Complejo Hospitalario de Navarra—IdiSNA, Pamplona, Spain
| | - Aitziber Aguinaga
- Department of Clinical Microbiology, Complejo Hospitalario de Navarra—IdiSNA, Pamplona, Spain
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra—IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública, Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra—IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública, Pamplona, Spain
| | - Cristina Burgui
- CIBER Epidemiología y Salud Pública, Pamplona, Spain
- Department of Pharmacy, Complejo Hospitalario de Navarra—IdiSNA, Pamplona, Spain
| | - Silvia Goñi-Esarte
- Department of Gastroenterology and Hepatology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Jesús Repáraz
- Department of Internal Medicine, Complejo Hospitalario de Navarra—IdiSNA, Pamplona, Spain
| | - José Manuel Zozaya
- Department of Gastroenterology and Hepatology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ramón San Miguel
- Department of Pharmacy, Complejo Hospitalario de Navarra—IdiSNA, Pamplona, Spain
| | - Carmen Ezpeleta
- Department of Clinical Microbiology, Complejo Hospitalario de Navarra—IdiSNA, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra—IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública, Pamplona, Spain
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17
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Treating HCV in a Captive Audience: Eradication Efforts in the Prison Microenvironment. Am J Gastroenterol 2018; 113:1585-1587. [PMID: 30038424 DOI: 10.1038/s41395-018-0201-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/26/2018] [Indexed: 02/07/2023]
Abstract
Testing for and treating Hepatitis C (HCV) patients in the prison setting is effective in the short term to reducing the overall burden of HCV in the prison microenvironment, with growing evidence that such efforts could yield substantial overall benefits in the effort to eradicate HCV in society. However, rates of reinfection are as yet unknown.
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18
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Cuadrado A, Llerena S, Cobo C, Pallás JR, Mateo M, Cabezas J, Fortea JI, Alvarez S, Pellón R, Crespo J, Echevarría S, Ayesa R, Setién E, Lopez-Hoyos M, Crespo-Facorro B, Agüero J, Chueca N, Garcia F, Calleja JL, Crespo J. Microenvironment Eradication of Hepatitis C: A Novel Treatment Paradigm. Am J Gastroenterol 2018; 113:1639-1648. [PMID: 29946175 DOI: 10.1038/s41395-018-0157-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 05/04/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Prisons are major reservoirs of hepatitis C virus (HCV) in which a therapeutic approach has been particularly difficult so far. Our aim was to create a permanent program of HCV elimination in a prison based on a "test and treat" strategy. METHODS This open-label clinical trial was conducted in the Spanish prison "El Dueso" between May 2016 and July 2017. Viremic patients were treated with a ledipasvir-sofosbuvir regimen (8-12 weeks) according to the 2015 Spanish Guidelines. A teleconsultation program was established to follow-up patients from the hospital. Non-responders were submitted for a phylogenetic analysis and offered retreatment. An evaluation of new cases of HCV infection was performed every 6 months and upon release in all inmates. RESULTS 847 (99.5%) inmates accepted to participate. HCV antibodies were present in 110 (13.0%) and 86 (10.2%) had detectable viremia. Most of them were genotype 1 or 3 (82.6%) and had <F2 fibrosis (52.2%). Treatment was started in the 69 inmates whose stay in prison was longer than 30 days. Sustained virological response was achieved in 64 out of 66 patients (96.9%), three of whom were successfully rescued with a salvage regimen after treatment failure. Two patients were lost to follow-up and three are currently on treatment without viremia. As a result, by July 2017 none of the 409 imprisoned was viremic, and neither reinfections nor de novo infections were detected. CONCLUSIONS A sustained "test-and-treat" strategy against HCV in prisons is feasible and beneficial. Spreading this strategy should entail a public health impact.
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Affiliation(s)
- Antonio Cuadrado
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain.,Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Susana Llerena
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain.,Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Carmen Cobo
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - José Ramón Pallás
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Miguel Mateo
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Joaquin Cabezas
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain.,Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - José Ignacio Fortea
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain.,Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Silvia Alvarez
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain.,Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Raúl Pellón
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Juan Crespo
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Santiago Echevarría
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain.,Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Rosa Ayesa
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain.,Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Esther Setién
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain.,Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Marcos Lopez-Hoyos
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Benedicto Crespo-Facorro
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain.,Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Jesus Agüero
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Natalia Chueca
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Federico Garcia
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Jose Luis Calleja
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Javier Crespo
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain.,Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish), Santoña, Spain. Medical Service. El Dueso Penitentiary Centre, Santoña, Spain. Radiology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Internal Medicine and Infectious Diseases Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Centro de investigación en red de Salud Mental (CIBERSAM), Santander, Spain. Department of Medicine and Psychiatry, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Immunology Department, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Cantabria, Spain. Department of Microbiology, Complejo Hospitalario Universitario Granada-Hospital San Cecilio, Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro. Majadahonda. School of Medicine, Universidad Autónoma Madrid, Madrid, Spain
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Abstract
PURPOSE The aim was to estimate seroprevalence and prevalence of hepatitis C virus (HCV) infection in a small health area of the Valencian Community, Spain. PATIENTS AND METHODS This is a descriptive cross-sectional study aimed at estimation of HCV infection prevalence in the whole adult population (25-70 years old), that is, a pilot study for an eventual population-based screening program. RESULTS A total of 5849 participants aged 25-70 years (51% male) were invited to participate by regular mail. Overall, 143 letters were returned owing to errors in the addresses. Of 5706 participants, 2637 (46.2%) participated in the study. Rapid test of anti-HCV antibody detection was positive in 30 cases (HCV seroprevalence 1.14%, 95% confidence intervals: 0.73-1.55%). Of those, seven were not aware of their condition. Participants who had a positive result in the rapid test of anti-HCV detection were given a confirmatory test by enzyme immune assay, and all had a positive result. RNA-HCV determination by quantitative PCR in positive anti-HCV patients showed positive viremia in 13 (43.3%) cases, of which five were not aware of the disease. Of the 17 patients who had negative viremia, two were unaware of their HCV status, one was a carrier of anti-HCV and was already aware of his condition, and 14 had been previously treated with satisfactory results. Regarding fibrosis, of the seven patients who were unaware of HCV infection, none of them had significant fibrosis. Moreover, 26 (86.7%) anti-HCV positive patients were reported to have one or more risk factors for HCV infection. CONCLUSION HCV screening strategies applied to the general population are good means to diagnose and treat patients who are not aware of their infection, avoiding new transmissions as well as disease progression.
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Berenguer J. Eliminación del virus de la hepatitis C en España: un reto pendiente. Enferm Infecc Microbiol Clin 2018; 36:323-324. [DOI: 10.1016/j.eimc.2018.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 03/03/2018] [Accepted: 03/09/2018] [Indexed: 12/19/2022]
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21
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Pallarés C, Carvalho-Gomes Â, Hontangas V, Conde I, Di Maira T, Aguilera V, Benlloch S, Berenguer M, López-Labrador FX. Performance of the OraQuick Hepatitis C virus antibody test in oral fluid and fingerstick blood before and after treatment-induced viral clearance. J Clin Virol 2018. [PMID: 29525634 DOI: 10.1016/j.jcv.2018.02.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND A reliable population screening strategy for hepatitis C virus (HCV) infection may be based in easy-to-use point-of-care (POC) tests for HCV antibodies, but validation data is needed before their potential widespread use in primary care or outreach practice. Besides, the sensitivity of these POC tests in patients with spontaneous or treatment-induced viral clearance is unknown. OBJECTIVES To test the performance of a non-invasive POC anti-HCV test (OraQuick HCV rapid test) in oral mucosal transudate (OMT) and fingerstick blood from patients with known anti-HCV serostatus and with or without active viremia (after treatment-induced clearance). STUDY DESIGN A risk factor questionnaire was collected from 317 consecutive patients (anti-HCV positive/HCV-RNA positive n = 107; anti-HCV positive/HCV-RNA negative after antiviral treatment n = 107; anti-HCV negative with other liver diseases n = 109) before performing the OraQuick HCV rapid test in OMT (n = 317) and fingerstick blood (n = 251). We calculated the sensitivity and specificity of the test by using anti-HCV serostatus as the reference gold-standard. RESULTS Among all anti-HCV seropositive patients, the clinical sensitivity and specificity of the OraQuick HCV rapid test in OMT was 89.9% and 100%, respectively. In fingerstick blood, the sensitivity improved to 98.8%. The sensitivity was higher in OMT (97.2%) in anti-HCV seropositive patients who were viremic as compared to that in non-viremic individuals (82.2%). In contrast, there were no significant differences in sensitivity between viremic and non-viremic individuals when testing fingerstick blood. Finally, extension of the read time to 40 min enhanced the sensitivity, especially in OMT (up to 94.7%) and in the subgroup of non-viremic, anti-HCV-positive patients (up to 90.1%). CONCLUSIONS The OraQuick HCV rapid test in OMT has a high sensitivity and specificity for detecting active HCV infection that decreases substantially in anti-HCV positive/HCV-RNA negative patients with treatment-induced viral clearance. For these individuals, extension of read times and testing fingerstick blood showed improved sensitivity.
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Affiliation(s)
- Carmina Pallarés
- Liver Transplantation and Hepatology Laboratory, Instituto Investigación Sanitaria La Fe, Valencia, Spain; CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Ângela Carvalho-Gomes
- Liver Transplantation and Hepatology Laboratory, Instituto Investigación Sanitaria La Fe, Valencia, Spain; CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Vanessa Hontangas
- Liver Transplantation and Hepatology Laboratory, Instituto Investigación Sanitaria La Fe, Valencia, Spain
| | - Isabel Conde
- Liver Transplantation and Hepatology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Tomasso Di Maira
- Liver Transplantation and Hepatology Laboratory, Instituto Investigación Sanitaria La Fe, Valencia, Spain
| | - Victoria Aguilera
- Liver Transplantation and Hepatology Laboratory, Instituto Investigación Sanitaria La Fe, Valencia, Spain; CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain; Liver Transplantation and Hepatology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Salvador Benlloch
- Liver Transplantation and Hepatology Laboratory, Instituto Investigación Sanitaria La Fe, Valencia, Spain; CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain; Liver Transplantation and Hepatology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Marina Berenguer
- Liver Transplantation and Hepatology Laboratory, Instituto Investigación Sanitaria La Fe, Valencia, Spain; CIBERehd, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain; Liver Transplantation and Hepatology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Medicine, Medical School, Universitat de València, Spain
| | - F Xavier López-Labrador
- Virology Laboratory, Genomics and Health Area, Center for Public Health Research, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO-Public Health), Generalitat Valenciana, Valencia, Spain; CIBEResp, Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.
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22
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Garriga C, Manzanares-Laya S, García de Olalla P, Gorrindo P, Lens S, Solà R, Martínez-Rebollar M, Laguno M, Navarro J, Torras X, Gurguí M, Barberá MJ, Quer J, Masdeu E, Simón P, Ros M, de Andrés A, Caylà JA. Evolution of acute hepatitis C virus infection in a large European city: Trends and new patterns. PLoS One 2017; 12:e0187893. [PMID: 29135988 PMCID: PMC5685589 DOI: 10.1371/journal.pone.0187893] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 10/27/2017] [Indexed: 12/15/2022] Open
Abstract
The aims of this study were to describe the evolution of acute hepatitis C virus (HCV) infections since 2004 and to determine its associated factors. Acute HCV infections diagnosed in Barcelona from 2004 to 2015 were included. Incidence ratios (IR) were then estimated for sex and age groups. Cases were grouped between 2004-2005, 2006-2011 and 2012-2015, and their incidence rate ratios (IRR) were calculated. In addition, risk factors for acute HCV infection were identified using multinomial logistic regression for complete, available and multiple imputed data. 204 new HCV cases were identified. Two peaks of higher IR of acute HCV infection in 2005 and 2013 were observed. Men and those aged 35-54 had higher IR. IRR for men was 2.9 times greater than in women (95% confidence intervals (CI): 1.8 ‒ 4.7). Factors related to the period 2012-2015 (versus 2006-2011) were: a) sexual risk factor for transmission versus nosocomial (relative-risk ratio (RRR): 13.0; 95% CI: 2.3 ‒ 72.1), b) higher educated versus lower (RRR: 5.4; 95% CI: 1.6 ‒ 18.7), and c) HIV co-infected versus not HIV-infected (RRR: 53.1; 95% CI: 5.7 ‒ 492.6). This is one of the few studies showing IR and RRRs of acute HCV infections and the first focused on a large city in Spain. Sexual risk for transmission between men, higher educational level and HIV co-infection are important factors for understanding current HCV epidemic. There has been a partial shift in the pattern of the risk factor for transmission from nosocomial to sexual.
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Affiliation(s)
- César Garriga
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
- Spanish Field Epidemiology Training Programme (FETP/PEAC), National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Sandra Manzanares-Laya
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Patricia García de Olalla
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Pilar Gorrindo
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
| | - Sabela Lens
- Liver Unit, Hospital Clínic, Barcelona. IDIBAPS, Barcelona, Spain
- CIBER of Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain
| | - Ricard Solà
- Internal Medicine-Infectious Diseases, Hospital del Mar, Barcelona, Spain
| | - María Martínez-Rebollar
- Hospital Clinic- August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Montserrat Laguno
- Hospital Clinic- August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Jordi Navarro
- Infectious Diseases, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Torras
- CIBER of Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, CIBERehd, Barcelona, Spain
| | - Mercè Gurguí
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María-Jesús Barberá
- Sexually Transmitted Infections Unit, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Quer
- Liver Unit, Internal Medicine, Laboratory of Malalties Hepàtiques, Vall d'Hebron Institut de Recerca-Hospital Universitari Vall d´Hebron, (VHIR-HUVH), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eva Masdeu
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
| | - Pere Simón
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
| | - Miriam Ros
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
| | - Anna de Andrés
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
| | - Joan A. Caylà
- Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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23
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Boix R, Cano R, Gallego P, Vallejo F, Fernández-Cuenca R, Noguer I, Larrauri A. Hepatitis C hospitalizations in Spain, 2004-2013: a retrospective epidemiological study. BMC Health Serv Res 2017; 17:461. [PMID: 28679375 PMCID: PMC5498875 DOI: 10.1186/s12913-017-2410-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 06/27/2017] [Indexed: 01/29/2023] Open
Abstract
Background Hepatitis C is an important public health problem about which there is currently scarce epidemiological information. The objective of this study is to describe and analyse the demographic and epidemiological characteristics of hospitalized cases of hepatitis C in the Spanish population between 2004 and 2013. Methods The study uses the Hospital Discharge Records Database of the Spanish National Health System. It is a retrospective descriptive epidemiological study. The variables analysed were year of infection, age, sex, diagnostic category, days admitted and co-morbidity. Results There have been a total of 351,996 hospitalizations; 225,138 men (64%) and 126,858 women (36%). They are divided between acute hepatitis 8161 (2.3%); chronic hepatitis 325,185 (92.4%) and unspecified hepatitis 18,650 (5.3%). The mean age for men is 53.7 (+/−15.2) and for women 62.3 (+/−17.3). 22.8% also present with an Human immunodeficiency virus (HIV) disease coinfection, and 14.7% with opioid dependencies. The trend is for a gradual increase in cases without statistical significance. Conclusions The Hepatitis C cases hospitalized had high levels of chronicity, which entails two distinct patterns of illness in men and women – who are affected in different age ranges.
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Affiliation(s)
- R Boix
- National Centre of Epidemiology, Institute of Health Carlos III, C/Monforte de Lemos, 5, 28029, Madrid, Spain.
| | - R Cano
- National Centre of Epidemiology, Institute of Health Carlos III, C/Monforte de Lemos, 5, 28029, Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), C/ Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - P Gallego
- National Centre of Epidemiology, Institute of Health Carlos III, C/Monforte de Lemos, 5, 28029, Madrid, Spain
| | - F Vallejo
- National Centre of Epidemiology, Institute of Health Carlos III, C/Monforte de Lemos, 5, 28029, Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), C/ Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - R Fernández-Cuenca
- National Centre of Epidemiology, Institute of Health Carlos III, C/Monforte de Lemos, 5, 28029, Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), C/ Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - I Noguer
- National Centre of Epidemiology, Institute of Health Carlos III, C/Monforte de Lemos, 5, 28029, Madrid, Spain
| | - A Larrauri
- National Centre of Epidemiology, Institute of Health Carlos III, C/Monforte de Lemos, 5, 28029, Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), C/ Monforte de Lemos, 3-5, 28029, Madrid, Spain
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Chronic hepatitis C and individuals with a history of injecting drugs in Spain: population assessment, challenges for successful treatment. Eur J Gastroenterol Hepatol 2017; 29:629-633. [PMID: 28230562 DOI: 10.1097/meg.0000000000000855] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In Spain, there is a need to improve chronic hepatitis C care among people who inject drugs (PWID). Injecting drug use is an important risk behaviour for hepatitis C virus (HCV) infection. Review of 28 sources of the relevant published literature mapped the size of the addiction-HCV population in Spain. Experts in opioid use disorder (OUD) treatment in Spain completed a consensus to define the population size, HCV prevalence and access or barriers to hepatitis C treatment for PWID populations. In Spain, over 300 000 individuals have a lifetime history of injecting drugs. Currently, 150 000 individuals in Spain have OUD; many have injected drugs. Each year, 80 000 individuals engage with treatment services for OUD. A proportion of this group continues to inject drugs. There is a high HCV prevalence in PWID - estimates of 60-80% in Spain. Uptake of hepatitis C therapy in PWID in Spain is limited; barriers include awareness of treatment pathways, advocacy for regular screening and effective joint care. There is an urgent need to address barriers to effective hepatitis C care for PWID in Spain. Practical and specific strategies including peer-led solutions, patient buddy systems and joint working models at the local level can make important short-term differences.
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25
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Aguinaga A, Díaz-González J, Pérez-García A, Barrado L, Martínez-Baz I, Casado I, Juanbeltz R, Ezpeleta C, Castilla J. The prevalence of diagnosed and undiagnosed hepatitis C virus infection in Navarra, Spain, 2014-2016. Enferm Infecc Microbiol Clin 2017; 36:325-331. [PMID: 28110858 DOI: 10.1016/j.eimc.2016.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 11/30/2016] [Accepted: 12/04/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the prevalence of hepatitis C virus (HCV) infection in Navarra, Spain, as well as to distinguish between diagnosed and undiagnosed infections. METHODS A study was conducted on patients scheduled for surgery unrelated to HCV infection. They were all tested for HCV antibodies, under a routine scheme, from January 2014 to September 2016. Patients with a positive result by enzyme immunoassay were confirmed using immunoblot and/or HCV-RNA. Previous laboratory results were also taken into account. The prevalence was adjusted to the sex and age structure of the Navarra population. RESULTS The study included a total of 7,378 patients with a median age 46 years, of whom 50% women. HCV antibodies were detected in 69 patients, which is a prevalence in the population of 0.83% (95% confidence interval: 0.64-1.05), and was higher in men (1.11%) than in women (0.56%; P=.0102). Among the HCV positive patients, 67 (97%) had had another previous positive result. Population prevalence of previous positive HCV was 0.80%, and was 0.03% for a new diagnosis. Of the HCV positive patients, 78% had detectable HCV-RNA. It was estimated that 0.65% of the population had had detectable HCV-RNA, and 0.51% continued to have it when recruited into the study. CONCLUSION Previous estimates of prevalence of HCV infection should be revised downwards. Only a small proportion of HCV positive patients remain undiagnosed, and only a small part have active infection.
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Affiliation(s)
- Aitziber Aguinaga
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España
| | - Jorge Díaz-González
- Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España
| | - Alejandra Pérez-García
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Pamplona, España
| | - Laura Barrado
- Hospital García Orcoyen, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Estella, Navarra, España
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Pamplona, España
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Pamplona, España
| | - Regina Juanbeltz
- Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Pamplona, España
| | - Carmen Ezpeleta
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Pamplona, España.
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Hepatitis C-related cirrhosis. Current status. Med Clin (Barc) 2016; 148:78-85. [PMID: 27855947 DOI: 10.1016/j.medcli.2016.09.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 12/15/2022]
Abstract
Chronic hepatitis C virus (HCV) infection affects around 150 million people. It is a leading cause of liver related morbidity and mortality through its predisposition to liver fibrosis, cirrhosis and end-stage liver complications. New treatments based on direct-acting antivirals have opened a new era in the management of HCV cirrhosis. They allow for HCV eradication without substantial side effects in almost all cirrhotic patients, reducing the risk of hepatocellular carcinoma, liver decompensation and mortality. This review provides an update on HCV cirrhosis. The paper focuses on the disease burden and major progresses in the diagnosis, follow-up and treatment of this patient subgroup.
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García-Alonso FJ, Bonillo-Cambrodón D, Bermejo A, García-Martínez J, Hernández-Tejero M, Valer López Fando P, Piqueras B, Bermejo F. Acceptance, yield and feasibility of attaching HCV birth cohort screening to colorectal cancer screening in Spain. Dig Liver Dis 2016; 48:1237-42. [PMID: 27481585 DOI: 10.1016/j.dld.2016.06.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 05/22/2016] [Accepted: 06/29/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The US Centers for Disease Control recommends hepatitis C virus (HCV) screening for baby boomers. Spain presents a similar distribution of infected patients. We performed a cross sectional prospective study to evaluate the prevalence of undiagnosed HCV infection in subjects born between 1949 and 1974. METHODS All out-patients within the age range, both symptomatic and screening procedures, undergoing colonoscopy between December 2014 and June 2015 were offered a HCV antibody blood test and a survey including risk factors for HCV infection and attitude toward HCV screening. Patients with chronic HCV or with a previous negative HCV antibody test were excluded. RESULTS A total of 570 subjects, 50% screening procedures, were analyzed. The median age was 55.7, 94.6% were born in Spain and 54.6% were women. Antibodies against HCV were found in 1.6% (95% CI: 0.8-3%) and HCV-RNA in 0.4% (0.1-1.3%). We found no statistically significant differences regarding HCV prevalence, risk factors or socioeconomic characteristics between subjects undergoing colorectal cancer screening and symptomatic subjects. CONCLUSION Symptomatic and screening subjects undergoing colonoscopy support HCV screening and present a similar HCV risk profile. Results suggest linking colorectal and HCV screening would yield good results.
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Affiliation(s)
| | - Daniel Bonillo-Cambrodón
- Gastroenterology Department, Fuenlabrada University Hospital, Fuenlabrada, Spain; Escuela Internacional de Doctorado, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - Andrea Bermejo
- Gastroenterology Department, Fuenlabrada University Hospital, Fuenlabrada, Spain
| | - Jesús García-Martínez
- Microbiology Area - Laboratory Medicine Department, Fuenlabrada University Hospital, Fuenlabrada, Spain
| | | | | | - Belén Piqueras
- Gastroenterology Department, Fuenlabrada University Hospital, Fuenlabrada, Spain
| | - Fernando Bermejo
- Gastroenterology Department, Fuenlabrada University Hospital, Fuenlabrada, Spain
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Giudici F, Bertisch B, Negro F, Stirnimann G, Müllhaupt B, Moradpour D, Cerny A, Keiser O. Access to therapy and therapy outcomes in the Swiss Hepatitis C Cohort Study: a person-centred approach. J Viral Hepat 2016; 23:697-707. [PMID: 27006320 DOI: 10.1111/jvh.12535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/10/2016] [Indexed: 12/25/2022]
Abstract
Socio-demographic and behavioural characteristics are associated with delayed diagnosis and disease progression in HCV-infected persons. However, many analyses focused on single variables rather than groups defined by several variables. We used latent class analysis to study all 4488 persons enrolled in the Swiss Hepatitis C Cohort Study. Groups were identified using predefined variables at enrolment. The number of groups was selected using the Bayesian information criterion. Mortality, loss to follow-up, cirrhosis, treatment status and response to antivirals were analysed using Laplace and logistic regressions. We identified five groups and named them according to their characteristics: persons who inject drugs, male drinkers, Swiss employees, foreign employees and retirees. Two groups did not conform to common assumptions about persons with chronic hepatitis C and were already in an advanced stage of the disease at enrolment: 'male drinkers' and 'retirees' had a high proportion of cirrhosis at enrolment (15% and 16% vs <10.3%), and the shortest time to death (adjusted median time 8.7 years and 8.8 years vs >9.0). 'Male drinkers' also had high substance use, but they were well educated and were likely to be employed. This analysis may help identifying high-risk groups which may benefit from targeted interventions.
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Affiliation(s)
- F Giudici
- Institute of Social and Preventive Medicine, Bern, Switzerland
| | - B Bertisch
- Institute of Social and Preventive Medicine, Bern, Switzerland.,Checkpoint Zürich, Zürich, Switzerland
| | - F Negro
- Divisions of Gastroenterology and Hepatology and of Clinical Pathology, University Hospitals, Geneva, Switzerland
| | - G Stirnimann
- University Clinic of Visceral Surgery and Medicine, Inselspital, Bern, Switzerland
| | - B Müllhaupt
- Swiss Hepato-Pancreato-Biliary Center and Department of Gastroenterology and Hepatology, University Hospital, Zürich, Switzerland
| | - D Moradpour
- Division of Gastroenterology and Hepatology, University Hospital, Lausanne, Switzerland
| | - A Cerny
- Epatocentro Ticino Foundation, Lugano, Switzerland
| | - O Keiser
- Institute of Social and Preventive Medicine, Bern, Switzerland
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Alonso López S, Agudo Fernández S, García Del Val A, Martínez Abad M, López Hermosa Seseña P, Izquierdo MJ, Núñez I, Berbel León S, Visedo Campillo L, Guisado Pérez C, Sánchez Lozano S, Mariño Pfeiffer I, García Bermúdez L, Sánchez Jiménez FJ, López Vega E, Zambrano Álvarez J, Castro Pastor ML, Montes Ramírez G, Murillo C, Villafranca Ortega N, Ayuso Hernández I, Espejo M, Lasala López P, Rodríguez Caravaca G, Carrascosa Aguilar B, Gutiérrez García ML, Fernández Rodríguez C. Hepatitis C seroprevalence in an at-risk population in the southwest Madrid region of Spain. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 39:656-662. [PMID: 27417563 DOI: 10.1016/j.gastrohep.2016.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 04/27/2016] [Accepted: 05/04/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The estimated seroprevalence of hepatitis C virus (HCV) in Spain is 1.7%, but is much higher in the at-risk population. The most efficient national screening strategy is unclear. AIMS To estimate the prevalence of HCV among the at-risk population seen in primary care (PC), and to determine their epidemiological profile. MATERIALS AND METHODS Cross-sectional descriptive prevalence study that included adult patients with risk factors for HCV infection seen in PC in the southwest Madrid region between 2010 and 2012. RESULTS A total of 158 patients (men=51.3%), mean age 46 years (SD=16.6), were included. The most common risk factors were hypertransaminasaemia (44.3%) and major surgery (13.3%). Immigration, unsafe sexual practices, and tattoos or body piercing were more prevalent in patients younger than 45 years of age. Fifteen patients (9.5%) were positive for anti-HCV; 9 of these (5.7%) were HCV-ARN positive. Of the positive patients, 4 (44.4%) had significant fibrosis at diagnosis (F3-F4). Male patients had a higher rate of positive anti-HCV results (13.8 vs. 5.3%; P=.072), as did patients older than 45 years of age (12.8 vs. 6.3%; P=.167). Intravenous and intranasal drug use were associated with a higher rate of positive anti-HCV results (50 vs. 8.5%; P=.005 and 66.7 vs. 8.4%; P=.001, respectively). CONCLUSIONS Patients with risk factors for HCV infection have high seroprevalence. Screening programmes must therefore be implemented to detect HCV infection in this population in PC.
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Affiliation(s)
| | - Sandra Agudo Fernández
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España; Unidad de Digestivo, Departamento de Medicina, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Móstoles, Madrid, España
| | | | | | | | | | - Isabel Núñez
- Centro de Salud Ramón y Cajal, Dirección Asistencial Oeste, Madrid, España
| | - Susana Berbel León
- Centro de Salud Gregorio Marañón, Dirección Asistencial Oeste, Madrid, España
| | | | | | | | | | | | | | - Elena López Vega
- Centro de Salud Ramón y Cajal, Dirección Asistencial Oeste, Madrid, España
| | | | | | | | - Cristina Murillo
- Centro de Salud Miguel Servet, Dirección Asistencial Oeste, Madrid, España
| | | | | | - María Espejo
- Centro de Salud Los Castillos, Dirección Asistencial Oeste, Madrid, España
| | - Pilar Lasala López
- Centro de Salud Gregorio Marañón, Dirección Asistencial Oeste, Madrid, España
| | - Gil Rodríguez Caravaca
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España; Servicio de Medicina Preventiva, Departamento de Medicina Preventiva y Salud Pública, Facultad Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
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Barbería-Marcalain E, Xifró-Collsamata A, Arroyo-Fernández A, Medallo-Muñiz J. Prevalencia de marcadores de los virus de la inmunodeficiencia humana y la hepatitis C en los cadáveres judiciales de Barcelona y Lleida. Enferm Infecc Microbiol Clin 2016; 34:391-3. [DOI: 10.1016/j.eimc.2015.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/12/2015] [Accepted: 08/15/2015] [Indexed: 11/24/2022]
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Bertisch B, Giudici F, Negro F, Moradpour D, Müllhaupt B, Moriggia A, Estill J, Keiser O. Characteristics of Foreign-Born Persons in the Swiss Hepatitis C Cohort Study: Implications for Screening Recommendations. PLoS One 2016; 11:e0155464. [PMID: 27227332 PMCID: PMC4882055 DOI: 10.1371/journal.pone.0155464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 04/29/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Switzerland recommends individuals who originate from high-prevalence countries to be screened for hepatitis C virus (HCV) infection. However, not all these persons are equally at risk. We thus aimed to describe the number and characteristics of persons with HCV infection born outside of Switzerland. METHODS We compared characteristics of anti-HCV-positive individuals in the Swiss Hepatitis C Cohort Study (SCCS) and of HCV cases reported to the Federal Office of Public Health (FOPH), with those of the general population in Switzerland. Persons who inject drugs (PWID) and persons who do not inject drugs (non-PWID) were compared by age groups for different countries of origin (represented by ≥1% of participants in the SCCS or FOPH). RESULTS We included 4,199 persons from the SCCS and 26,610 cases from the FOPH. Both groups had similar characteristics. In both data sources non-PWID were more frequent in foreign-born than in Swiss-born persons (63% versus 34% in the SCCS). The only subgroup with a clearly higher proportion both in the SCCS and FOPH than in the general population were persons over 60 years from Italy and Spain, with a 3.7- and 2.8-fold increase in the SCCS. These persons were non-PWID (99%), less frequently HIV- and anti-HBc positive and more often female than PWID from Italy and Spain; cirrhosis at enrolment was frequent (31%). Their HCV genotypes were consistent with those observed in elderly non-PWID of their birth countries. In the FOPH a higher proportion than in the general population was also seen for cases from Georgia and Russia. CONCLUSION The identification of subgroups in which HCV infection is particularly frequent might allow for better targeting HCV screening among foreign-born persons in Switzerland and elsewhere.
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Affiliation(s)
- Barbara Bertisch
- Institute of Social and Preventive Medicine, Bern, Switzerland
- Checkpoint Zürich, Zürich, Switzerland
| | - Fabio Giudici
- Institute of Social and Preventive Medicine, Bern, Switzerland
| | - Francesco Negro
- Divisions of Gastroenterology and Hepatology and of Clinical Pathology, University Hospitals, Geneva, Switzerland
| | - Darius Moradpour
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Beat Müllhaupt
- Swiss Hepato-Pancreato-Biliary Center and Department of Gastroenterology and Hepatology, University Hospital, Zürich, Switzerland
| | | | - Janne Estill
- Institute of Social and Preventive Medicine, Bern, Switzerland
| | - Olivia Keiser
- Institute of Social and Preventive Medicine, Bern, Switzerland
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Novo-Veleiro I, Alvela-Suárez L, Chamorro AJ, González-Sarmiento R, Laso FJ, Marcos M. Alcoholic liver disease and hepatitis C virus infection. World J Gastroenterol 2016. [PMID: 26819510 DOI: 10.3748/wjg.v22.i4.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Alcohol consumption and hepatitis C virus (HCV) infection have a synergic hepatotoxic effect, and the coexistence of these factors increases the risk of advanced liver disease. The main mechanisms of this effect are increased viral replication and altered immune response, although genetic predisposition may also play an important role. Traditionally, HCV prevalence has been considered to be higher (up to 50%) in alcoholic patients than in the general population. However, the presence of advanced alcoholic liver disease (ALD) or intravenous drug use (IDU) may have confounded the results of previous studies, and the real prevalence of HCV infection in alcoholic patients without ALD or prior IDU has been shown to be lower. Due to the toxic combined effect of HCV and alcohol, patients with HCV infection should be screened for excessive ethanol intake. Patients starting treatment for HCV infection should be specifically advised to stop or reduce alcohol consumption because of its potential impact on treatment efficacy and adherence and may benefit from additional support during antiviral therapy. This recommendation might be extended to all currently recommended drugs for HCV treatment. Patients with alcohol dependence and HCV infection, can be treated with acamprosate, nalmefene, topiramate, and disulfiram, although baclofen is the only drug specifically tested for this purpose in patients with ALD and/or HCV infection.
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Affiliation(s)
- Ignacio Novo-Veleiro
- Ignacio Novo-Veleiro, Lucía Alvela-Suárez, Department of Internal Medicine, University Hospital of Santiago de Compostela, 37007 Salamanca, Spain
| | - Lucía Alvela-Suárez
- Ignacio Novo-Veleiro, Lucía Alvela-Suárez, Department of Internal Medicine, University Hospital of Santiago de Compostela, 37007 Salamanca, Spain
| | - Antonio-Javier Chamorro
- Ignacio Novo-Veleiro, Lucía Alvela-Suárez, Department of Internal Medicine, University Hospital of Santiago de Compostela, 37007 Salamanca, Spain
| | - Rogelio González-Sarmiento
- Ignacio Novo-Veleiro, Lucía Alvela-Suárez, Department of Internal Medicine, University Hospital of Santiago de Compostela, 37007 Salamanca, Spain
| | - Francisco-Javier Laso
- Ignacio Novo-Veleiro, Lucía Alvela-Suárez, Department of Internal Medicine, University Hospital of Santiago de Compostela, 37007 Salamanca, Spain
| | - Miguel Marcos
- Ignacio Novo-Veleiro, Lucía Alvela-Suárez, Department of Internal Medicine, University Hospital of Santiago de Compostela, 37007 Salamanca, Spain
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Lens S, Bonacci M. Coste y efectividad de los nuevos antivirales para la hepatitis C. Aten Primaria 2015; 47:479-81. [PMID: 26433699 PMCID: PMC6983822 DOI: 10.1016/j.aprim.2015.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 06/30/2015] [Indexed: 11/09/2022] Open
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Brito-Zerón P, Gheitasi H, Retamozo S, Bové A, Londoño M, Sánchez-Tapias JM, Caballero M, Kostov B, Forns X, Kaveri SV, Ramos-Casals M. How hepatitis C virus modifies the immunological profile of Sjögren syndrome: analysis of 783 patients. Arthritis Res Ther 2015; 17:250. [PMID: 26370711 PMCID: PMC4570241 DOI: 10.1186/s13075-015-0766-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/24/2015] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION We conducted a study to analyze how infection by hepatitis C virus (HCV) may influence the immunological serum pattern of patients with Sjögren syndrome (SS). METHODS Since 1994, we have tested serum HCV-IgG antibodies in 783 patients with SS diagnosed according to the 1993 European classification criteria. The immunological profile at diagnosis was compared according to the presence or absence of HCV. RESULTS Of the 783 patients with SS, 105 (13.4 %) tested positive for HCV-IgG antibodies (88 females, 17 males, mean age at SS diagnosis: 62.9 years). Multivariate analysis showed that patients with SS-HCV had a higher mean age and a higher frequency of low C3/C4 levels, cryoglobulins, and hematological neoplasia compared with patients without HCV. The frequency of anti-La antibodies compared with anti-Ro antibodies was higher in patients with SS-HCV (17 % vs. 15 %) and lower in patients without HCV infection (30 % vs. 43 %). The frequency of concomitant detection of the three main cryoglobulin-related markers (cryoglobulins, rheumatoid factor activity, and C4 consumption) was threefold higher in patients with SS-HCV compared with patients without HCV. SS-HCV patients with genotype 1b showed the highest frequencies of immunological abnormalities related to cryoglobulins and the lowest frequencies of anti-Ro/La antibodies. CONCLUSIONS We found HCV infection in 13 % of a large series of Spanish patients with SS. The HCV-driven autoimmune response was characterized by a lower frequency of anti-Ro/La antibodies, an abnormal predominance of anti-La among anti-Ro antibodies, and a higher frequency of cryoglobulinemic-related immunological markers in comparison with patients without HCV infection. This immunological pattern may contribute to the poor outcomes found in patients with SS-HCV.
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Affiliation(s)
- Pilar Brito-Zerón
- Josep Font Autoimmune Diseases Laboratory, CELLEX, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Villarroel 170, Barcelona, 08036, Spain.
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, C/Villarroel, 170, 08036, Barcelona, Spain.
| | - Hoda Gheitasi
- Josep Font Autoimmune Diseases Laboratory, CELLEX, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Villarroel 170, Barcelona, 08036, Spain.
| | - Soledad Retamozo
- Josep Font Autoimmune Diseases Laboratory, CELLEX, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Villarroel 170, Barcelona, 08036, Spain.
| | - Albert Bové
- Josep Font Autoimmune Diseases Laboratory, CELLEX, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Villarroel 170, Barcelona, 08036, Spain.
| | - María Londoño
- Viral Hepatitis Unit, Liver Unit, CIBERehd, Hospital Clínic, University of Barcelona, IDIBAPS, C/ Villarroel 170, Barcelona, 08036, Spain.
| | - Jose-Maria Sánchez-Tapias
- Viral Hepatitis Unit, Liver Unit, CIBERehd, Hospital Clínic, University of Barcelona, IDIBAPS, C/ Villarroel 170, Barcelona, 08036, Spain.
| | - Miguel Caballero
- ENT Department, Hospital Clínic, University of Barcelona, IDIBAPS, C/ Villarroel 170, Barcelona, 08036, Spain.
| | - Belchin Kostov
- Primary Care Research Group, IDIBAPS, Primary Care Centre Les Corts, CAPSE, Mejia Lequerica, s / n, Barcelona, 08028, Spain.
| | - Xavier Forns
- Viral Hepatitis Unit, Liver Unit, CIBERehd, Hospital Clínic, University of Barcelona, IDIBAPS, C/ Villarroel 170, Barcelona, 08036, Spain.
| | - Srini V Kaveri
- Immunopathology and Therapeutic Immunointervention, Centre de Recherche des Cordeliers, INSERM, 15 Rue de l'Ecole de Medecine, Paris, F-75006, France.
| | - Manuel Ramos-Casals
- Josep Font Autoimmune Diseases Laboratory, CELLEX, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Villarroel 170, Barcelona, 08036, Spain.
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, C/Villarroel, 170, 08036, Barcelona, Spain.
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Two unusual hepatitis C virus subtypes, 2j and 2q, in Spain: Identification by nested-PCR and sequencing of a NS5B region. J Virol Methods 2015; 223:105-8. [PMID: 26253334 DOI: 10.1016/j.jviromet.2015.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 07/31/2015] [Accepted: 07/31/2015] [Indexed: 12/11/2022]
Abstract
Many studies have reported the use of the NS5B gene to subtype hepatitis C virus (HCV). Other HCV genes, such as HCV-5' UTR, Core (C) and E1, have also been used. In some studies, NS5B have been used together with 5'-UTR or C genes to improve genotyping results obtained using commercial procedures. Only two studies in Spain have compared molecular techniques versus commercial procedures regarding the efficacy of HCV subtyping. The aim of this study was to determine whether nested PCR and sequencing of a NS5B region was more reliable than commercial procedures to subtype HCV. We analyzed the results of HCV genotyping in [726] serum specimens collected from 2001 to 2013. From 2001 to 2011, we used PCR and INNO-LiPA hybridization or its new version Versant HCV Genotype 2.0 assay (471 samples). From 2012 to 2013, we used nested PCR and sequencing of a NS5B region (255 cases). This method used two pairs of primers to amplify the RNA of the sample converted to DNA by retrotranscription. The amplification product of 270 base pairs was further sequenced. To identify the subtype, the sequences obtained were compared to those in the international database: http://hcv.lanl.gov./content/sequence/, HCV/ToolsOutline.html and Geno2pheno[hcv] http://hcv.bioinf.mpi-inf.mpg.de/index.php. Nested PCR of a NS5B region and sequencing identified all but one subtype (0.4%, 1/255), differentiated all 1a subtypes from 1b subtypes, and characterized all HCV 2-4 subtypes. This approach also distinguished two subtypes, 2j and 2q, that had rarely been detected previously in Spain. However, commercial procedures failed to subtype 12.7% (60/471) of samples and to genotype 0.6% of specimens (3/471). Nested PCR and sequencing of a NS5B region improved the subtyping of HCV in comparison with classical procedures and identified two rare subtypes in Spain: 2j and 2q. However, full length genome sequencing is recommended to confirm HCV 2j and 2q subtypes.
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[Validation of the Spanish version of the HIV Related Fatigue Scale and application in people with hepatitis C]. ENFERMERIA CLINICA 2015; 25:245-53. [PMID: 26145731 DOI: 10.1016/j.enfcli.2015.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 04/11/2015] [Accepted: 04/13/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To validate the American fatigue scale HIV-Related Fatigue Scale (HRFS) and present the Spanish version called Integrated Fatigue Assessment Scale to assess fatigue in HCV and co-infected patients. METHOD Psychometric study with cross-sectional design was used. The HRFS was translated into Spanish using the back-translation method-later to be validated. Participants completed the questionnaire adapted to a self-report form, as well as a sociodemographic questionnaire. The reliability and validity of the Spanish version was evaluated. RESULTS A total of 7 public service hospitals and two prisons in Catalonia participated in the evaluation. The sample consisted of 122 subjects selected by consecutive sampling in the fourth week of treatment of hepatitis C with combination therapy or triple therapy. The Cronbach alpha for the total scale was 0.958. Content Validity Index (I-CVI) varied from 0.5 to 1. Validity Scale Content-level (S-CVI) was 0.85. Pearson correlations between the three dimensions were between 0.49 and 0.68. CONCLUSIONS The process followed for the cultural adaptation and validation shows that the Spanish version of the HRFS) is a valid and reliable instrument that can be used in clinical practice and in the investigation of fatigue in patients with hepatitis C.
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García Comas L, Ordobás Gavín M, Sanz Moreno JC, Ramos Blázquez B, Gutiérrez Rodríguez A, Astray Mochales J, Moreno Guillén S. Prevalence of hepatitis C antibodies in the population aged 16-80 years in the Community of Madrid 2008-2009. J Med Virol 2015; 87:1697-701. [PMID: 25989026 DOI: 10.1002/jmv.24219] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2015] [Indexed: 12/18/2022]
Abstract
Together with AIDS, the burden of hepatitis C virus (HCV) in Spain heads the list of communicable diseases in terms of impact on public health. The aim of this study was to estimate the prevalence of HCV antibodies in the Community of Madrid, assess changes in recent years and analyse associated risk factors. Descriptive cross-sectional study of a target population consisting of Community of Madrid residents aged 16-80 years old. Two-stage cluster sampling was performed, with stratification by socioeconomic status and percentage immigrant population. The sampling frame consisted of public blood extraction centers attached to the Madrid Health Service. Seroprevalence of HCV antibodies, prevalence ratios by age groups in comparison with 1999 survey data and prevalence association with risk factors were assessed using a logistic regression model. Prevalence of HCV antibodies for the age group 16-80 years was 1.8% (95% CI: 1.3-2.5). The age group with the highest prevalence was 41-60 years. In comparison with the 1999 survey, prevalence fell for the age groups 21-30 and 31-40 years and increased for the age group 41-60. Statistically significant associations were found for age, education, history of hepatitis C and consultation regarding liver problems. Seroprevalence of HCV antibodies in the Community of Madrid is similar to that shown in other regions of Spain. It is increasing in older age groups as the population at risk ages. Incidence of hepatitis C may be decreasing considering the decrease in the seroprevalence in the population younger than 40 related to the previous serosurvey.
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Affiliation(s)
- Luis García Comas
- Subdirectorate of Health Promotion and Prevention, Health Department of the Community of Madrid (institution at which the work was performed), Madrid, Spain
| | - María Ordobás Gavín
- Subdirectorate of Health Promotion and Prevention, Health Department of the Community of Madrid (institution at which the work was performed), Madrid, Spain
| | - Juan Carlos Sanz Moreno
- Health Department of the Community of Madrid, Regional Public Health Laboratory, Madrid, Spain
| | - Belén Ramos Blázquez
- Health Department of the Community of Madrid, Regional Public Health Laboratory, Madrid, Spain
| | - Angeles Gutiérrez Rodríguez
- Subdirectorate of Health Promotion and Prevention, Health Department of the Community of Madrid (institution at which the work was performed), Madrid, Spain
| | - Jenaro Astray Mochales
- Subdirectorate of Health Promotion and Prevention, Health Department of the Community of Madrid (institution at which the work was performed), Madrid, Spain
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Khyatti M, Trimbitas RD, Zouheir Y, Benani A, El Messaoudi MD, Hemminki K. Infectious diseases in North Africa and North African immigrants to Europe. Eur J Public Health 2015; 24 Suppl 1:47-56. [PMID: 25107998 DOI: 10.1093/eurpub/cku109] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The epidemiological transition has reduced infectious diseases mortality in most European countries, yet increased migrant influx risks importing diseases. All reported prevalence rates must be considered on a case-by-case basis depending on the disease in question, respective European Union (EU) country and migratory patterns at work. Tuberculosis has seen a re-emergence in Europe and is concentrated among migrants. Migrants arriving from North Africa (NA) and sub-Saharan Africa (SSA) carry higher rates of hepatitis C and B than the local EU population. The human immunodeficiency virus (HIV) impact of NA migrants to Europe is very low but a hallmark of the HIV epidemic is the penetration and circulation of non-B strains, recombinant forms and HIV-drug-resistant profiles through SSA migrants using NA as a transit point into Europe. Leishmaniasis is a re-emerging zoonotic disease prevalent to Southern Europe although not specifically isolated in migrant groups. Although not endemic in NA countries, malaria represent S: a risk in terms of re-emergence in Europe through transitory migrants arriving from SSA with the destination to Europe. Schistosomiasis has been largely eliminated from NA. High migrant flux into European countries has resulted in changing patterns of communicable disease and collectively requires a continuous surveillance. World Health Organization guidelines recommend targeted screening and preventative vaccination, followed by integration of migrants into the local health-care systems allowing for long-term treatment and follow-up. Finally, effective public health campaigns as a form of prevention are essential for the mitigation of disease dissemination in the migrant pool and for second-generation children of migrants.
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Affiliation(s)
- Meriem Khyatti
- 1 Laboratory of Onco-Virology, Pasteur Institute of Morocco, Casablanca, Morocco
| | | | - Yassine Zouheir
- 1 Laboratory of Onco-Virology, Pasteur Institute of Morocco, Casablanca, Morocco
| | - Abdelouaheb Benani
- 1 Laboratory of Onco-Virology, Pasteur Institute of Morocco, Casablanca, Morocco
| | | | - Kari Hemminki
- 2 Department of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Roura M, Domingo A, Leyva-Moral JM, Pool R. Hispano-Americans in Europe: what do we know about their health status and determinants? A scoping review. BMC Public Health 2015; 15:472. [PMID: 25948239 PMCID: PMC4430018 DOI: 10.1186/s12889-015-1799-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 04/24/2015] [Indexed: 12/19/2022] Open
Abstract
Background Policy makers and health practitioners are in need of guidance to respond to the growing geographic mobility of Hispano-American migrants in Europe. Drawing from contributions from epidemiology, social sciences, demography, psychology, psychiatry and economy, this scoping review provides an up-to-date and comprehensive synthesis of studies addressing the health status and determinants of this population. We describe major research gaps and suggest specific avenues of further inquiry. Methods We identified systematically papers that addressed the concepts “health” and “Hispano Americans” indexed in five data bases from Jan 1990 to May 2014 with no language restrictions. We screened the 4,464 citations retrieved against exclusion criteria and classified 193 selected references in 12 thematic folders with the aid of the reference management software ENDNOTE X6. After reviewing the full text of all papers we extracted relevant data systematically into a table template to facilitate the synthesising process. Results Most studies focused on a particular disease, leaving unexplored the interlinkages between different health conditions and how these relate to legislative, health services, environmental, occupational, and other health determinants. We elucidated some consistent results but there were many heterogeneous findings and several popular beliefs were not fully supported by empirical evidence. Few studies adopted a trans-national perspective and many consisted of cross-sectional descriptions that considered “Hispano-Americans” as a homogeneous category, limiting our analysis. Our results are also constrained by the availability and varying quality of studies reviewed. Conclusions Burgeoning research has produced some consistent findings but there are huge gaps in knowledge. To prevent unhelpful generalisations we need a more holistic and nuanced understanding of how mobility, ethnicity, income, gender, legislative status, employment status, working conditions, neighbourhood characteristics and social status intersect with demographic variables and policy contexts to influence the health of the diverse Hispano-American populations present in Europe. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1799-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Roura
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB) Hospital Clínic, Universitat de Barcelona, Rosselló 132, 4th floor, 08036, Barcelona, Spain.
| | - Andreu Domingo
- Centre for Demographic Studies, Autonomous University of Barcelona, Carrer de Ca n'Altayó. Edifici E2, Bellaterra, Barcelona, 08193, Spain.
| | - Juan M Leyva-Moral
- Escola Superior d'Infemeria del Mar, University Pompeu Fabra, Doctor Aiguader, 80, Barcelona, Spain.
| | - Robert Pool
- Social Science and Global Health, Centre for Social Science and Global Health, University of Amsterdam, Postbus 15718, 1001, NE, Amsterdam, The Netherlands.
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Serrano-Villar S, Sobrino-Vegas P, Monge S, Dronda F, Hernando A, Montero M, Viciana P, Clotet B, Pineda JA, Del Amo J, Moreno S. Decreasing prevalence of HCV coinfection in all risk groups for HIV infection between 2004 and 2011 in Spain. J Viral Hepat 2015; 22:496-503. [PMID: 25363502 DOI: 10.1111/jvh.12353] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 09/18/2014] [Indexed: 01/17/2023]
Abstract
While hepatitis C virus (HCV) infection seems to be expanding among HIV-infected men who have sex with men (MSM), the rate of coinfection in intravenous drug users (IDU) is assumed to remain constant. We evaluated the serial prevalence of HIV/HCV coinfection across all risk groups for HIV infection in Spain. We used data from 7045 subjects included in the multicentre, prospective Spanish Cohort of Adult HIV-infected Patients (CoRIS) between 2004 and 2011. We analysed risk factors for HIV/HCV coinfection by logistic regression analyses. The prevalence of HIV/HCV coinfection decreased from 25.3% (95% CI, 23.1-27.5) in 2004-2005 to 8.2% (95% CI, 6.9-9.5) in 2010-2011. This trend was consistently observed from 2004 to 2011 among all risk groups: IDU, 92.4% to 81.4%; MSM, 4.7% to 2.6%; heterosexual men, 13.0-8.9%; and heterosexual women, 14.5-4.0% (all P < 0.05). Strongest risk factors for HIV/HCV coinfection were IDU (OR, 54.9; 95% CI, 39.4-76.4), birth decade 1961-1970 (OR, 2.1; 95% CI, 1.1-3.7) and low educational level (OR, 2.4; 95% CI, 1.6-3.5). Hence, the prevalence of HIV/HCV coinfection decreased in Spain between 2004 and 2011. This decline was observed across all risk groups and is likely to be explained by a declining burden of HCV in the general population.
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Affiliation(s)
- S Serrano-Villar
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal and IRYCIS, Madrid, Spain
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Garcias-Ladaria J, Pérez-Ferriols A, Ortega-García P, Diago M. Management of Refractory Telaprevir-Induced Dermatitis Using Oral Corticosteroids. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2014.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Fernández-Dávila P, Folch C, Ferrer L, Soriano R, Diez M, Casabona J. Hepatitis C virus infection and its relationship to certain sexual practices in men-who-have-sex-with-men in Spain: results from the European MSM internet survey (EMIS). Enferm Infecc Microbiol Clin 2014; 33:303-10. [PMID: 25444047 DOI: 10.1016/j.eimc.2014.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/07/2014] [Accepted: 07/22/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare sexual practices and risk behaviours between MSM who were first diagnosed with hepatitis C (HCV) in the previous 12 months and those who were never diagnosed; and, to identify factors associated with a diagnosis of HCV. METHODS The European-MSM-Internet-Survey (EMIS) was implemented for 3 months during 2010, mainly on websites for MSM. Data on socio-demographic characteristics, sexual behaviour, drug use, STI history, and other sexual health variables were collected. The Chi-square test and logistic regression analysis were used to analyse the data. RESULTS Data from 13,111 respondents were analysed. The proportion of MSM who had ever been diagnosed with HCV infection was 1.9% (n=250), and of those currently infected with the virus was 0.6% (n=78). The percentage of those first diagnosed in the last 12 months was 0.4% (n=46), of whom 70% were HIV-negative and 22% had HIV coinfection. Having a first diagnosis of HCV in the last 12 months was more common among HIV-positive than among HIV-negative MSM (0.9% vs 0.4%) and among MSM born abroad than among Spanish-born (0.7% vs 0.3%). MSM diagnosed with HCV in the last 12 months were more likely to have had: more than 10 sexual partners, sex abroad, receptive anal intercourse, insertive/receptive fisting, and unprotected anal intercourse with non-steady partners of unknown or discordant HIV-status. Likewise, they reported more frequent visits to sex-focused venues, higher drug use, as well as a higher proportion of STI diagnosis. In the multivariate model, visiting a public sex-focused venue, practicing receptive fisting, using erection enhancing medication and having a diagnosis of syphilis were independently associated with a first diagnosis of HCV in the last 12 months. CONCLUSIONS HCV infection does not seem to be restricted to HIV-infected MSM. Certain sexual behaviour (fisting, visiting sex-focused venues), drug use, and ulcerative STI seem to be associated with a diagnosis of HCV.
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Affiliation(s)
- Percy Fernández-Dávila
- Centre de Estudis Epidemiològics sobre les ITS i SIDA de Catalunya (CEEISCAT); ICO/Departament de Salut, Spain; Research Department, Stop Sida, Barcelona, Spain; Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna, Ramón Llull University, Barcelona, Spain.
| | - Cinta Folch
- Centre de Estudis Epidemiològics sobre les ITS i SIDA de Catalunya (CEEISCAT); ICO/Departament de Salut, Spain; CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain; Universitat Autònoma de Barcelona, Spain
| | - Laia Ferrer
- Centre de Estudis Epidemiològics sobre les ITS i SIDA de Catalunya (CEEISCAT); ICO/Departament de Salut, Spain; CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | | | - Mercedes Diez
- CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain; Centro Nacional de Epidemiología, Unidad de Epidemiología y Conductas de Riesgo, Madrid, Spain
| | - Jordi Casabona
- Centre de Estudis Epidemiològics sobre les ITS i SIDA de Catalunya (CEEISCAT); ICO/Departament de Salut, Spain; CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain; Universitat Autònoma de Barcelona, Spain
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Multicenter study on the discontinuation and efficacy of chronic hepatitis C treatment in the Spanish penitentiary population (EPIBAND study). Eur J Gastroenterol Hepatol 2014; 26:1083-9. [PMID: 25076064 DOI: 10.1097/meg.0000000000000163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Imprisonment entails a golden opportunity for chronic hepatitis C treatment, as treatment adherence can easily be achieved in this setting. The objective of this study was to determine the proportion and causes of discontinuation of chronic hepatitis C therapy among the Spanish penitentiary population. METHODS This is an observational, prospective multicenter study performed in 26 Spanish penitentiaries between October 2007 and December 2009. Patients with chronic hepatitis C who were undergoing treatment with pegylated interferon plus ribavirin in accordance with clinical practice were included. The primary variable in the study was the proportion of discontinuation of treatment for chronic hepatitis C. RESULTS A total of 431 patients were included in this analysis (92.3% male; mean age, 37.9±6.3 years; 66.4% with high viral load; genotype 1, 51.0%; genotype 3, 35.7%; genotype 4, 11.8%; genotype 2, 1.4%; coinfected with HIV, 24.4%). The proportion of treatment discontinuation for chronic hepatitis C was 22.5% (n=97; 95% confidence interval: 18.65-26.75). Therapy discontinuation was more frequent during the first trimester of treatment (n=45; 46.4%), and release from prison was the most frequent cause for treatment discontinuation (n=35; 36.1% of discontinuations). Among 407 patients included in the efficacy analysis, sustained viral response was achieved in 52.1% (95% confidence interval: 47.12-57.02). CONCLUSION Treatment discontinuation for chronic hepatitis C in the penitentiary setting is low. However, further efforts should be made to improve the coordination between penitentiary institutions and external centers to ensure treatment after the inmates are released or transferred to other prisons.
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Miranda García M, Gutiérrez Teira B, Ariza Cardiel G. [A study on the hepatitis B virus vaccination rates in hepatitis C-infected patients in a Primary Care centre]. Aten Primaria 2014; 46:395. [PMID: 25034721 PMCID: PMC6983625 DOI: 10.1016/j.aprim.2013.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/09/2013] [Accepted: 10/11/2013] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mario Miranda García
- Medicina de Familia y Comunitaria, Centro de Salud «El Soto», Móstoles, Madrid, España.
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Fernández Rodriguez CM, Gutierrez Garcia ML. [Impact of antiviral therapy on the natural history of hepatitis C virus]. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:583-92. [PMID: 25066318 DOI: 10.1016/j.gastrohep.2014.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/28/2014] [Indexed: 02/08/2023]
Abstract
Chronic hepatitis C virus infection affects around 150 million persons, and 350,000 persons worldwide die of this disease each year. Although the data on its natural history are incomplete, after the acute infection, most patients develop chronic forms of hepatitis C with variable stages of fibrosis. In these patients, continual inflammatory activity can cause significant fibrosis, cirrhosis, decompensation of the liver disease, or hepatocarcinoma. In the next few years, it is expected that hepatitis C virus infection and its complications will significantly increase, as will the incidence of hepatocarcinoma in Spain. This review presents the data on the natural history of hepatitis C virus infection and discusses the potential impact of antiviral therapy on the distinct stages of the disease.
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Caballería L, Pera G, Bernad J, Canut S, Navarro E, Bruguera M. Strategies for the detection of hepatitis C viral infection in the general population. Rev Clin Esp 2014. [DOI: 10.1016/j.rceng.2014.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Garcias-Ladaria J, Pérez-Ferriols A, Ortega-García P, Diago M. Management of refractory telaprevir-induced dermatitis using oral corticosteroids. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:e55-60. [PMID: 24786187 DOI: 10.1016/j.ad.2013.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 12/16/2013] [Accepted: 12/31/2013] [Indexed: 11/25/2022] Open
Abstract
We present a series of 12 patients with telaprevir-induced skin toxicity. Some patients presented eczematous lesion, while others presented nonscaling macular lesions that became more purpuric in the lower limbs. Seven of the 12 patients had skin lesions affecting more than 50% of the body surface area, but none had systemic manifestations. Oral corticosteroids, prescribed in 7 patients, produced symptomatic improvement, and the response to the antiviral treatment in these patients was good. The 3 biopsies performed showed a superficial perivascular dermatitis with foci of red cell extravasation. Monitoring is central to the management of skin reactions secondary to the protease inhibitors, as severe drug eruptions have been reported. Treatment is usually symptomatic. We describe 7 cases in which oral corticosteroids-whose use continues to be controversial -were administered as a last resort for the control of pruritus.
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Affiliation(s)
- J Garcias-Ladaria
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España.
| | - A Pérez-Ferriols
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España
| | - P Ortega-García
- Servicio de Farmacia, Hospital General Universitario de Valencia, Valencia, España
| | - M Diago
- Servicio de Patología Digestiva, Hospital General Universitario de Valencia, Valencia, España
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Strategies for the detection of hepatitis C viral infection in the general population. Rev Clin Esp 2014; 214:242-6. [PMID: 24598246 DOI: 10.1016/j.rce.2014.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 01/21/2014] [Accepted: 01/26/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate which of the three studied strategies is the most effective to detect new cases of Hepatitis C virus (HCV) infections in primary care. METHODS This is an observational, prospective, and multicentre study evaluating three strategies. Strategy 1: provide an explanatory letter to adults assigned to two primary care teams (PCTs), inviting them to have a blood test. Strategy 2: place posters and leaflets in PCTs advertising the possibility of laboratory tests. Strategy 3: reexamine HCV antibody test results in patients with hypertransaminasemia diagnosed within the last two years through electronic records, and determine anti-HCV status in undiagnosed cases. RESULTS There were a total 598 participants (51% female with an average age of 50.6 ± 13 years). There were 238 people (4.1% of letters sent) in Strategy 1, 69 people (0.3% of potential participation) in Strategy 2, and 291 people (100% participation) from Strategy 3. One new case of HCV was found in both Strategy 1 and Strategy 2, representing a prevalence of 0.4 and 1.4%, respectively. Two new cases of HCV were found in Strategy 3, representing a prevalence of 0.7%. CONCLUSIONS The three studied strategies for detecting new cases of HCV infection are ineffective, especially in regards to their cost and effort.
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Marco A, Gallego C, Caylà JA. Incidence of hepatitis C infection among prisoners by routine laboratory values during a 20-year period. PLoS One 2014; 9:e90560. [PMID: 24587394 PMCID: PMC3938777 DOI: 10.1371/journal.pone.0090560] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 02/03/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND To estimate the incidence of Hepatitis C virus (HCV) and the predictive factors through repeated routine laboratory analyses. METHODS An observational cohort study was carried out in Quatre Camins Prison, Barcelona. The study included subjects with an initial negative HCV result and routine laboratory analyses containing HCV serology from 1992 to 2011. The incidence of infection was calculated for the study population and for sub-groups by 100 person-years of follow-up (100 py). The predictive factors were determined through Kaplan-Meier curves and a Cox regression. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated. RESULTS A total of 2,377 prisoners were included with a median follow-up time of 1,540.9 days per patient. Among the total population, 117 HCV seroconversions were detected (incidence of 1.17/100 py). The incidence was higher between 1992 and 1995 (2.57/100 py), among cases with HIV co-infection (8.34/100 py) and among intravenous drug users (IDU) without methadone treatment (MT) during follow-up (6.66/100 py). The incidence rate of HCV seroconversion among cases with a history of IDU and current MT was 1.35/100 py, which is close to that of the total study population. The following variables had a positive predictive value for HCV infection: IDU (p<0.001; HR = 7,30; CI: 4.83-11.04), Spanish ethnicity (p = 0.009; HR = 2,03; CI: 1.93-3.44) and HIV infection (p = 0.015; HR = 1.97; CI: 1.14-3.39). CONCLUSION The incidence of HCV infection among prisoners was higher during the first part of the study and among IDU during the entire study period. Preventative programs should be directed toward this sub-group of the prison population.
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Affiliation(s)
- Andrés Marco
- Health Services of Barcelona Men’s Penitentiary Centre, Barcelona, Department of Justice, Government of Catalonia, Barcelona, Spain
| | - Carlos Gallego
- Health Services of Quatre Camins Penitentiary Centre, La Roca del Vallés, Barcelona, Department of Justice, Government of Catalonia, Barcelona, Spain
| | - Joan A. Caylà
- Epidemiology Service of the Public Health Agency of Barcelona, CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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Turnes J, Romero-Gómez M, Planas R, Solà R, García-Samaniego J, Diago M, Crespo J, Calleja JL, Rubio-Terrés C, Ventayol P. Pharmacoeconomic analysis of the treatment of chronic hepatitis C with peginterferon alfa-2a or peginterferon alfa-2b plus ribavirin in Spain. GASTROENTEROLOGIA Y HEPATOLOGIA 2013; 36:555-64. [DOI: 10.1016/j.gastrohep.2013.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/02/2013] [Accepted: 08/05/2013] [Indexed: 11/16/2022]
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