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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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