Cambios en el patrón epidemiológico de la hepatitis B crónica en reclusos de Cataluña: prevalencia actual y variables predictivas / Changes in the epidemiological pattern of chronic B hepatitis amongst inmates in Catalonia: current prevalence and predictive variables

Introducción: El patrón epidemiológico de la hepatitis crónica por virus de la hepatitis B (HCVHB) en España ha cambiado por las migraciones y la vacunación. El objetivo es comprobar si también ha cambiado la prevalencia en presos de Cataluña y las posibles variables predictivas de la infección. Material y método: Estudio transversal y multicéntrico de prevalencia de HCVHB. Se incluyeron variables epidemiológicas y clínicas, calculándose su capacidad predictiva mediante un modelo de regresión logística multivariante. Resultados: Se estudiaron 6.508 reclusos. La prevalencia de HCVHB fue del 1,7%, mucho menor que en estudios realizados en años previos. En los presos del Magreb, Asia, Europa del Este y África subsahariana, la prevalencia fue 2,8, 4,2, 4,9 y 16,2 veces mayor, respectivamente, que en los españoles, que era del 0,6%, igual que fuera de prisión. La HCVHB se asoció con: a) ser extranjero (2,6%; razón de posibilidades u odds ratio [OR]: 4,18; intervalo de confianza [IC]: 2,50-6,90; p <0,001); b) no estar vacunado (0,3%; OR: 0,13; IC: 0,06-0,26; p <0,001); y c) estar infectado por el virus de la inmunodeficiencia humana (VIH) (3,9%; OR: 3,23; IC: 1,24-8,40; p = 0,016). Conclusión: La prevalencia de HCVHB en presos se ha reducido mucho en los últimos 30 años, debido a la vacunación, pero sigue siendo alta en extranjeros y en infectados por VIH. Se recomienda: a) mantener el cribado de virus de la hepatitis B (VHB) en los ingresados en prisión; b) continuar con el programa de vacunación; y c) derivar a los infectados a programas especializados para estudio y, si se precisa, tratamiento. (AU)

Background: The epidemiology of chronic hepatitis B (CHB) in Spain has changed due to migratory movements and the implementation of vaccination programs. The objective is to determine if prevalence has also changed amongst in Catalonia and the potential predictive variables of the infection. Material and method: Observational cross-sectional multi-centre study of CHB prevalence. Epidemiological and clinical variables were included, and their predictive capacity is analysed by means of a multivariable logistic regression model. Results: A total of 6508 prisoners were studied. CHB prevalence was 1.7%, much less than in studies carried out in previous years. In inmates from North Africa, Asia, Eastern Europe, and Sub-Saharan Africa the CHB rate was 2.8, 4.2, 4.9 and 16.2 times higher, respectively, than amongst those born in Spain, which was 0.6%, the same as in the general population. CHB was associated with: a) being an immigrant [2.6%; OR: 4.18 (CI: 2.50-6.90; P <0.001); b) being unvaccinated (3.1%; OR: 0.13; CI: 0.06-0.26; P <0.001); and c) being infected by the human immunodeficiency virus (HIV) [3.9%; OR: 3.23; CI: 1.24-8.40; P = 0.016]. Conclusion: Vaccination against HBV (hepatitis B virus) has greatly reduced CHB prevalence in inmates over the past 30 years but remains high in immigrants and those with HIV. We recommend: a) maintaining HBV screening amongst inmates; b) continuing with vaccination programmes; and c) referring CHB cases to specialized programs for further study and treatment if needed. (AU)

[Metabolic morbidity in the prison population of Catalonia, Spain]. / Morbilidad metabólica en la población penitenciaria de Cataluña.

OBJECTIVE: To investigate the prevalence of metabolic morbidity (MM) amongst prison inmates. DESIGN: Multicentric, cross-sectional observational study. SETTING: All (nine) prisons in Catalonia. PARTICIPANTS: Convicted inmates that are not in an «open regime¼, whose healthcare relies on the Prison Primary Care Teams. INTERVENTIONS: MM was defined as the presence of at least one component of the metabolic syndrome, i.e., obesity, arterial hypertension, type2 diabetes, and/or dyslipidemia. The variables collected included anthropometric measurements, medical history and laboratory values related to MM. The source of information was the Catalan Primary Healthcare Services Information System (SISAP). MAIN MEASUREMENTS: The prevalence of MM, overall and by several participant subcategories, was calculated. To investigate the risk factors associated to a higher prevalence of MM, a multivariable logistic regression analysis was carried out and expressed as adjusted odds ratios and 95% confidence intervals. RESULTS: 4338 inmates were studied, of whom 93.9% were male. Mean age was 38.4years, 51.7% were born in European Union countries, and 6.7% were infected by HIV. The variables associated with a significantly increased risk of presenting MM were older age and HIV infection, whereas certain geographical origins (i.e., non-UE European countries, Maghreb and Sub-Saharan Africa) were associated with lower risk of MM. CONCLUSIONS: In spite of being an overall young population, prison inmates present high rates of MM. Older age, HIV infection and geographic origin appear as the most strongly associated factors with MM in the prison population. MM should be detected early in order to prevent complications. Prevention, screening and treatment of MM ought to be considered a priority in the clinical routine of prison healthcare professionals.

Late diagnosis of HIV infection among prisoners.

HIV-risk populations are over-represented in prisons. It is very important to identify late HIV infection diagnosis in this setting from a public health perspective. The objectives of this study are to estimate the prevalence of late diagnosis and identify the predictive factors among inmates of two prisons in Barcelona from 2010 to 2012, and to review late diagnosis in other prisons. A cross-sectional study design was used on inmates with newly-diagnosed HIV infection. Less than 350 CD4 lymphocytes/µl was considered late diagnosis. A Medline search was performed. Of the 3,933 total inmates, 1.2% (n = 47) were diagnosed with HIV infection, 1.7% from Prison A and 0.6% from Prison B (p < 0.001). Late diagnosis occurred in 47.7% of cases. A higher number of cases with late diagnosis were found in Prison A, among the immigrant population, and among intravenous drug users (p = 0.026, p = 0.007, p = 0.03, respectively). The proportion of late diagnosis decreased from 60% in 2010, to 44.4% in 2011 and 20% in 2012 (p = 0.05). The multivariate analysis confirmed an association between late diagnosis and immigrant status (OR: 7.85; 95% CI: 1.8-34.13) and the declining prevalence (p = 0.032). This is the first study to estimate late diagnosis in a prison population. Late diagnosis occurs mainly among the immigrant inmate population. The prison can serve as an opportunity to identify and treat HIV infection among people who have little contact with health services, thus avoiding further transmission.

[Predictors of adherence to treatment of chronic hepatitis C in drug-dependent inmate patients in four prisons in Barcelona, Spain]. / Factores predictivos de cumplimiento del tratamiento de la hepatitis C crónica en personas drogodependientes de cuatro prisiones de Barcelona.

BACKGROUND: Drug addiction is not a contraindication to indicate treatment of chronic hepatitis C (CHC), but it has been observed that consumers are more abandon. To study the clinical outcome of hepatitis C treatment in inmate patients with a history in injecting drugs and to analyze which were the causes of abandon. METHODS: A multicenter retrospective clinical trial including 162 inmate patients that underwent HCV therapy with pegylated interpheron and ribavirin between January 2003 and January 2008 was performed. It was found in medical history who completed treatment. We used a questionnaire to determine variables associated with discontinuation of treatment and multivariate analysis was performed using logistic regression to identify predictors. RESULTS: 82.7% were intravenous drug users, 21.7% had HIV coinfection and 20.5% were on methadone maintenance therapy. 91.4% completed the whole treatment; 33.1% admitted heroin and/or cocaine consumption during therapy and 7.9% admitted needle and syringe-sharing. Relapse in intravenous consumption in or out of prison was the only one predictive factor of treatment interruption (OR: 10.39, IC: 1.93-55.88; p = 0.006). CONCLUSION: Only 9,6% of patients discontinued treatment. Drug use was the main cause of discontinuation of treatment. We recommend the treatment of drug addiction to reduce the discontinuations of treatment for chronic hepatitis C.

Factores predictivos de cumplimiento del tratamiento de la hepatitis C crónica en personas drogodependientes de cuatro prisiones de Barcelona / Predictors of adherence to treatment of chronic hepatitis C in drug-dependent inmate patients in four prisons in Barcelona, Spain

Fundamentos: La drogadicción no es una contraindicación para indicar tratamiento de la hepatitis C crónica (HCC), pero se ha observado que los consumidores de drogas abandonan más el tratamiento. El objetivo del trabajo es estudiar los factores predictivos de discontinuación del tratamiento en internos drogodependientes tratados de la HCC con interferon pegilado más ribavirina. Métodos: Estudio multicéntrico con presos drogodependientes tratados de HCC entre 01/01/2003-31/12/2007 y que permanecían encarcelados en 2008 (n=162). Se comprueba mediante la historia clínica informatizada cuántos finalizaron el tratamiento. Se emplea un cuestionario diseñado “ad hoc” para conocer posibles variables asociadas a la no finalización y se realiza un análisis multivariado mediante regresión logística para identificar factores predictivos. Resultados: El 82,7% era usuario de drogas intravenosas, el 21,7% estaba coinfectado por el VIH y el 20,5% realizaba tratamiento con metadona. El 91,4% completó el tratamiento, aunque el 33,1% consumió heroína y/o cocaína en alguna ocasión y el 7,9% reconoció haber compartido jeringas. El único factor predictivo de discontinuación fue la recaída en el consumo endovenoso, dentro o fuera de prisión (OR: 10,39. IC: 1,93-55,88. p= 0,006). Conclusión: Sólo el 9,6% de los casos discontinuó el tratamiento. La recaída en el consumo de drogas fue la única variable predictiva de discontinuación. Se recomienda, valorar y tratar la drogadicción con el fin de detectar y evitar interrupciones de tratamiento(AU)

Background: Drug addiction is not a contraindication to indicate treatment of chronic hepatitis C (CHC), but it has been observed that consumers are more abandon. To study the clinical outcome of hepatitis C treatment in inmate patients with a history in injecting drugs and to analyze which were the causes of abandon. Methods: Amulticenter retrospective clinical trial including 162 inmate patients that underwent HCV therapy with pegylated interpheron and ribavirin between January 2003 and January 2008 was performed. It was found in medical history who completed treatment. We used a questionnaire to determine variables associated with discontinuation of treatment and multivariate analysis was performed using logistic regression to identify predictors. Results: 82,7% were intravenous drug users, 21.7% had HIV coinfection and 20,5% were on methadone maintenance therapy. 91,4% completed the whole treatment; 33.1% admitted heroin and/or cocaine consumption during therapy and 7.9% admitted needle and syringe-sharing. Relapse in intravenous consumption in or out of prison was the only one predictive factor of treatment interruption (OR: 10.39, IC: 1.93-55.88; p= 0.006). Conclusion: Only 9,6% of patients discontinued treatment. Drug use was the main cause of discontinuation of treatment. We recommend the treatment of drug addiction to reduce the discontinuations of treatment for chronic hepatitis C(AU)

[Expert recommendations for the diagnosis and treatment of chronic hepatitis C infection in the prison setting]. / Recomendaciones de expertos sobre el diagnóstico y tratamiento de la hepatitis C crónica en el medio penitenciario.

The prevalence of HCV infection in Spanish prisons is very high (38.5%). The characteristics of the infected patients, particularly the high rate of HIV coinfection, makes it very likely that the morbidity and mortality produced by serious liver disease secondary to this infection will increase considerably in the coming years. A group of Spanish experts with experience in patients who are inmates has been invited to establish a series of recommendations for the diagnosis and treatment of chronic hepatitis C infection in Spanish prisons.

[Expert recommendations for the diagnosis and treatment of chronic hepatitis C infection in the prison setting]. / Recomendaciones de expertos sobre el diagnóstico y tratamiento de la hepatitis C crónica en el medio penitenciario.

The prevalence of HCV infection in Spanish prisons is very high (38.5%). The characteristics of the infected patients, particularly the high rate of HIV coinfection, makes it very likely that the morbidity and mortality produced by serious liver disease secondary to this infection will increase considerably in the coming years. A group of Spanish experts with experience in patients who are inmates has been invited to establish a series of recommendations for the diagnosis and treatment of chronic hepatitis C infection in Spanish prisons.

Recomendaciones de expertos sobre el diagnóstico y tratamiento de la hepatitis C crónica en el medio penitenciario / Expert recommendations on the diagnosis and treatment of chronic hepatitis C in prisons

Las características de los pacientes infectados, especialmente la elevada coinfección con el virus de la inmunodeficiencia humana (VIH), hacen probable que la morbilidad y mortalidad producida por enfermedad hepática grave secundaria a esta infección aumente de forma considerable en los próximos años. Un grupo de expertos multidisciplinar con experiencia con pacientes internados en prisiones españolas ha sido invitado a establecer una serie de recomendaciones para el diagnóstico y tratamiento de la hepatitis C en las prisiones españolas

The prevalence of HCV infection in Spanish prisons is very high (38.5%). The characteristics of the infected patients, particularly the high rate of HIV coinfection, makes it very likely that the morbidity and mortality produced by serious liver disease secondary to this infection will increase considerably in the coming years. A group of Spanish experts with experience in patients who are inmates has been invited to establish a series of recommendations for the diagnosis and treatment of chronic hepatitis C infection in Spanish prisons

Recomendaciones de expertos sobre el diagnóstico y tratamiento de la hepatitis C crónica en el medio penitenciario / Expert recommendations for the diagnosis and treatment of chronic hepatitis C infection in the prison setting

La prevalencia de la infección por el virus de la hepatitis C (VHC) en las prisiones españolas es muy elevada (38,5%). Las características de los pacientes infectados, especialmente la elevada coinfección con el virus de la inmunodeficiencia humana (VIH), hacen probable que la morbilidad y mortalidad producida por enfermedad hepática grave secundaria a esta infección aumente de forma considerable en los próximos años. Un grupo de expertos multidisciplinar con experiencia con pacientes internados en prisiones españolas ha sido invitado a establecer una serie de recomendaciones para el diagnóstico y tratamiento de la hepatitis C en las prisiones españolas (AU)

The prevalence of HCV infection in Spanish prisons is very high (38.5%). The characteristics of the infected patients, particularly the high rate of HIV coinfection, makes it very likely that the morbidity and mortality produced by serious liver disease secondary to this infection will increase considerably in the coming years. A group of Spanish experts with experience in patients who are inmates has been invited to establish a series of recommendations for the diagnosis and treatment of chronic hepatitis C infection in Spanish prisons (AU)