Chronic hepatitis C virus infection and associated liver disease among the inmates of a Spanish prison

Objetivos el objetivo de este estudio fue determinar la prevalencia de la infección crónica por el virus de la hepatitis C (VHC) y sus genotipos en una población penitenciaria, así como también describir los hallazgos histológicos encontrados en una subpoblación de sujetos a los que se les realizó biopsia hepática y en los que se identificaron los posibles factores de riesgo asociados a la fibrosis y a la actividad inflamatoria. Métodos se seleccionaron 800 internos, de los cuales 730 aceptaron el cribado con serología del VHC y confirmación por PCR (polymerase chain reaction 'reacción en cadena de la polimerasa'). Se estudiaron las variables sociodemográficas, conductuales y relacionadas con la encarcelación. A los sujetos con infección crónica por VHC se les ofreció la realización de una biopsia hepática. Se definió enfermedad hepática avanzada como fibrosis (..) (AU)

Objective: The objective of this study was to determine the prevalence and genotype distribution of chronic hepatitis C virus (HCV) infection in a penitentiary population. The secondary objective was to describe histological findings in liver of the biopsied population, and identify risk factors associated with liver fibrosis and inflammatory activity. Methods: Among 800 inmates, 730 accepted HCV antibody screening and PCR confirmation. Sociodemographic, behavioral, and incarceration-related variables were analyzed. Liver biopsy was offered to individuals with chronic HCV infection. Advanced liver disease was defined as fibrosis ¡Ý3 and/or an inflammatory activity index score ¡Ý8).Results: HCV antibodies were found in 279 inmates. PCR confirmed HCV infection in 250 inmates, yielding a prevalence of 34.2% (95% confidence interval [CI]: 30.8¨C37.8). Intravenous drug use was independently associated with HCV infection, odds ratio (OR) 51.7 (95% CI: 31¨C86). Genotypes were 1a 32.9%, 3 29.7%, 1b 18.4% and 4 17.1%. Fifty-one liver biopsies were performed; advanced liver disease was found in 7 patients (13.7%) based on fibrosis and in 31 patients (60.7%) based on the inflammatory activity index. High AST and ALT levels were associated with advanced liver disease established on both fibrosis and inflammatory activity (P<.05). Lengthy intravenous drug use was associated with inflammatory activity (P=.02; OR 1.2; 95% CI: 1.03¨C1.7).Conclusions: Persistent HCV infection is highly prevalent among prison inmates and is associated with intravenous drug abuse. HCV genotype diversity is higher in prison inmates than in the general population. Higher transaminase levels are associated with advanced liver disease (AU)

[Chronic hepatitis C virus infection and associated liver disease among the inmates of a Spanish prison]. / Infección crónica por el virus de la hepatitis C y enfermedad hepática asociada en una prisión española.

OBJECTIVE: The objective of this study was to determine the prevalence and genotype distribution of chronic hepatitis C virus (HCV) infection in a penitentiary population. The secondary objective was to describe histological findings in liver of the biopsied population, and identify risk factors associated with liver fibrosis and inflammatory activity. METHODS: Among 800 inmates, 730 accepted HCV antibody screening and PCR confirmation. Sociodemographic, behavioral, and incarceration-related variables were analyzed. Liver biopsy was offered to individuals with chronic HCV infection. Advanced liver disease was defined as fibrosis 3 and/or an inflammatory activity index score 8). RESULTS: HCV antibodies were found in 279 inmates. PCR confirmed HCV infection in 250 inmates, yielding a prevalence of 34.2% (95% confidence interval [CI]: 30.8-37.8). Intravenous drug use was independently associated with HCV infection, odds ratio (OR) 51.7 (95% CI: 31-86). Genotypes were 1a 32.9%, 3 29.7%, 1b 18.4% and 4 17.1%. Fifty-one liver biopsies were performed; advanced liver disease was found in 7 patients (13.7%) based on fibrosis and in 31 patients (60.7%) based on the inflammatory activity index. High AST and ALT levels were associated with advanced liver disease established on both fibrosis and inflammatory activity (P<.05). Lengthy intravenous drug use was associated with inflammatory activity (P=.02; OR 1.2; 95% CI: 1.03-1.7). CONCLUSIONS: Persistent HCV infection is highly prevalent among prison inmates and is associated with intravenous drug abuse. HCV genotype diversity is higher in prison inmates than in the general population. Higher transaminase levels are associated with advanced liver disease.

[Predictive markers of HIV and HCV infection and co-infection among inmates in a Spanish prison]. / Factores predictivos de infección por el VIH, VHC y coinfección en la población reclusa de una prisión española.

OBJECTIVE: To study the prevalence and factors associated with HIV and HCV infection among inmates of a Spanish prison. METHOD: A cross-sectional study was carried out in July 2001. We determined HCV (ELISA and RIBA-3) and HIV (ELISA and Western-blot) serology in the prison population. Study variables included age, sex, nationality and previous intravenous drug use (IDU). In IDU inmates we analyzed the age when intravenous drug use was initiated, years of consumption, age at first admission in prison and syringe sharing with other inmates. The subpopulations of Arab and Romani (gypsy) inmates were studied differentially. RESULTS: A total of 800 inmates (mean age 34.2 6 6.2 years) were evaluated; 74.3% were Spanish and 33.6% IDU. HCV serology was obtained in 730 inmates and HIV serology in 773 with the following seroprevalence results: HCV 38.2%, HIV 19.1% and HCV-HIV co-infection 18.8%. The variables associated with HCV or HIV infection in the univariate analysis were Spanish nationality, previous IDU and coinfection by the other virus. In the multivariate analysis, only coinfection and, particularly, previous IDU (HCV infection: adjusted ORp 104.8 [95% CI: 49.4-222.2]) (HIV infection adjusted ORp 45.1 [95% CI: 14.0-144.9]) maintained an association with the two infections. CONCLUSIONS: The prevalence of HIV and HCV infection and coinfection is high in Spanish prisons. Infection by either of these viruses and previous IDU were independently associated with both infections. The percentage of non-Spanish inmates with these infections is low.

Factores predictivos de infección por el VIH, VHC y coinfección en la población reclusa de una prisión española / Predictive markers of HIV and HCV infection and co-infection among inmates in a Spanish prison

OBJETIVO. Estudiar la prevalencia y factores asociados a infección por el virus de la inmunodeficiencia humana(VIH) y virus de la hepatitis C (VHC) en la población reclusa de un centro penitenciario español. MÉTODO. Estudio transversal realizado en julio de 2001. Se determinó la serología de VHC (análisis de inmunoabsorción ligado a enzimas [ELISA] y RIBA-3 [recombinant immunobloting assay]) y VIH (ELISA y Western-blot) en los internos. Las variables estudiadas fueron edad, sexo, nacionalidad y adicción a drogas por vía intravenosa (ADVI). En los internos ADVI se analizó: edad de inicio de consumo de drogas, años de consumo, edad primer ingreso en prisión y si compartían jeringuillas en prisión. Se estudiaron de forma diferenciada los internos de origen árabe y al colectivo gitano. RESULTADOS. Se evaluaron 800 internos, edad media 34,2 +/- 6,2 años, de los que el 74,3% eran españoles y 33,6%ADVI. La serología de VHC se conoció en 730 internos y la de VIH en 773. La sero prevalencia de VHC fue del 38,2%, de VIH: 19,1%; y de coinfección VHC-VIH: 18,8%. En el análisis univariado, la nacionalidad española, antecedentes de ADVI y presencia de coinfección por el otro virus se asociaron a infección por VHC o VIH. En el análisis multivariante, sólo la coinfección y sobre todo antecedentes de ADVI (infección por el VHC: Odds ratio de prevalencia [ORp] ajustada 101,7 intervalo de confianza del 95% [IC 95%, 48,2-214,4])(infección por el VIH ORp ajustada 54 [IC 95%, 15,9-183,2])mantuvieron su asociación a ambas infecciones. CONCLUSIONES. La prevalencia de infección por VIH, VHC y coinfección es elevada en los centros penitenciarios españoles. La infección por alguno de estos virus y el antecedente de ADVI se asocian de manera independiente a ambas infecciones. El porcentaje de ambas infecciones en los reclusos no españoles es bajo (AU)

OBJECTIVE. To study the prevalence and factors associated with HIV and HCV infection among inmates of a Spanish prison. METHOD. A cross-sectional study was carried out in July 2001. We determined HCV (ELISA and RIBA-3) and HIV(ELISA and Western-blot) serology in the prison population. Study variables included age, sex, nationality and previous intravenous drug use (IDU). In IDU in mates we analyzed the age when intravenous drug use was initiated, years of consumption, age at first admission in prison and syringe sharing with other inmates. The subpopulations of Arab and Romani (gypsy) inmates were studied differentially. RESULTS. A total of 800 inmates (mean age 34.2 +/- 6.2 years)were evaluated; 74.3% were Spanish and 33.6% IDU. HCV serology was obtained in 730 inmates and HIV serology in773 with the following seroprevalence results: HCV 38.2%,HIV 19.1% and HCV-HIV co-infection 18.8%. The variables associated with HCV or HIV infection in the univariate analysis were Spanish nationality, previous IDU and coinfection by the other virus. In the multivariate analysis, only coinfection and, particularly, previous IDU (HCV infection: adjusted ORp 104.8 [95% CI: 49.4-222.2]) (HIV infection adjusted ORp 45.1 [95% CI: 14.0-144.9])maintained an association with the two infections. CONCLUSIONS. The prevalence of HIV and HCV infection and coinfection is high in Spanish prisons. Infection by either of these viruses and previous IDU were independently associated with both infections. The percentage of non-Spanish inmates with these infections is low (AU)

[Primary HIV drug resistance in a prison population. REPRICOVA-2 Study]. / Resistencias primarias de VIH en una población penitenciaria. Estudio REPRICOVA-2.

INTRODUCTION: Currently, there are few reports on primary human immunodeficiency virus (HIV) drug resistance in the prison population. METHODS: This is a descriptive, one-day prevalence study to identify HIV drug-resistant mutations in chronically infected treatment-naïve prisoners. Systematic randomized sampling was performed and genotyping was done by automatic sequencing. RESULTS: A total of 90 patients were studied. Two samples were found to have nucleoside reverse transcriptase inhibitor (NRTI)-resistant mutations, four had non-nucleoside reverse transcriptase inhibitor (NNRTI)-resistant mutations and one had protease inhibitor (PI)-resistant mutations. CONCLUSIONS: There was a low rate of primary resistance in our series. Therefore, resistance testing is not required before prescribing initial antiretroviral therapy in these patients.

[Mutations of resistance of HIV-1 in previously untreated patients at penitentiary centers of the Autonomous Community of Valencia, Spain. REPRICOVA study]. / Mutaciones de resistencia de virus de la inmunodeficiencia humana tipo 1 en pacientes no tratados de los centros penitenciarios de la Comunidad Valenciana. Estudio REPRICOVA.

BACKGROUND: Our purpose was to determine the prevalence of mutations of resistance to nucleoside inhibitors of reverse transcriptase (NIRT) and protease inhibitors (PI) in the HIV-1 genotype of naïve infected subjects in the prisons of the Autonomous Community of Valencia, Spain. PATIENTS AND METHOD: Multicentric, descriptive, cross-sectional study of prevalence including a systematic stratified and randomised sampling by centres. Demographic, clinical, virological and immunological data were collected. The HIV gene of protease and transcriptase was studied in peripheral blood plasma samples by means of double PCR amplification and subsequent automatic sequence. Reference: wild strain HXB2. RESULTS: Plasma was obtained from 133 individuals (119 men and 14 women). 117 samples were selected and the rest did not have enough copies for transcription. With regard to NIRT, 7 samples (5.2% of total) showed some mutation of resistance: M41L, D67N, L210W and K219Q, all them secondary to and associated with resistance to zidovudine, abacavir as well as group B multinucleoside-resistance. With regard to PI, only one sample showed a primary mutation, M46I, which was associated with resistance to indinavir. Moreover, a further 41 samples were found to express some secondary mutation. CONCLUSIONS: In our series, there was a low number of primary mutations of resistance. These results allow us to exclude the systematic use of resistance tests before an initiation antiretroviral therapy.

Mutaciones de resistencia de virus de la inmunodeficiencia humana tipo 1 en pacientes no tratados de los centros penitenciarios de la comunidad valenciana. estudio repricova / Mutations of resistance of HIV-1 in previously untreated patients at penitentiary centers of the Autonomous Community of Valencia, Spain. REPRICOVA study

FUNDAMENTO: Determinar la prevalencia de mutaciones de resistencia a inhibidores nucleósidos de la transcriptasa inversa (INTI) y a inhibidores de proteasas (IP) en el genoma del virus de la inmunodeficiencia humana tipo 1 de infectados no tratados de las prisiones de la Comunidad Valenciana. PACIENTES Y MÉTODO: Estudio multicéntrico, descriptivo, transversal de prevalencia en un día. Muestreo aleatorio, sistemático estratificado por centros. Se recogen variables demográficas, clínicas, virológicas e inmunológicas. Se estudia el gen de la proteasa y de la transcriptasa del VIH en muestras plasmáticas de sangre periférica mediante doble amplificación por reacción en cadena de la polimerasa y subsiguiente secuenciación automática. Secuencia de referencia: cepa salvaje HXB2. RESULTADOS: Se obtiene plasma de 133 individuos (119 varones y 14 mujeres). Se secuencian 117 muestras, ya que las restantes no tienen suficiente número de copias para ser transcritos. Respecto a INTI, 7 muestras (el 5,2 por ciento del total) presentaba alguna mutación de resistencia: M41L, D67N, L210W y K219Q, todas secundarias y asociadas a resistencia a zidovudina, abacavir y multirresistencia del grupo B. Respecto a IP, sólo una muestra expresa la primaria M46I asociada a resistencia a indinavir; otras 41 muestras expresan alguna mutación secundaria. CONCLUSIONES: En la serie analizada, hay un escaso número de mutaciones primarias de resistencia. Estos resultados permiten excluir la utilización sistemática de las pruebas de resistencia previas a la terapia antirretroviral de inicio (AU)