Palliative Sedation in COVID-19 End-of-Life Care. Retrospective Cohort Study.

Background and Objectives: Descriptions of end-of-life in COVID-19 are limited to small cross-sectional studies. We aimed to assess end-of-life care in inpatients with COVID-19 at Alicante General University Hospital (ALC) and compare differences according to palliative and non-palliative sedation. Material and Methods: This was a retrospective cohort study in inpatients included in the ALC COVID-19 Registry (PCR-RT or antigen-confirmed cases) who died during conventional admission from 1 March to 15 December 2020. We evaluated differences among deceased cases according to administration of palliative sedation. Results: Of 747 patients evaluated, 101 died (13.5%). Sixty-eight (67.3%) died in acute medical wards, and 30 (44.1%) received palliative sedation. The median age of patients with palliative sedation was 85 years; 44% were women, and 30% of cases were nosocomial. Patients with nosocomial acquisition received more palliative sedation than those infected in the community (81.8% [9/11] vs 36.8% [21/57], p = 0.006), and patients admitted with an altered mental state received it less (20% [6/23] vs. 53.3% [24/45], p = 0.032). The median time from admission to starting palliative sedation was 8.5 days (interquartile range [IQR] 3.0-14.5). The main symptoms leading to palliative sedation were dyspnea at rest (90%), pain (60%), and delirium/agitation (36.7%). The median time from palliative sedation to death was 21.8 h (IQR 10.4-41.1). Morphine was used in all palliative sedation perfusions: the main regimen was morphine + hyoscine butyl bromide + midazolam (43.3%). Conclusions: End-of-life palliative sedation in patients with COVID-19 was initiated quite late. Clinicians should anticipate the need for palliative sedation in these patients and recognize the breathlessness, pain, and agitation/delirium that foreshadow death.

Isolation of Candida auris in large hospitals in the Autonomous Community of Valencia; population-based study (2013-2017).

BACKGROUND: Candida auris is an emerging multidrug-resistant and highly virulent yeast that spreads easily among patients. AIMS: To describe the characteristics of candidemia caused by C. auris in the southeast of Spain (Autonomous Community of Valencia - ACV) through a 5-year population-based study. METHODS: An analysis of all the episodes of candidemia diagnosed in the ACV, with approximately 4,500,000 inhabitants, during 2013-2017, was done. Data were obtained from the Epidemiological Surveillance Valencian Network, a network that collects all the microbiological data from the hospitals in the study region. RESULTS: Based on the records, 1.9% of the isolates recovered from the positive blood cultures (corresponding to 1789 patients) were yeasts. This implies an annual rate of 7.09 cases/100,000 inhabitants. Of the 23 yeast species isolated, Candida albicans was the most frequent (37.3%), showing a higher frequency than Candida parapsilosis (28.4%) and Candida glabrata (15.6%) (p<0.0001). It is remarkable the emergence of C. auris during 2016 and 2017, as this species became the fourth more prevalent in 2016 (9.2%), and the third in 2017 (15.7%). Fungemia was more common in hospitals with >500 beds (63.3% versus 36.7% in small hospitals) (p<0.0001), and C. auris was mostly isolated in large hospitals (8.5% versus 0.3%); its incidence was higher in autumn and among the age group of 65-84 years. CONCLUSIONS: The information about the local epidemiology of candidemia is essential in order to decide the best empirical treatment approach. This study reports the novel presence of C. auris in large hospitals. This pathogen has usually resistance to several antifungals and causes severe fungemia, so the results of this work reveal the need to monitor the presence of this species systematically.

Etiology of bloodstream infections at a population level during 2013-2017 in the Autonomous Community of Valencia, Spain / Etiología de las bacteriemias a nivel poblacional durante 2013-2017 en la Comunidad Autónoma de Valencia, España

INTRODUCTION: Bloodstream Infections has become in one of the priorities for the antimicrobial stewardship teams due to their high mortality and morbidity rates. Usually, the first antibiotic treatment for this pathology must be empirical, without microbiology data about the microorganism involved. For this reason, the population studies about the etiology of bacteremia are a key factor to improve the selection of the empirical treatment, because they describe the main microorganisms associated to this pathology in each area, and this data could facilitate the selection of correct antibiotic therapy. MATERIAL AND METHODS: This study describes the etiology of bloodstream infections in the Southeast of Spain. The etiology of bacteremia was analysed by a retrospective review of all age-ranged patients from every public hospital in the Autonomous Community of Valencia (approximately 5,000,000 inhabitants) for five years. RESULTS: A total of 92,097 isolates were obtained, 44.5% of them were coagulase-negative staphylococci. Enterobacteriales was the most prevalent group and an increase in frequency was observed along the time. Streptococcus spp. were the second microorganisms more frequently isolated. Next, the most prevalent were Staphylococcus aureus and Enterococcus spp., both with a stable incidence along the study. Finally, Pseudomonas aeruginosa was the fifth microorganism more frequently solated. CONCLUSIONS: These data constitute a useful tool that can help in the choice of empirical treatment for bloodstream infections, since the knowledge of local epidemiology is key to prescribe a fast and appropriate antibiotic therapy, aspect capital to improve survival

INTRODUCCIÓN: Las bacteriemias se han convertido en una de las prioridades de los Programas de Optimización de uso de Antimicrobianos (PROA) debido a sus altas tasas de morbimortalidad. Normalmente, el tratamiento antibiótico tiene que ser pautado de forma empírica, sin datos del microorganismo implicado. Por esto, los estudios poblacionales sobre la etiología de las bacteriemias son un factor clave para mejorar la elección del tratamiento empírico, ya que describen los principales microorganismos asociados a esta patología en cada área, lo que facilita en gran medida la selección del antibiótico correcto. MATERIAL Y MÉTODOS: Este estudio describe la etiología de las bacteriemias en el sureste de España durante los años 2013-2017. La etología fue analizada de forma retrospectiva estudiando los microorganismos implicados en todas las bacteriemias diagnosticadas en la Comunidad Valenciana (5.000.000 de habitantes). RESULTADOS: Se obtuvieron un total de 92.097 aislados clínicos, de los cuales un 44,5% fueron Staphylococcus coagulasa negativos. Las enterobacterias fueron el grupo más prevalente, su frecuencia se incrementó durante el estudio. Los cocos grampositivos, tipo Streptococcus, fueron los siguientes microorganismos que se aislaron de forma más frecuente, su frecuencia disminuyó a lo largo del periodo estudiado. A continuación, Staphylococcus aureus y Enterococcus spp. les siguieron en prevalencia, manteniéndose sus tasas estables a lo largo del estudio. Por último, el quinto microorganismo más prevalente fue Pseudomonas aeruginosa. CONCLUSIONES: Los datos obtenidos en este estudio constituyen una herramienta que puede facilitar la elección correcta del tratamiento empírico inicial que debe aplicarse en estos procesos

Efficacy and Safety of Switching to Dolutegravir/Lamivudine Fixed-Dose 2-Drug Regimen vs Continuing a Tenofovir Alafenamide-Based 3- or 4-Drug Regimen for Maintenance of Virologic Suppression in Adults Living With Human Immunodeficiency Virus Type 1: Phase 3, Randomized, Noninferiority TANGO Study.

BACKGROUND: The 2-drug regimen dolutegravir (DTG) + lamivudine (3TC) is indicated for treatment-naive adults with human immunodeficiency virus type 1 (HIV-1). We present efficacy and safety of switching to DTG/3TC in virologically suppressed individuals. METHODS: TANGO is an open-label, multicenter, phase 3 study that randomized adults (1:1, stratified by baseline third agent class) with HIV-1 RNA <50 copies/mL to switch to once-daily fixed-dose DTG/3TC or remain on a tenofovir alafenamide (TAF)-based regimen. The primary end point was proportion of participants with HIV-1 RNA ≥50 copies/mL at week 48 (US Food and Drug Administration Snapshot algorithm) in the intention-to-treat-exposed population (4% noninferiority margin). RESULTS: 743 adults were enrolled; 741 received ≥1 dose of study drug (DTG/3TC, N = 369; TAF-based regimen, N = 372). At week 48, proportion of participants with HIV-1 RNA ≥50 copies/mL receiving DTG/3TC was 0.3% (1/369) vs 0.5% (2/372) with a TAF-based regimen (adjusted treatment difference [95% confidence interval], -0.3 [-1.2 to .7]), meeting noninferiority criteria. No participants receiving DTG/3TC and 1 receiving a TAF-based regimen met confirmed virologic withdrawal criteria, with no emergent resistance at failure. Drug-related grade ≥2 adverse events and withdrawals due to adverse events occurred in 17 (4.6%) and 13 (3.5%) participants with DTG/3TC and 3 (0.8%) and 2 (0.5%) with a TAF-based regimen, respectively. CONCLUSIONS: DTG/3TC was noninferior in maintaining virologic suppression vs a TAF-based regimen at week 48, with no virologic failure or emergent resistance reported with DTG/3TC, supporting it as a simplification strategy for virologically suppressed people with HIV-1. CLINICAL TRIALS REGISTRATION: NCT03446573.

Infective endocarditis in elderly and very elderly patients.

AIMS: To compare the clinical and epidemiological characteristics and the evolution of infective endocarditis in adults aged under 65 years, 65-79 years, and 80 years or older. METHODS: An observational retrospective cohort study in patients with infective endocarditis was performed in a public hospital in Spain from January 2013 to December 2017. RESULTS: Seventy-two patients were treated: 26 (36.1%) were under 65 years old, 28 (38.9%) were 65-79 years old, and 18 (25%) were aged 80 or older. Prosthetic valve endocarditis was less common in patients aged 65-79 years (3.6%) than in younger (23.1%; p = 0.047) or older (38.9%; p = 0.004) patients. In contrast, degenerative heart disease was more prevalent in the 65-79 year age group [64.3% compared to 15.4% (p < 0.001) in the youngest group, and 33.3% (p = 0.04) in the oldest]. Surgical interventions were similar in patients aged 65-79 (50%) and under 65 years (42.3%), but less common in people over 80 years (16.7%; p = 0.022). CONCLUSIONS: The characteristics of infective endocarditis are different in patients aged 65-79 years and in those over 80 years.

Association of Human Papillomavirus Genotype 16 Viral Variant and Viral Load with Cervical High-grade Intraepithelial Lesions.

Human papillomavirus genotype 16 (HPV16) is by far the genotype most strongly associated with cervical cancer; viral variant and/or viral load of HPV16 could modulate this association. The objective was to determine the association between the viral variant and viral load of HPV16 and the presence of cervical high-grade lesions. This cross-sectional study included all women in whom HPV infection was found by cervical smear during routine gynecologic health checks. Women with single or multiple HPV16 infections (n = 176) were selected for viral variant and viral load analysis. Smear results were classified using the Bethesda system. HPV types were classified according to the International Agency for Research on Cancer. Odds ratios (OR) with their 95% confidence intervals (CI) were estimated by logistic regression, adjusted for age, immigrant status, and coinfection with other high-risk genotypes. No statistically significant associations were found regarding the detected viral variants. A viral load above the median (>1,367.79 copies/cell) was associated with a significant risk of high-grade epithelial lesion or carcinoma, after adjusting for age, immigrant status, coinfections, and viral variant: (adjusted OR 7.89; 95% CI: 2.75-22.68). This relationship showed a statistically significant dose-response pattern after categorizing by viral load tertiles: adjusted OR for a viral load greater than the third tertile was 17.23 (95% CI: 4.20-70.65), with adjusted linear P trend = 0.001. In patients infected with HPV16, viral load is associated with high-grade intraepithelial lesions or cervical carcinoma. This could be useful as prognostic biomarker of neoplastic progression and as screening for cervical cancer.

Diferencias en pacientes oncológicos y no oncológicos ingresados en una unidad de cuidados paliativos de reciente creación en un hospital de tercer nivel en la Comunidad Valenciana (España) / Differences in cancer patients and non-cancer patients admitted to a new palliative care unit of the general university hospital of the Valencian Community (Spain)

OBJETIVO: Evaluar las diferencias entre pacientes paliativos oncológicos y no oncológicos ingresados en la Unidad de Cuidados Paliativos. MATERIAL Y MÉTODOS: Estudio retrospectivo y analítico de los paciente paliativos atendidos en la Unidad de Cuidados Paliativos perteneciente al Servicio de Medicina Interna del Hospital General Universitario de Alicante entre el 1 junio de 2013 y el 31 de junio del 2014. De cada paciente se recogieron variables epidemiológicas (edad, sexo), clínicas (fiebre, caquexia/anorexia, astenia, náuseas/vómitos, somnolencia, síntomas psicológicos, dolor y disnea), evolutivas y necesidad de sedación paliativa. RESULTADOS: Fueron estudiados en la Unidad de Cuidados Paliativos 143 de los 1.599 (8,9%) ingresados en la sección de medicina interna. La mediana de edad de los paciente fue de 83 años (recorrido intercuartílico: 75-89) y la relación hombre/mujeres fue de 1,4. Sesenta y cuatro (44,7%) ingresos fueron pacientes paliativos oncológicos y 79 (65,3%) no oncológicos. Y dentro de los pacientes no oncológicos estos fueron: 38 (48,1%) pacientes pluripatológicos con progresión irreversible de comorbilidades, 33 (41,8%) (pacientes por enfermedad crónica en estadio final y 8 (10,1%) pacientes de edad avanzada en estadio final de la vida. Respecto a los síntomas hubo una mayor probabilidad de disnea en los pacientes paliativos no oncológicos (odds ratio [OR]: 4,65, intervalo de confianza [IC] 95%: 2,17-10,7) y una menor probabilidad de dolor (OR: 0,23; IC 95%: 0,09-0,54) y náuseas/vómitos (p = 0,025) en ellos. Así como un mayor control de síntomas fue mayor en los pacientes paliativos no oncológicos (OR: 2,03; IC95%: 1,0-4,10). La sedación paliativa fue administrada en el 23% de los casos, similar en los dos grupos de pacientes. CONCLUSIÓN: La sintomatología de los cuidados paliativos es diferente en pacientes no oncológicos y oncológicos

OBJECTIVE: To evaluate patient differences between palliative cancer and non-cancer patients admitted to the Unit of Palliative Care. MATERIAL AND METHODS: A retrospective and analytical study of the palliative patients treated in the Unit of Palliative Care under the Department of Internal Medicine, Hospital General Universitario of Alicante between 1 June 2013 and 31 June 2014. Variables included were epidemiological (age, sex), clinical symptoms (fever, cachexia / anorexia, asthenia, nausea / vomiting, drowsiness, psychological symptoms, pain and dyspnoea), outcome and need for palliative sedation. RESULTS: One hundred and forty-three patients out of the 1,599 (8.9%) admitted to the Section of Internal Medicine were studied in the Unit of Palliative Care. The median age of the patients was 83 years (interquartile range: 75-89) and the male: female ratio was 1.4. Sixty-four (44.7%) were palliative cancer patients and 79 (65.3%) were non-cancer palliative. Out of 79 non-cancer palliative PATIENTS: 38 (48.1%) were patients with irreversible progression of comorbidities, 33 (41.8%) patients with end-stage chronic disease and 8 (10.1%) elderly patients in the final stage of life. With regard to symptoms, the non-cancer palliative patients were more likely to experience dyspnoea (odds ratio [OR]: 4.65, 95% confidence interval [CI]:, 1.7-10 7) and less likely to experience pain (OR: 0.23; 95% CI: 0.09 to 0.54) and nausea /vomiting (p =.025). Symptoms were better controlled in the non- non- cancer palliative patients (OR: 2.03; 95% CI 1.0 to 4.10). Palliative sedation was administered to 23% of the patients, similar in both types of PATIENTS: CONCLUSIONS: The symptoms of palliative care were different in the non-cancer and cancer patients

Malestar emocional de pacientes y familiares en la Unidad de Cuidados Paliativos de un hospital general: un estudio piloto / Emotional distress of patients and caregivers in a Palliative Care Unit at a general hospital: a pilot study

ANTECEDENTES Y OBJETIVO: La experiencia de una enfermedad avanzada genera malestar emocional en los pacientes y familiares. El objetivo del trabajo consiste en valorar un procedimiento de evaluación del malestar emocional del binomio paciente-cuidador en una UCP-HA de reciente creación, como un primer paso para reducirlo en la medida de lo posible. Sujetos y MÉTODO: Se realizó un muestreo de conveniencia entre noviembre de 2015 y marzo de 2016. Fueron entrevistados 25 pacientes utilizando el índice de Barthel, el Cuestionario de Evaluación de Síntomas Edmonton y el Cuestionario de Detección del Malestar Emocional. Fueron evaluados 25 cuidadores mediante la Escala Hospitalaria de Ansiedad y Depresión y la Escala Zarit reducida. RESULTADOS: Se pudo evaluar al 37% de los pacientes y cuidadores ingresados en la UCP durante el periodo de estudio. Existe un alto nivel de malestar emocional en el 88% de los pacientes. En los cuidadores evaluados aparecen niveles altos de ansiedad y se observa sobrecarga del cuidador en el 80% según la Escala Zarit reducida. CONCLUSIÓN: A pesar de las dificultades que conlleva evaluar a los pacientes con enfermedad avanzada y sus cuidadores, consideramos que estos procedimientos contribuyen a detectar el sufrimiento y promover su bienestar

BACKGROUND AND OBJECTIVE: The experience of an advanced disease causes emotional distress in patients and relatives. The objective of this paper is to assess a process of evaluation of emotional distress of both patients and caregivers in a recently created Palliative Care Unit of a General Hospital, as a first step towards reducing it as far as possible. Subjects and METHODS: A convenience sampling was used, from November 2015 to 2016 March. A total of 25 patients were interviewed using the Barthel Index, the Edmonton Symptom Assessment System and the questionnaire of Detection of Emotional Distress. Also 25 caregivers were interviewed using the Hospital Anxiety and Depression Score and the reduced Zarit Scale. RESULTS: 37% of patients and caregivers admitted in the Palliative Care Unit during the period of study could be evaluated. A high level of emotional distress was detected among 88% of PATIENTS: Caregivers were observed to have high levels of anxiety and burden was detected in 80% according to the reduced Zarit Scale. CONCLUSIONS: Despite the difficulties involved in evaluating patients with advanced disease and their caregivers, we think these procedures contribute to detecting suffering and to promoting their wellness

Asociación entre marcadores inflamatorios y traslocación bacteriana en pacientes con infección por el virus de la inmunodeficiencia humana en tratamiento antirretroviral / Association between inflammatory markers and microbial translocation in patients with human immunodeficiency virus infection taking antiretroviral treatment

Fundamento y objetivo: Ciertos marcadores inflamatorios están elevados en pacientes con infección por el virus de la inmunodeficiencia humana (VIH). El tratamiento antirretroviral (TAR) mejora algunos de estos parámetros, pero no suele normalizarlos. El objetivo de este estudio es determinar los factores, incluida la traslocación bacteriana, asociados a una mayor actividad inflamatoria en pacientes con infección por VIH en tratamiento. Pacientes y métodos: Estudio observacional transversal. Se incluyeron pacientes con infección por VIH que recibían TAR y tenían carga viral plasmática del VIH (CVP-VIH) < 400 copias/ml. Se seleccionaron pacientes consecutivos entre noviembre de 2011 y enero de 2012. Las variables de resultado fueron los valores séricos de interleucina 6 (IL-6) y de tumour necrosis factor α (TNF-α, «factor de necrosis tumoral α»). La variable explicativa principal fueron los marcadores de traslocación bacteriana (ADN ribosomal 16S y sCD14). Los pacientes con valores de IL-6 o TNF-α por encima del percentil 75 (grupo 1) se compararon con el resto de pacientes (grupo 2), y se calcularon las odds ratio (OR) brutas y ajustadas (análisis multivariante). Resultados: Se incluyeron 81 pacientes (73% varones, edad mediana 45 años, 48% en estadio C). El 26% tenía hepatitis crónica C. La mediana de linfocitos CD4 era de 493 cél/mm3 y el 30% tenía CVP-VIH detectable. Se detectó ADN ribosomal en el 21% de los pacientes. Los integrantes del grupo 1 presentaron con mayor frecuencia ADN ribosomal (OR 77, p < 0,0001), valores altos de sCD14 (p < 0,0001) y antecedentes de enfermedad cardiovascular (OR 15, p < 0,01). En el análisis multivariante la asociación se mantuvo para la presencia de ADN ribosomal (OR 62, p < 0,0001) y antecedentes cardiovasculares (OR 25, p < 0,01). Conclusiones: En pacientes con infección por VIH en tratamiento, los mayores valores de marcadores inflamatorios se observan en aquellos casos con traslocación bacteriana y antecedentes de enfermedad cardiovascular (AU)

Background and objective: Inflammatory biomarkers are increased in patients with human immunodeficiency virus (HIV) infection. Antiretroviral treatment (ART) improves some parameters but do not normalize them. The aim of this study is to determine those factors (including microbial translocation) associated with higher inflammation in HIV treated patients. Patients and methods: Transversal observational study. Inclusion criteria: HIV patients receiving ART with an HIV viral load (VL) < 400 copies/mL. Selection of patients: consecutively between November 2011 and January 2012. Main variable: plasma levels of interleukin 6 (IL-6) and tumour necrosis factor α (TNF-α). Main explanatory variable: microbial translocation markers (16S ribosomal DNA and sCD14). Patients with IL-6 or TNF-α levels above percentile 75 (group 1) were compared with the rest of patients (group 2). Odds ratio (OR) were determined. Results: Eighty-one patients were included (73% male, median age 45 years, 48% stage C). Twenty-six percent had chronic hepatitis C. Median CD4 cell was 493/mm3 and 30% had detectable HIV VL. 16S ribosomal DNA was detected in 21% of patients. Factors associated with the higher levels of inflammatory markers were 16S ribosomal DNA (OR 77, P < .0001), sCD14 levels (P < .0001) and history of cardiovascular disease (OR 15, P < .01). In multivariate analysis, associations remained for 16S ribosomal DNA (OR 62, P < .0001) and previous cardiovascular disease (OR 25, P < .01). Conclusions: In patients with HIV infection receiving treatment, the higher levels of inflammatory markers are associated with microbial translocation and past cardiovascular events (AU)

[Association between inflammatory markers and microbial translocation in patients with human immunodeficiency virus infection taking antiretroviral treatment]. / Asociación entre marcadores inflamatorios y traslocación bacteriana en pacientes con infección por el virus de la inmunodeficiencia humana en tratamiento antirretroviral.

BACKGROUND AND OBJECTIVE: Inflammatory biomarkers are increased in patients with human immunodeficiency virus (HIV) infection. Antiretroviral treatment (ART) improves some parameters but do not normalize them. The aim of this study is to determine those factors (including microbial translocation) associated with higher inflammation in HIV treated patients. PATIENTS AND METHODS: Transversal observational study. INCLUSION CRITERIA: HIV patients receiving ART with an HIV viral load (VL)<400 copies/mL. Selection of patients: consecutively between November 2011 and January 2012. Main variable: plasma levels of interleukin 6 (IL-6) and tumour necrosis factor α (TNF-α). Main explanatory variable: microbial translocation markers (16S ribosomal DNA and sCD14). Patients with IL-6 or TNF-α levels above percentile 75 (group 1) were compared with the rest of patients (group 2). Odds ratio (OR) were determined. RESULTS: Eighty-one patients were included (73% male, median age 45 years, 48% stage C). Twenty-six percent had chronic hepatitis C. Median CD4 cell was 493/mm(3) and 30% had detectable HIV VL. 16S ribosomal DNA was detected in 21% of patients. Factors associated with the higher levels of inflammatory markers were 16S ribosomal DNA (OR 77, P<.0001), sCD14 levels (P<.0001) and history of cardiovascular disease (OR 15, P<.01). In multivariate analysis, associations remained for 16S ribosomal DNA (OR 62, P<.0001) and previous cardiovascular disease (OR 25, P<.01). CONCLUSIONS: In patients with HIV infection receiving treatment, the higher levels of inflammatory markers are associated with microbial translocation and past cardiovascular events.

[Consensus statement on the clinical management of human immunodeficiency virus-associated neurocognitive disorders]. / Documento de consenso sobre el manejo clínico de los trastornos neurocognitivos asociados a la infección por el virus de la inmunodeficiencia humana (enero 2013).

OBJECTIVE: To develop a consensus document containing clinical recommendations for the management of human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND). METHODS: We assembled a panel of experts appointed by GeSIDA and the Secretariat of the National AIDS Plan (PNS), including internal medicine physicians with expertise in the field of HIV, neuropsychologists, neurologists and neuroradiologists. Scientific information was reviewed to October 2012 in publications and conference papers. In support of the recommendations using two levels of evidence: the strength of the recommendation in the opinion of the experts (A, B, C) and the level of empirical evidence (I, II, III), two levels based on the criteria of the Infectious Disease Society of America, already used in previous documents GeSIDA/SPNS. RESULTS: Multiple recommendations for the clinical management of these disorders are provided, including two graphics algorithms, considering both the diagnostic and possible therapeutic strategies. CONCLUSIONS: Neurocognitive disorders associated with HIV infection is currently highly prevalent, are associated with a decreased quality of life and daily activities, and given the possibility of occurrence of an increase in the coming years, there is a need to adequately manage these disorders, from a diagnostic as well as therapeutic point of view, and always from a multidisciplinary perspective.

[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)