[Concordance of tuberculin tests and Interferon gamma release assays in the prison population]. / Concordancia de las pruebas de tuberculina e Interferón gamma en población reclusa.

OBJECTIVE: To study the agreement of Tuberculin Skin Tests (TST) and Interferon Gamma Release Assays (IGRA) when screening tuberculosis infection amongst inmates recently admitted to prison. MATERIALS AND METHODS: Prospective study conducted in a prison during the months of May and June 2009. Inmates without a TB history, with previous TST negatives or without prior TSTs were included. Participants signed an informed consent form and the study was approved by an independent Ethical Committee. TST (positive 10 > or = mm) and IGRA (Quantiferon TB-Gold) were performed and standardized data collection was carried out. The agreement between both tests was analysed using the Kappa index. RESULTS: A total of 181 people were included. 62% were foreign-born, 17% had previous BCG vaccination, 8.4% were IDUs and 4% HIV-infected. Foreign born subjects were more frequently vaccinated and presented less drug use and HIV infection than people born in Spain. (p=0.02, p=0.02 and p=0.01 respectively). TST results were positive in 24% and IGRA in 26%. Both tests were performed in 149 people (82%). Discordant results were observed in 15.8%. Agreement of the Kappa coefficient was 0.6 (CI 0.4-0.7). Agreement was better in the native population (K=0.8) and worse in BCG vaccinated (K=0.4) and foreign-born subjects (K=0.8). CONCLUSION: Overall agreement was moderate and was less amongst vaccinated subjects and those born abroad. Extension of the study could be useful to evaluate which test better predicts the risk of progression to active TB and the cost-benefit of both tests among the prison population.

Concordancia de las pruebas de tuberculina e Interferón gamma en población reclusa / Concordance of tuberculin test and Interferon gamma release assays in the prison population

Objetivo: Estudiar en población penitenciaria la concordancia de la prueba de la tuberculina (PT) y las pruebas de interferón gamma (IFG). Material y Métodos: Estudio prospectivo realizado en una prisión en mayo-junio de 2009. Se estudian los ingresos sin antecedente de tuberculosis (TB) o con PT previa negativa o no realizada. Se realizó IDR de Mantoux (positivo ³ 10 mm) y extracción sanguínea para prueba de IFG (QuantiFERON®-TB Gold). En los infectados, se realizó despistaje de TB. Se pasó un cuestionario y se solicitó consentimiento informado. El estudio fue aprobado por un Comité Ético ajeno a instituciones penitenciarias. La concordancia entre PT e IFG se basó en el índice Kappa. Resultados: Se incluyeron 181 casos. El 62% eran extranjeros, el 17% vacunados por BCG, el 8,4% UDI y el 4% VIH+. En los extranjeros había más vacunados, menos UDI y menos infectados por VIH que en autóctonos (p=0,02, p=0,02, y p=0,01, respectivamente). La PT fue positiva en el 24% y la IFG en el 26%. Hubo información de ambas en 149 (82%) casos. El 15,8% fueron discordantes. El índice Kappa fue de 0,6 (0,4-0,7). La concordancia varió según subgrupos, siendo mayor en autóctonos (kappa= 0,8) y menor en vacunados (kappa=0,4) e inmigrantes (kappa=0,5). Conclusión: La concordancia global fue moderada-buena, pero en vacunados e inmigrantes fue menor. El nivel de discordancia aconseja ampliar el estudio, así como evaluar que prueba predice mejor el riesgo de progresión a TB y el coste-beneficio de ambas en la población reclusa de nuestro país(AU)

Objective: To study the agreement of Tuberculin Skin Tests (TST) and Interferon Gamma Release Assays (IGRA) when screening tuberculosis infection amongst inmates recently admitted to prison. Materials and Methods: Prospective study conducted in a prison during the months of May and June 2009. Inmates without a TB history, with previous TST negatives or without prior TSTs were included. Participants signed an informed consent form and the study was approved by an independent Ethical Committee. TST (positive 10 >= mm) and IGRA (Quantiferon TB-Gold) were performed and standardized data collection was carried out. The agreement between both tests was analysed using the Kappa index. Results: A total of 181 people were included. 62% were foreign-born, 17% had previous BCG vaccination, 8.4% were IDUs and 4% HIV-infected. Foreign born subjects were more frequently vaccinated and presented less drug use and HIV infection than people born in Spain. (p=0.02, p=0.02 and p=0.01 respectively). TST results were positive in 24% and IGRA in 26%. Both tests were performed in 149 people (82%). Discordant results were observed in 15.8%. Agreement of the Kappa coefficient was 0.6 (CI 0.4-0.7). Agreement was better in the native population (K=0.8) and worse in BCG vaccinated (K=0.4) and foreign-born subjects (K=0.8) Conclusion: Overall agreement was moderate and was less amongst vaccinated subjects and those born abroad. Extension of the study could be useful to evaluate which test better predicts the risk of progression to active TB and the cost-benefit of both tests among the prison population(AU)

[Survival of patients with HIV-related tuberculosis. Study of mortality during the first 9 months of treatment]. / Supervivencia en pacientes con tuberculosis infectados por VIH. Estudio de los fallecimientos en los primeros nueve meses de tratamiento.

BACKGROUND: Among the individuals with tuberculosis who are infected with HIV a high degree of lethality has been found to exist during the first few weeks following the start of tuberculosis treatment. In this study, the survival of these individuals is studied within the framework of a retrospective cohort study. METHODS: This study included 1135 subjects infected by HIV over age fifteen and residents of Barcelona who were registered by the Barcelona Tuberculosis Prevention and Control Program and were diagnoses within the 1988-1993 period. The variables analyzed were age, gender, former imprisonment, municipal district, risk group, percentage of T CD4+ lymphocytes, tuberculin test, AIDS diagnosis (as per CDC-1987), X-ray pattern, bacteriology and part of the body affected by the tuberculosis. The Cox semiparametric method, the Kaplan-Meir curves and the log-rank test were employed. RESULTS: A 77% probability of survival during the first nine months was found to exist, with wide-ranging variations among the different subgroups. The only significant variables in the Cos multivariate model were AIDS, the percentage of T CD4+ lymphocytes and their interaction. The risk of death for an individual not having AIDS and a T CD4+ lymphocyte percentage of 14% or lower was 7.69 times higher than the risk of dying for an individual not having AIDS who had a T CD4+ lymphocyte percentage of above 14%. CONCLUSIONS: The survival of those individuals having tuberculosis who are infected with HIV varies greatly. Those who died in the short term were diagnosed as having AIDS on starting the tuberculosis treatment and who also had a T CD4+ lymphocyte percentage of 14% or lower.

[Infectious disease and sociodemographic characteristics of foreign immigrants in the Central Penitentiary for Men in Barcelona]. / Enfermedades infecciosas y características sociodemográficas de los inmigrantes extranjeros del Centro penitenciario de Hombres de Barcelona.

BACKGROUND: Immigration from socioeconomically under-developed countries is relatively recent in our country. Analyzing the impact of diseases such as HIV/AIDS and tuberculosis among these populations is of particular interest with regard to public health. METHODS: Case study and tests conducted at the Male Prison Facility in Barcelona from January 1, 1996 to September 30, 1996, the cases being the foreign immigrants from socioeconomically underdeveloped countries, and the checks of the native prisoners paired by age (+/- 5 years). A description is provided of the epidemiological and sociodemographic characteristics of the immigrants, and a comparison is drawn between the two populations. RESULTS: 450 prisoners, 300 native and 150 immigrants. Sixty-three percent (63%) of the immigrants were from the Maghreb, 72% being in this country illegally, 55% having resided in our country for over 5 years and 53% not living with any family members. The immigrants used less injected drugs that the native prisoners (OR: 0.2; IC95% 0.09-0.41), had less HIV infection (OR: 0.2; IC95% 0.05-0.49) and lived to a lesser extent with family (OR: 0.2; IC95% 1.011-0.36). No differences were found to exist with regard to infection by Mycobacterium tuberculosis nor tubercular disease. The legal immigrants were older (OR: 1.07; IC95% 1.01-1.13) lived to a greater extent with family (OR: 2.7; IC95% 1.23-5.80) and drank more alcohol (OR: 1.7; IC95% 1.07-2.59) than the illegal residents. CONCLUSIONS: The native prisoners had HIV to a greater extent than the immigrants, the use of injected drugs, more common among the natives, bearing an influence on this aspect. As regards the immigrants, the high degree of illegal residence and the absence of a stable core family comprise indicators of a situation of being socially disadvantaged.

[Extension of reporting AIDS cases in Catalonia: study based on requests for CD4 lymphocyte count and prescription of antiretroviral drugs]. / Exhaustividad de la notificación de los casos de SIDA en Cataluña: un estudio basado en las solicitudes de determinaciones de linfocitos CD4 y en la prescripción de antirretrovirales.

BACKGROUND: To ascertain the degree to which AIDS is officially reported in Catalunya. METHOD: The request for T CD4+ white blood cell counts and the prescribing of antiretroviral drugs in seven university hospitals in Catalunya from January 1, 1994 to June 31, 1994 were used as data-comparison sources. A case was considered to not have been reported when the clinical history showed a diagnosis of AIDS (according to the Europe 93 definition) and the case in question did not show up on the AIDS Registry for Catalunya. RESULTS: Of the 1,370 cases studied, 50 unreported AIDS cases were found. In all, 98.6% of all cases were found to have been reported, for a 95% confidence interval (95% CI): 98.2-99.0. Most of the unreported cases were males (72%) averaging 37.3 years of age (HCA: 11.8), 52% of whom were injected drug users (IDU's), extrapulmonary tuberculosis being the disease most often diagnosed (16%), 81.4% having been found to have a T CD4+ white blood cell count of 200 WBC/mm3 or below. 92% of these cases were detected based on T CD4+ white blood cell counts. CONCLUSIONS: The degree of completeness found is considered to be adequate. It is recommended that the white blood cell count records being used for this type of studies.

[Evaluation of the prevalence of HIV infection in prison inmates at the time of their imprisonment during the period 1991-1995]. / Evolución de la prevalencia de infección por virus de la inmunodeficiencia humana en población reclusa al ingreso en prisión durante el período 1991-1995.

BACKGROUND: Inmates of Spanish prisons include a high number of intravenous drug users (IVDUs) and other people whose practices entail the risk of infection with the human immunodeficiency virus (HIV). The aim of this work is to find out the evolution of the prevalence of HIV infection at the time of admission to prison and the factors associated with it in this population group. This may enable us to form an idea of the effectiveness of risk reduction strategies and help to improve them. METHODS: All those people who were placed in a provincial penal institution in the northwest of Spain between 1991 and 1995. Socio-demographic, penal and HIV risk factor variables were gathered. The HIV infection test (ELISA and Western-blot) was carried out with the consent of the subjects. RESULTS: Of the 1,663 people studied, 19.4% were HIV-positive. The prevalence HIV infection was particularly marked statistically in: women (26.0%), the 25-34 age group (29.1%), whites (20.9%), single people (22.8%), those people with a tattoo (29.9%), those people with a background in self-inflicted injuries (42.2%), IVDUs (46.3%), those who admitted sharing syringes (61.5%) and those with a prison record of one or more years (37.3%). Logistical regression analysis showed the following as predictors of HIV infection: IVDUs, those who went to prison in 1992, women, the 25-34 and 35-44 age group, tattooed men, those with a background in self-inflicted injuries and those with a prison record, of more than one year. The gypsy ethnic group revealed a lower probability of HIV infection. The HIV infection time trend, stratified according to the prison record showed an almost significant drop (P = 0.064). The infection trend per IVDU did not show any modification (P = 0.16). CONCLUSIONS: A high prevalence of HIV infection was detected in a prison located in a region which has not been particularly affected by AIDS. IVDUs and some characteristics that may be related to this population group have an enormous influence on this phenomenon. The time trend for this infection in this population group has decreased through the lower number of IVDUs that are admitted to prison although very high levels of prevalence of the infection were maintained in this group over the five years of the study. It is recommended that risk-reduction programmes in prisons be fostered (methadone maintenance programmes, syringe exchange pilot programmes).

[Influence of the HIV (+) cases on the epidemiology of infantile tuberculosis in Barcelona]. / Influencia de los VIH (+) en la epidemiología de la tuberculosis infantil en Barcelona.

OBJECTIVE: To understand better the characteristics of tuberculosis (TBC) in children and to identify sources of infection. DESIGN: Crossover study. SITE. At the community level in the city of Barcelona. PATIENTS: Children under 15 with tuberculosis, who were diagnosed between Oct 1, 1989 and Sept 30, 1990 and were resident in Barcelona. MAIN MEASUREMENTS AND RESULTS: Among the 78 cases found, we identified the source of infection for 26 children (33.3%). 6 of these (23.1%) had been infected by three cases of HIV+. A relationship was posited between the economic level of the population and the incidence of TBC. This was confirmed by the economic level of the families (80% of the sources of infection identified belonged to professions requiring few or no qualifications) and where they lived, given that the specific rate for children under 15 in the most depressed social-economic area (Ciutat Vella) was 206 per 100,000, whereas in the wealthiest area (Sarrià-Sant Gervasi) the rate was 4.3 per 100,000. CONCLUSIONS: This study makes clear the importance of investigating the contacts of children with tuberculosis. It should be fundamental for the TBC control programmes to focus closely on those with HIV. They are much more likely to contract and spread TBC to the least protected groups of the population, especially to the children of poor families.