Eligibility for and outcome of treatment of latent tuberculosis infection in a cohort of HIV-infected people in Spain.

BACKGROUND: Previous studies have demonstrated the efficacy of treatment for latent tuberculosis infection (TLTBI) in persons infected with the human immunodeficiency virus, but few studies have investigated the operational aspects of implementing TLTBI in the co-infected population.The study objectives were to describe eligibility for TLTBI as well as treatment prescription, initiation and completion in an HIV-infected Spanish cohort and to investigate factors associated with treatment completion. METHODS: Subjects were prospectively identified between 2000 and 2003 at ten HIV hospital-based clinics in Spain. Data were obtained from clinical records. Associations were measured using the odds ratio (OR) and its 95% confidence interval (95% CI). RESULTS: A total of 1242 subjects were recruited and 846 (68.1%) were evaluated for TLTBI. Of these, 181 (21.4%) were eligible for TLTBI either because they were tuberculin skin test (TST) positive (121) or because their TST was negative/unknown but they were known contacts of a TB case or had impaired immunity (60). Of the patients eligible for TLTBI, 122 (67.4%) initiated TLTBI: 99 (81.1%) were treated with isoniazid for 6, 9 or 12 months; and 23 (18.9%) with short-course regimens including rifampin plus isoniazid and/or pyrazinamide. In total, 70 patients (57.4%) completed treatment, 39 (32.0%) defaulted, 7 (5.7%) interrupted treatment due to adverse effects, 2 developed TB, 2 died, and 2 moved away. Treatment completion was associated with having acquired HIV infection through heterosexual sex as compared to intravenous drug use (OR:4.6; 95% CI:1.4-14.7) and with having taken rifampin and pyrazinamide for 2 months as compared to isoniazid for 9 months (OR:8.3; 95% CI:2.7-24.9). CONCLUSIONS: A minority of HIV-infected patients eligible for TLTBI actually starts and completes a course of treatment. Obstacles to successful implementation of this intervention need to be addressed.

Biomonitoring of metal in children living in a mine tailings zone in Southern Mexico: A pilot study.

Accumulation of metals in soil represents a health risk for individuals living near mining areas, especially for children who have a higher susceptibility to metal related diseases. The Taxco mining district in Southern Mexico was one of the largest Mexican metal producers of silver and gold, among other metals. The aim of this pilot study was to evaluate metal exposure on children aged 6-11 years living in and around the Taxco mine tailings zone. Lead in blood (PbB) was measured by graphite furnace atomic absorption spectrophotometry (AAS). Urine arsenic (AsU) was measured by hydride generation AAS, urinary Hg (HgU) by flow injection cold vapor atomic absorption, and urinary concentration of other metals such as chromium (Cr), nickel (Ni), cadmium (Cd), barium (Ba), cobalt (Co), copper (Cu), zinc (Zn), manganese (Mn), molybdenum (Mo), strontium (Sr), and iron (Fe) were determined by inductively coupled plasma optical emission spectrometry. Fifty samples were analyzed for PbB, AsU, and HgU, and 35 samples for the other metals. The mean concentration+/-SD for each metal was: PbB, 9.4+/-3.3 microg/dL; NiU, 75.4+/-30.7 microg/L; BaU, 18.4+/-4.1 microg/L; MnU, 5.2+/-0.7 microg/L; CuU, 29.6+/-6.8 microg/L; AsU, 16.5+/-8.3 microg/L; HgU, 0.7+/-0.86 microg/L; CdU, 4.7+/-2.7 microg/L; CrU, 15.1+/-4.45 microg/L; CoU, 18.3+/-9.7 microg/L; SrU, 49.2+/-30.7 microg/L; ZnU, 628.4+/-438.9 microg/L; FeU, 30.5+/-17.7 microg/L; and MoU, 52.1+/-29.3 microg/L. Results of this exploratory study show that children residing in the mining area of Taxco were environmentally exposed to several metals and a high percentage of these children had levels of Ni, Ba, Mn, Cr, Co, Cd, As, Hg, and Pb above reference values. Thus, further studies are needed to assess the effects of simultaneous exposure to toxic metals in children residing in mining areas.

[Factors related to non-prescription of tuberculin skin testing in a cohort of HIV-infected people]. / Factores asociados con la no realización de la prueba de la tuberculina en una cohorte de pacientes VIH positivos.

INTRODUCTION: Tuberculin skin testing (TST) for tuberculosis (TB) is recommended for all patients with HIV infection because of the known relationship between these two conditions. In this report we analyze the incidence and variables associated with non-prescription of TST in a cohort of HIV-infected people. PATIENTS AND METHODS: Longitudinal study conducted between 2000 and 2002 at 10 HIV hospital-based clinics. All HIV-infected patients who had not been regularly followed-up previously in dedicated clinics were identified. Data about TST and other variables related to TB were obtained from the clinical records. We calculated the percentage of patients who did not undergo TST and the associated factors, using odds ratios (ORs) and the 95% CI to investigate associations. A multivariate logistic regression analysis was performed. RESULTS: A total of 1242 patients met the inclusion criteria. TST was not performed in 185 patients (17.6% of those eligible). The fact of being an intravenous drug abuser was associated with a higher probability of TST non-prescription (OR: 2.6, 95% CI 1.1-6.5), whereas being unemployed (OR: 0.6, 95% CI 0.3-1.0), having a CD4 cell count >200 (CD4 200-499: OR 0.5, 95% CI 0.3-0.9. CD4> or =500: OR 0.3, 95% CI 0.2-0.6), and contact with persons with TB (OR 0.2, 95% CI 0.1-0.5) were associated with a lower probability. CONCLUSIONS: In this study, the percentage of TST non-prescription was quite high. The results suggest that TST non-prescription in this population is related to the clinicians' expectations regarding the results of the test and the patients' adherence to treatment for latent TB infection.

Dos nuevos casos de hepatitis E autóctonos / Two new cases of autochthonous hepatitis E

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