Hormigueo o formicación secundario tras el consumo de cocaína / Prickling or formication after the use of cocaine

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[The progression of liver fibrosis in prison inmates co-infected by HIV and HCV who started on boosted protease inhibitor therapy]. / Evolución de la fibrosis hepática en reclusos coinfectados por VIH y VHC que inician tratamiento con inhibidores de la proteasa potenciados.

OBJECTIVES: To analyse the progression of liver fibrosis as measured by elastography and biochemical testing in prisoninmates co-infected by HIV and HCVwho started on ritonavir-boosted protease inhibitor (PI) therapy. METHODS: A prospective, observational and multi-centre study. The progression of liver fibrosis as measured by transient elastography (FibroScan) and biochemical testing was monitored for 48 weeks in a Spanish prison population co-infected with HIV and HCV. RESULTS: Of the 94 patients included, 54 (57.4%) were followed-up for 48 weeks. At week 48, no significant changes were seen in the grade of fibrosis measured using FibroScan (8.1 kPa vs. 8.3 kPa; p=0.20) or the Forns index (5.6 vs. 5.1; p= 0.50), although significant changes were detected using the APRI (0.7 vs. 0.6; p=0.05) and the FIB-4 indexes (p= 0.02).When measurement was done compared to baseline fibrosis, it was seen that therapy reduced the percentage of patients with fibrosis ≥3 but <4 (50% vs. 15%; p=0.001), but no change was seen in those found to have grade 4 fibrosis at baseline (20.4% vs. 20.4%). CONCLUSION: The inmates co-infected with HIV and HCV who were started on antiretroviral therapy with the boosted protease inhibitor (PI) showed stasterilizationbilisation of the liver fibrosis as measured with FibroScan after one year of follow-up. Overall, the therapy improved fibrosis when measured using the APRI or FIB-4 indexes, but not when using the Forns index or elastography.

Evolución de la fibrosis hepática en reclusos coinfectados por VIH y VHC que inician tratamiento con inhibidores de la proteasa potenciados / The progression of liver fibrosis in prison inmates co-infected by HIV and HCV who started on boosted protease inhibitor therapy

Objetivos: Analizar la evolución de la fibrosis hepática medida por elastografía y pruebas bioquímicas en reclusos coinfectados por VIH y VHC que han iniciado tratamiento antirretroviral con lopinavir/ritonavir u otros inhibidores de la proteasa potenciados con ritonavir. Métodos: Estudio prospectivo, observacional y multicéntrico. Se comprobó durante 48 semanas la evolución de la fibrosis hepática medida mediante elastografía de transición (FibroScan) y pruebas bioquímicas en población penitenciaria española coinfectada por VIH y VHC. Resultados: De los 94 pacientes incluidos, 54 (57,4%) fueron seguidos durante 48 semanas. En la semana 48, no hubo cambios significativos en el grado de fibrosis medida mediante FibroScan (8,1 Kpa vs 8,3; p=0.20) o índice de FORNS (5,6 vs 5,1; p=0,50), aunque sí con el índice APRI (0.7 vs 0.6; p=0.05) y el índice FIB-4 (p=0,02). Cuando la medición se realizó en función del grado de fibrosis basal, se observó que el tratamiento redujo el porcentaje de pacientes con fibrosis basal de grado 3/4 (50% vs 15%; p=0,001), pero no hubo cambios en los que ya tenían basalmente grado 4 (20,4% vs 20,4%). Conclusión: Los reclusos coinfectados por VIH y VHC que inician tratamiento antirretroviral con lopinavir/ritonavir muestran una estabilización de la fibrosis hepática medida con FibroScan® tras un año de seguimiento. En conjunto, el tratamiento mejoró la fibrosis cuando la referencia de medición fue el índice APRI y el FIB-4, pero no con el índice FORNS o la elastografía (AU)

Objectives: To analyse the progression of liver fibrosis as measured by elastography and biochemical testing in prison inmates co-infected by HIV and HCVwho started on ritonavir-boosted protease inhibitor (PI) therapy. Methods: A prospective, observational and multi-centre study. The progression of liver fibrosis as measured by transient elastography (FibroScan) and biochemical testing was monitored for 48 weeks in a Spanish prison population co-infected with HIV and HCV. Results: Of the 94 patients included, 54 (57.4%) were followed-up for 48 weeks. At week 48, no significant changes were seen in the grade of fibrosis measured using FibroScan (8.1 kPa vs. 8.3 kPa; p=0.20) or the Forns index (5.6 vs. 5.1; p=0.50), although significant changes were detected using the APRI (0.7 vs. 0.6; p=0.05) and the FIB-4 indexes (p= 0.02).When measurement was done compared to baseline fibrosis, it was seen that therapy reduced the percentage of patients with fibrosis ≥3 but <4 (50% vs. 15%; p=0.001), but no change was seen in those found to have grade 4 fibrosis at baseline (20.4% vs. 20.4%). Conclusion: The inmates co-infected with HIV and HCV who were started on antiretroviral therapy with the boosted protease inhibitor (PI) showed stasterilizationbilisation of the liver fibrosis as measured with FibroScan after one year of follow-up. Overall, the therapy improved fibrosis when measured using the APRI or FIB-4 indexes, but not when using the Forns index or elastography (AU)

[Multi-centre study of the prevalence of latent tuberculosis infection amongst inmates in Spanish prisons]. / Estudio multicéntrico de prevalencia de infección tuberculosa latente en los internados en prisiones españolas.

AIMS: To study the prevalence of latent tuberculosis infection (LTBI) amongst inmates in Spanish prisons. MATERIALS AND METHODS: Multi-centre, cross-sectional study; two stage sampling. Socio-demographic, prison and clinical variables were gathered. A univariate, bivariate and multivariate analysis was carried out using logistic regression with the variables that showed statistical significance. The odds ratio was calculated with a confidence interval of 95%. RESULTS: 378 patients. The Mantoux test (PPD) assessable in 90.2% was available. 91.2% men, 37.8% foreigners with average age of 35.9±10.3 years. Average stay in prison: 2 years, 28.7% had been > 5 years in prison. 49.6% entered prison in 2006 or before. 24.5% had a history of intravenous drug use (IDU). 50.4% presented LTBI that was associated with: age > 40 years (63.2 vs 43.8%; CI: 1.39-3.49; OR: 2.20; p=0.001); stay of > 5 years in prison (71.2 vs 41.3%; CI: 2.13-5.75; OR: 3.50; p<0.001); in prison since 2006 or before (58.1 vs 42.6%; CI: 1.22-2.88; OR:1.87; p=0.004); infected with HCV+ (66.3 vs 45.3%; CI:1.40-4.0; OR: 2.37; p=0.001). The logistic regression model confirmed the independent association of LTBI with: a) age > 40 years (OR: 1.76; CI: 1.08-2.87; p=0.024); and length of prison stay > 5 years (OR: 2.50; CI: 1.41-4.43; p=0.002). CONCLUSIONS: The prevalence of LTBI in prison is very high, especially amongst inmates over 40 and those who have been in prison for more than five years. To prevent the risk of progression to tuberculosis, treatment is recommended for those who require it along with the maintenance of control programmes for this pathology.

Estudio multicéntrico de prevalencia de infección tuberculosa latente en los internados en prisiones españolas / Multi-centre study of the prevalence of latent tuberculosis infection amongst inmates in spanish prisons

Objetivo: Estudiar la prevalencia de infección tuberculosa latente (ITL) entre los presos internados en las prisiones españolas. Material y Método: Estudio multicéntrico, observacional y transversal; muestreo por conglomerado bietápico. Se recogieron variables sociodemográficas, penitenciarias y clínico-serológicas. Se realizó análisis univariante, bivariante y multivariante mediante regresión logística con las variables que mostraron significación estadística. Se calculó la odds ratio con intervalo de confianza del 95%. Resultados: 378 pacientes. Se dispuso de intradermorreacción de Mantoux (IDRM) valorable en el 90,2%. 91,2% hombres, 37,8% extranjeros con edad media de 35,9±10,3 años. Mediana de estancia en prisión: 2 años y el 28,7% había estado > 5 años en prisión. El 49,6% ingresó en prisión en 2006 o antes. El 24,5% tenía antecedentes de uso de drogas intravenosas (UDI). El 50,4% presentaba ITL que se asoció a: edad > 40 años (63,2 vs 43,8%; IC: 1,39-3,49; OR: 2,20; p=0,001); haber estado > 5 años en prisión (71,2 vs 41,3%; IC: 2,13-5,75; OR: 3,50; p<0,001); estar en prisión desde 2006 o antes (58,1 vs 42,6%; IC: 1,22-2,88; OR:1,87; p=0,004); estar infectado por el VHC+ (66,3 vs 45,3%; IC:1,40-4,0; OR: 2,37; p=0,001). El modelo de regresión logística confirmó la asociación independiente de la ITL con: a) edad > 40 años (OR:1,76; IC: 1,08-2,87; p=0,024); y b) estancia > 5 años en prisión (OR: 2,50; IC: 1,41-4,43; p=0,002). Conclusiones: La prevalencia de ITL en prisión es muy alta, sobre todo en los mayores de 40 años y los que están más de cinco años en prisión. Para evitar el riesgo de progresión a tuberculosis, se recomienda tratar a los infectados que lo precisen y mantener los programas de control de esta patología(AU)

Aims: To study the prevalence of latent tuberculosis infection (LTBI) amongst inmates in Spanish prisons. Materials and Methods: Multi-centre, cross-sectional study; two stage sampling. Socio-demographic, prison and clinical variables were gathered. A univariate, bivariate and multivariate analysis was carried out using logistic regression with the variables that showed statistical significance. The odds ratio was calculated with a confidence interval of 95%. Results: 378 patients. The Mantoux test (PPD) assessable in 90.2% was available. 91.2% men, 37.8% foreigners with average age of 35.9±10.3 years. Average stay in prison: 2 years, 28.7% had been > 5 years in prison. 49.6% entered prison in 2006 or before. 24.5% had a history of intravenous drug use (IDU). 50.4% presented LTBI that was associated with: age > 40 years (63.2 vs 43.8%; CI: 1.39-3.49; OR: 2.20; p=0.001); stay of > 5 years in prison (71.2 vs 41.3%; CI: 2.13-5.75; OR: 3.50; p<0.001); in prison since 2006 or before (58.1 vs 42.6%; CI: 1.22- 2.88; OR:1.87; p=0.004); infected with HCV+ (66.3 vs 45.3%; CI:1.40-4.0; OR: 2.37; p=0.001). The logistic regression model confirmed the independent association of LTBI with: a) age > 40 years (OR: 1.76; CI: 1.08-2.87; p=0.024); and length of prison stay > 5 years (OR: 2.50; CI: 1.41-4.43; p=0.002). Conclusions: The prevalence of LTBI in prison is very high, especially amongst inmates over 40 and those who have been in prison for more than five years. To prevent the risk of progression to tuberculosis, treatment is recommended for those who require it along with the maintenance of control programmes for this pathology(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.

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

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