ABSTRACT
Background and Aims: In Spain, HIV, HBV, and HCV prevalence are lower in females. A 2017–2018 Ministry of Health serosurvey in 7, 675 primary care patients found 0.35% and 0.08% chronic HCV infection in men and women. A previous opportunistic, population-based screening program in 11, 449 primary care patients seen in our health department found 0.18% and 0.06% HIV infection prevalence, 1.11% and 0.56% chronic HBV infection prevalence, and 0.73% and 0.25% chronic HCV infection prevalence in men and women from February to December 2019. We aimed to assess HIV, HBV, and HCV prevalence among women seeking care in our health department’s 5 Sexual and Reproductive Health Units (SRHU), in the Human Reproduction Unit (HRU), and the Obstetrics and Gynecology Service (OGS). Method: We implemented opportunistic HIV, HBV, and HCV screening from March to October 2021, despite challenges related to a fifth wave of the SARS-CoV-2 pandemic. We used existing infrastructure and staff, aided by electronic health record system modifications, to identify screening eligibility and request serologies. Patients were eligible for testing upon verbal consent if they were between 18 and 80, and had no record of testing in the previous year, and required blood tests in their current health care visit. Follow-up or discharge was given, regardless of test results. A case manager contacted positive patients to ensure and monitor linkage to specialist medical care. Herein we analyze data from patients aged 18 to 45 — the maximum age of patients seen in the HRU. Results: We screened 934 women, of whom 48.1% (449) in SRHUs, 26.0% (243) in the HRU, and 25.9% (242) in the OGS (26%). Regarding age and nationality,14.6.% (136)were aged 18 to 25, 45.5% (425)were 26 to 35, 39.9% (373) were 36 to 45, and 20.6% (192) were foreigners. We found 1 (0.1%) HIV antibody positive patient (a 45-year-old from the Dominican Republic), 1 (0.1%) HBV surface antigen positive patient (a 36-year-old from China), 1 (0.1%) HCV antibody positive patient, and no HCV RNA positive patients. Conclusion: HIV prevalence among Valencian women in reproductive and sexual health serviceswas similar to the general population in primary health care in the area. In contrast, chronic HBV infection prevalence was low, and chronic HCV infection was not found. Our data suggest that opportunistic HBV and HCV screening of women aged 18 to 45 out of populations at increased risk is an inefficient public health strategy in our area
ABSTRACT
Background: COVID-19 is commonly manifested with respiratory pathology, but has also been reported to cause liver damage Our aim is to assess in admitted patients with COVID-19 whether liver damage is associated with a worse prognosis and if there are differences between the moment of the onset of liver damage (at or during admission) Methods: We use an unicentric retrospective study with adult patients admitted with COVID-19 (PCR diagnosis) Patients with previous liver disease or damage and those with suspected drug hepatotoxicity were excluded 303 patients were registered and their baseline characteristics were determined: age, sex and chronic diseases (cardiovascular risk factors, pneumological and cardiological diseases and chronic renal impairment). Liver damage was defined as ALT, AST, bilirubin, ALP or GGT elevation over our laboratory ranges COVID-19 moderate stage is considered if advanced interstitial radiological pattern or pneumonia is presented and severe stage if it associates tachypnea, hypoxia or respiratory failure. Deterioration is defined as a more serious stage progression and improvement as a change to a less serious stage Statistical analysis was performed by age-adjusted binary logistic regression. The significance level (p-value) was 5% (α=0'05). Results: Males predominate (51'3%) with an average age of 69'3 years old The overall prevalence of liver damage was 60 9%, with 46 4% liver damage at admission and the remaining 14 5% during admission (74 8% for the first 8 days). At admission 52.7% had moderate stage and 34 1% severe Subgroups with and without liver damage had no significant differences in baseline characteristics. Significant association between liver damage was observed at moderate and severe stages (p 0'011 and p 0'031) During admission 66 2% improved the initial stage, but 13 2% deteriorated (moderate to severe) 14 9% required admission to ICU and 21 9% died At admission it was observed that patients with liver damage had a higher risk of deterioration (p 0'001) and a lower probability of improvement (p 0'001) If liver damage occurs during admission there is still a higher risk of deterioration (p 0'002);however, there is a tendency without statistical significance, regarding the likelihood of non improvement (p 0'055) Conclusion: The liver damage prevalence in our study in admitted COVID-19 patients is high and is related to greater severity and less favorable evolution, whether it appears at or during admission Therefore, it is important to monitor liver function parameters.