Efficacy of a comprehensive strategy for the detection and treatment of hepatitis C infection in a population attending addiction centers.

Background and aims: The burden hepatitis C infection in people with history or current drug use suppose a high risk of hepatic complications and transmission infectious disease. This population is poor linked to heath system and is difficult to achieve them and support treatment because they have high rates of lost follow-up. Our aim was to evaluate an intervention for the diagnosis and treatment of chronic hepatitis C and HIV in this population. Methods: Six-hundred and eighty-three people attended in Drugs and Addictions Centers (DAC) were asked to participate in health counseling and provide blood sample for test HCV, HIV, and syphilis from April 2019 to June 2020. Totally 556 subjects were surveyed and tested. All of them were assigned to a patient navigation program to improve health education and linking to the sanitary system. Hepatitis C infection patients were evaluated in an ampliated medical consult to evaluate hepatic stage with transient liver elastography and initiated Direct Acting Antivirals to achieve Sustained Viral Response. Results: Of the 556 patients who agreed to participate in the study, 33 (5.9%) had active HCV infection. Of the 33 patients infected with HCV, three were lost to follow-up once the diagnosis of HCV infection was made. Twenty-eight patients (93.3%) completed treatment and 26 achieved Sustained Viral Response (78.8%). Of the 30 patients, seven (23.3%) had advanced fibrosis, and of these, four (16.6%) had liver cirrhosis. One of the cirrhotic patients had hepatic space-occupying lesions at the baseline evaluation and was diagnosed with hepatocarcinoma. Conclusions: Our study suggests that the implementation of strategies based on personalized intervention models can contribute to the control of HCV infection in DAC users.

Comparison of hepatitis B and SARS-CoV2 vaccination rates in people who attended Drugs and Addiction Centres.

Background and aims: Persons with substance use disorder are at increased risk for hepatitis B virus (HBV) infection. Although most of them are attached to social health centers, the vaccination rate in this group is low. In this context, we designed a study to evaluate the prevalence of users of drug addiction centers (DAC) not immunized against hepatitis B and to compare the rate of vaccination against hepatitis B with the rate of immunization against SARS-Cov-2 in 2 years of follow-up. Design: Retrospective study that included individuals attended at DAC. Patients were screened at baseline (June 2020-January 2021) for HBV immunization. Individuals with HBsAb < 10 IU/mL were recommended to receive hepatitis B vaccine, during follow-up (January 2021-October 2022). At the end of follow-up, the HBV vaccination rate among candidates was determined and compared with the vaccination rate against SARS-Cov-2 in this population in the same period. Findings: A total of 325 subjects were surveyed and tested. At baseline, the 65% (211/325) of were candidates to initiate vaccination and were advisor to HBV vaccination. During the follow-up 15 individuals received at least one dose of HBV vaccine, supposing a vaccination rate of 7.2%. In the same period, 186 individuals received at least one dose against SARS-Cov-2, representing a vaccination rate of 83%. The comparison between vaccination rates reached statistically significant (p < 0.001). Conclusion: Our study manifests a low rate of immunization against HBV in DAC users, despite a high level of immunization for SARS-Cov-2 during the same period in the same population. Consequently, the lack of immunization against HVB in this population might be related with health policy issue more than to individuals linked to care and awareness. A similar approach for vaccination intended for SARS-CoV2 should be applied in high-risk population to warrant the success of immunization program against other preventable diseases such as HBV.

[Venlafaxine extended release and alcohol dependence]. / Venlafaxina retard y trastorno por dependencia de alcohol.

OBJECTIVES: The aim is to determine the effect of the treatment with venlafaxine extended release in patients with alcohol or cocaine dependence disorder that initiate detoxification treatment. METHODS: Observational, open, prospective study carried out in Spain in 2005. 55 patients older than 18 years of age with diagnosis of alcohol and/or cocaine dependence disorder, hospitalized in Specialty Care Center to initiate detoxification treatment, were included. Daily doses of 75 to 225 mg of venlafaxine extended release were administered for 6 months. RESULTS: Treatment was associated with significant reductions in EuropASI scores in the following areas: 3, alcohol use, baseline and final score of 8.2 +/- 0.2 and 6.4 +/- 0.4, respectively (P < 0.01); 5, family/social relations, initial score of 6.9 +/- 0.2 and of 5.2 +/- 0.5 at endpoint (P < 0.001); 1, medical status, scores of 3.7 +/- 0.4 and 0.9 +/- 0.3 (baseline and final visits, respectively) (P < 0.001); and 6, psychiatric status, with a baseline score of 7.8 +/- 0.1 and final score of 5.4 +/- 0.4 (P < 0.001). The VAS alcohol craving scores at baseline were 26.7 +/- 4.6, decreasing to 4.1 +/- 1.5 at endpoint (P < 0.001). CONCLUSIONS: The results of this observational study suggest that venlafaxine extended release could be effective as a coadyuvant in the treatment of alcohol dependent patients in alcohol detoxification therapy. Nevertheless, this should be confirmed with bigger placebo-controlled samples.

Venlafaxina retard y trastorno por dependencia de alcohol / Venlafaxine extended release and alcohol dependence

Objetivos: Determinar el efecto del tratamiento con venlafaxina retard en pacientes con trastorno por dependencia de alcohol o de alcohol y cocaína que inician un tratamiento de desintoxicación. Metodología: Estudio observacional, abierto y prospectivo, realizado en España en 2005. Se incluyen 55 pacientes mayores de 18 años con diagnóstico de trastorno por dependencia de alcohol o alcohol y cocaína, ingresados en un centro de Atención Especializada para iniciar tratamiento de desintoxicación. Se administró durante 6 meses venlafaxina retard, a dosis entre 75 y 225 mg/día. Resultados: El tratamiento se asoció a reducciones significativas en las puntuaciones del EuropASI en las siguientes áreas: 3, uso de alcohol, con una puntuación basal y final de 8,2 ± 0,2 y 6,4 ± 0,4, respectivamente (P < 0,01); 5, relaciones familiares/sociales, puntuación inicial de 6,9 ± 0,2 y final de 5,2 ± 0,5 (P < 0,001); 1, situación médica, con puntuaciones de 3,7 ± 0,4 y 0,9 ± 0,3 (visitas basal y final, respectivamente) (P < 0,001); y 6, situación psiquiátrica, con puntuación basal de 7,8 ± 0,1 y final de 5,4 ± 0,4 (P < 0,001). La puntuación basal en la Escala Visual Analógica de craving de alcohol fue de 26,7 ± 4,6, descendiendo a 4,1 ± 1,5 en la visita final (P < 0,001). Conclusiones: Los resultados de este estudio observacional sugieren que venlafaxina retard podría ser efectiva en el tratamiento coadyuvante de pacientes dependientes de alcohol, que están siguiendo terapia de deshabituación. No obstante, esto debe ser replicado con series más amplias y controladas con placebo

Objectives: The aim is to determine the effect of the treatment with venlafaxine extended release in patients with alcohol or cocaine dependence disorder that initiate detoxification treatment. Methods: Observational, open, prospective study carried out in Spain in 2005. 55 patients older than 18 years of age with diagnosis of alcohol and/or cocaine dependence disorder, hospitalized in Specialty Care Center to initiate detoxification treatment, were included. Daily doses of 75 to 225 mg of venlafaxine extended release were administered for 6 months. Results: Treatment was associated with significant reductions in EuropASI scores in the following areas: 3, alcohol use, baseline and final score of 8.2±0.2 and 6.4±0.4, respectively (P < 0.01); 5, family/social relations, initial score of 6.9±0.2 and of 5.2±0.5 at endpoint (P < 0.001); 1, medical status, scores of 3.7±0.4 and 0.9±0.3 (baseline and final visits, respectively) (P < 0.001); and 6, psychiatric status, with a baseline score of 7.8±0.1 and final score of 5.4±0.4 (P < 0.001). The VAS alcohol craving scores at baseline were 26.7±4.6, decreasing to 4.1±1.5 at endpoint (P < 0.001). Conclusions: The results of this observational study suggest that venlafaxine extended release could be effective as a coadyuvant in the treatment of alcohol dependent patients in alcohol detoxification therapy. Nevertheless, this should be confirmed with bigger placebo-controlled samples