ABSTRACT
OBJECTIVE: To ascertain the prevalence of HIV and hepatitis C (HCV) coinfection in the Health Area of León in the period of 1992 to 2000. PATIENTS, MATERIAL AND METHODS: The study included patients with HIV infection, residing for at least two years in the area, and attended at the Department of Internal Medicine of León Hospital. Sociodemographic information and risk behavior were recorded. Data from the Municipal Census of 1 May 1996 were used to calculate prevalence. Statistical analyses were carried out with the chi-square test or analysis of variance, according to the cases. RESULTS: The prevalence of HCV infection among HIV-positive patients was 56.8%. Coinfected men were younger than women and coinfection was higher in the parenteral transmission than in the sexual transmission groups. Prevalence was estimated at 53.2 cases per 100,000 inhabitants of the Area (82.7 for men and 25.7 for women). The groups showing the highest prevalence were men aged 25-34 and 35-44 years. The epidemiology of the coinfection was mainly attributable to injected drug use. There was a decrease in the number of coinfection cases diagnosed during the study period. CONCLUSIONS: The prevalence of HIV/HCV coinfection in the León Health Area was lower than the rate estimated for Spain as a whole owing to a lower incidence of HIV infection and intravenous drug use. Nevertheless, HIV/HCV coinfection is a major public health problem, and resources should be allocated for its prevention and treatment.
Subject(s)
HIV Infections/epidemiology , Hepatitis C/epidemiology , Adolescent , Adult , Catchment Area, Health , Comorbidity , Female , Humans , Male , Middle Aged , Prevalence , Risk Factors , Sexual Behavior , Spain/epidemiology , Transfusion Reaction , Urban PopulationABSTRACT
Objetivo. Conocer la prevalencia de coinfección por el virus de la inmunodeficiencia humana (VIH) y el virus de la hepatitis C (VHC) en el Área de Salud de León en el período 1992-2000. Pacientes, material y métodos. Pacientes con infección por VIH y 2 años de residencia en el Área atendidos en el Servicio de Medicina Interna del Hospital de León. Se recogieron datos sociodemográficos y prácticas de riesgo. Para el cálculo de las prevalencias poblacionales se utilizó el Padrón Municipal de Habitantes de 1 de mayo de 1996. Los análisis estadísticos se realizaron con la prueba de la chi cuadrado o análisis de la varianza según los casos. Resultados. La prevalencia de infección por VHC en los infectados por VIH fue de 56,8%. Los varones coinfectados eran más jóvenes y la prevalencia de coinfección fue significativamente más elevada en los grupos de transmisión parenteral que sexual. La prevalencia poblacional estimada para el Área fue de 53,2 casos por 100.000 habitantes (82,7 en varones y 25,7 en mujeres). Los grupos de mayor prevalencia fueron los varones de 25 a 34 y de 35 a 44 años. La epidemiología de la coinfección viene fundamentalmente explicada por el uso de drogas intravenosas. El diagnóstico de la coinfección ha seguido un curso declinante a lo largo del período de estudio. Conclusiones. La prevalencia de la coinfección VIH-VHC en el área de León es inferior a la estimada para España debido a la menor incidencia de la infección por VIH y al menor porcentaje de uso de drogas intravenosas. A pesar de ello supone un importante problema de salud pública al que se deben de dedicar recursos en prevención y tratamiento (AU)
Objective. To ascertain the prevalence of HIV and hepatitis C (HCV) coinfection in the Health Area of León in the period of 1992 to 2000. Patients, material and methods. The study included patients with HIV infection, residing for at least two years in the area, and attended at the Department of Internal Medicine of León Hospital. Sociodemographic information and risk behavior were recorded. Data from the Municipal Census of 1 May 1996 were used to calculate prevalence. Statistical analyses were carried out with the chi-square test or analysis of variance, according to the cases. Results. The prevalence of HCV infection among HIV-positive patients was 56.8%. Coinfected men were younger than women and coinfection was higher in the parenteral transmission than in the sexual transmission groups. Prevalence was estimated at 53.2 cases per 100,000 inhabitants of the Area (82.7 for men and 25.7 for women). The groups showing the highest prevalence were men aged 25-34 and 35-44 years. The epidemiology of the coinfection was mainly attributable to injected drug use. There was a decrease in the number of coinfection cases diagnosed during the study period. Conclusions. The prevalence of HIV/HCV coinfection in the León Health Area was lower than the rate estimated for Spain as a whole owing to a lower incidence of HIV infection and intravenous drug use. Nevertheless, HIV/HCV coinfection is a major public health problem, and resources should be allocated for its prevention and treatment (AU)
Subject(s)
Male , Female , Adult , Adolescent , Humans , HIV Infections/epidemiology , HIV Infections/complications , Hepatitis C/epidemiology , Hepatitis C/complications , Socioeconomic Factors , Spain/epidemiology , Risk Factors , PrevalenceABSTRACT
OBJECTIVE: To assess the contribution of the determination of concentrations of indinavir (IND) in plasma to the assessment of self-reported adherence and keeping of appointments to withdraw drugs from the hospital pharmacy. PATIENTS AND METHODS: Adherence was assessed using three criteria: questionnaires, punctuality at appointments to withdraw drugs, and plasma concentrations of IND. Blood samples were obtained from 106 HIV-infected patients who had been receiving IND in combination with two nucleoside reverse transcriptase inhibitors for longer than 6 months. Logistic regression analysis was carried out, and receiver operating characteristic curves were drawn. RESULTS: The kappa index showed a low concordance for the three measures. When pharmacy appointments and self-report are used together, the nondetection of drug levels is more reliably predicted (AUC = 0.75). With the viral load as the gold standard, plasma levels contribute nothing to the information given by the other two measures combined (AUC = 0.63, AUC = 0.64). CONCLUSION: Measurement of adherence to highly active antiretroviral therapy is complex. Because there is no gold standard for it, we demonstrated that each of three common adherence measures has shortcomings that can be minimized in a combined measurement system. Indinavir plasma levels appear to provide no additional information, so further studies are undoubtedly necessary.
