Hepatitis C hospitalizations in Spain, 2004-2013: a retrospective epidemiological study.

BACKGROUND: Hepatitis C is an important public health problem about which there is currently scarce epidemiological information. The objective of this study is to describe and analyse the demographic and epidemiological characteristics of hospitalized cases of hepatitis C in the Spanish population between 2004 and 2013. METHODS: The study uses the Hospital Discharge Records Database of the Spanish National Health System. It is a retrospective descriptive epidemiological study. The variables analysed were year of infection, age, sex, diagnostic category, days admitted and co-morbidity. RESULTS: There have been a total of 351,996 hospitalizations; 225,138 men (64%) and 126,858 women (36%). They are divided between acute hepatitis 8161 (2.3%); chronic hepatitis 325,185 (92.4%) and unspecified hepatitis 18,650 (5.3%). The mean age for men is 53.7 (+/-15.2) and for women 62.3 (+/-17.3). 22.8% also present with an Human immunodeficiency virus (HIV) disease coinfection, and 14.7% with opioid dependencies. The trend is for a gradual increase in cases without statistical significance. CONCLUSIONS: The Hepatitis C cases hospitalized had high levels of chronicity, which entails two distinct patterns of illness in men and women - who are affected in different age ranges.

Lessons from the history of the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic among Spanish drug injectors.

In Spain, approximately 10 years passed between the time when human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) harm-reduction programs should have been developed with sufficient coverage to have an optimum impact on public health (before the HIV/AIDS epidemic's explosion in 1984) and the date of their actual implementation. This delay yielded an enormous cost for the country. The introduction of the virus in drug injector networks during a period of widespread diffusion of heroin injection and the lack of political awareness of the growing problem were 2 important factors that contributed to the important diffusion of the HIV infection among Spanish injection drug users. Lessons can be learned that may be of great interest in countries or territories facing similar challenges now and in the future.

Leishmania in discarded syringes from intravenous drug users.

Needle sharing by intravenous drug users (IVDUs) has been proposed as providing an alternative, artificial, and anthroponotic cycle for leishmania transmission. We looked for parasites in syringes discarded by IVDUs using two different PCR techniques. Leishmania spp were detected in 65 (52%) of 125 syringes collected in southern Madrid, Spain, in 1998, and in 52 (34%) of 154 collected in southwestern Madrid in 2000-01. We found shared restriction fragment length polymorphisms in 12 of 65 positive samples tested, suggesting that syringe sharing can indeed promote the spread of leishmania clones among IVDUs.

[Are we diagnosing people infected with HIV in time?]. / Estamos diagnosticando a tiempo a las personas infectadas por el VIH?

OBJECTIVE: To describe the number of AIDS cases who did not know of their HIV infection until they developed AIDS, and the factors relating to this situation. DESIGN: Descriptive study of data of the National AIDS Register.Setting. Spain.Patients. Cases of AIDS in the over-14s diagnosed between 1997 and 1999. RESULTS: Of the 6910 cases of AIDS studied, 35% (n = 2421) knew that they were HIV-positive at the same time as they were diagnosed with AIDS (in the same month or the previous one). The multi-variate analysis showed that this situation occurred less commonly in women (OR = 0.61; 95% CI, 0.53-0.71), in cases diagnosed in prison (OR = 0.19; 95% CI, 0.13-0.27), in cases diagnosed early (OR = 0.49; 95% CI, 0.41-0.60) and among residents in provinces with AIDS rates higher than the Spanish average (OR = 0.88; 95% CI, 0.78-0.99). Ignorance of HIV infection until the AIDS diagnosis was associated to ages of under 25 and over 34, homo/bisexual transmission (OR = 3.20; 95% CI, 2.69-3.80) and heterosexual transmission (OR = 4.88; 95% CI, 4.21-5.65) compared with intravenous drug users, and to the person coming from countries other than Spain, both developed (OR = 2.78; 95% CI, 1.89-4.08) and under-developed (OR = 1.85; 95% CI, 1.26-2.72) countries. CONCLUSIONS: A considerable number of people diagnosed with AIDS were unaware of their HIV infection, especially among people who had never injected drugs. HIV needs to be diagnosed earlier so as to improve prevention and treatments.

¿Estamos diagnosticando a tiempo a las personas infectadas por el VIH? / Are we diagnosing people infected by hiv in time?

Objetivo. Describir la proporción de casos de sida que no conocían su infección por el VIH hasta que desarrollaron sida y los factores asociados a esta situación. Diseño. Estudio descriptivo de datos del Registro Nacional de Sida. Emplazamiento. España. Pacientes. Casos de sida mayores de 14 años diagnosticados entre 1997 y 1999.Resultados. De los 6.910 casos de sida estudiados, un 35 por ciento (n = 2.421) supo que estaba infectado por el VIH coincidiendo con el diagnóstico de sida (en el mismo mes o en el anterior). En el análisis multivariante esta situación fue menos frecuente en mujeres (OR, 0,61; IC del 95 por ciento, 0,53-0,71); en los casos diagnosticados en prisión (OR, 0,19; IC del 95 por ciento, 0,13-0,27) o en los que habían estado presos con anterioridad (OR, 0,49; IC del 95 por ciento, 0,41-0,60) frente al resto, y los residentes en provincias con tasas de sida mayores que la española (OR, 0,88; IC del 95 por ciento, 0,78-0,99). Por el contrario, el desconocimiento de su infección por el VIH hasta el diagnóstico de sida se asoció a la edad menor de 25 o mayor de 34 años, a las categorías de transmisión homo/bisexual (OR, 3,20; IC del 95 por ciento, 2,69-3,80) y heterosexual (OR, 4,88; IC del 95 por ciento, 4,215,65) en comparación con los usuarios de drogas por vía parenteral, y a la procedencia de países distintos de España, tanto desarrollados (OR, 2,78; IC del 95 por ciento, 1,894,08) como en desarrollo (OR, 1,85; IC del 95 por ciento, 1,26-2,72).Conclusiones. Una proporción importante de las personas diagnosticadas de sida desconocía su infección por el VIH, especialmente aquellas que nunca habían usado drogas por vía patenteral. Se debe mejorar el diagnóstico precoz del VIH para conseguir un mayor impacto de la prevención y de los tratamientos (AU)

Seroprevalence of HIV and HTLV in a representative sample of the Spanish population.

HIV and HTLV seroprevalence was determined by means of unlinked anonymous testing of 2144 sera, originally obtained from primary care patients by representative sampling of the Spanish population aged 15-39 years in 1996. HIV-1 seroprevalence was 4.3 per 1000 population in the 15-39 years age group [95% confidence interval (CI), 1.5-10.7] and 5.6 per 1000 (95% CI, 1.8-15.3) in the 20-39 years age group. Seroprevalence proved higher in males and urban residents. No antibodies to HIV-2 and HTLV-I were detected in any of the sera studied. However, presence of antibodies to HTLV-II was confirmed in one serum sample, while HTLV seroreactivity, though detected in another, could not be typed. The two HTLV-positive results equated to a seroprevalence of 1.9 per 1000 in the 20-39 years age group (95% CI, 0.3-8.6). HIV-I seroprevalence was consistent with previous estimates yielded by back-calculation. The level of HTLV seroprevalence found suggests endemicity.

Características sociales y conductas de riesgo para el VIH en un grupo de travestis y transexuales masculinos que ejercen la prostitución en la calle / Social characteristics and risk behaviour for HIV infection in male transgender street prostitutes

Objetivo: Describir las condiciones de vida y de trabajo, las prácticas asociadas a la transmisión del VIH, la cobertura y los resultados autoinformados de la prueba de VIH, en un grupo de travestis y transexuales que ejercen la prostitución en la calle. Métodos: Estudio descriptivo de serie de casos de travestis y transexuales masculinos que ejercían la prostitución en la calle, en Madrid, y que fueron atendidas por la unidad móvil de un programa de reducción de daños en 1998. Se recogieron datos sobre características sociodemográficas, condiciones de trabajo, consumo de drogas ilegales, conductas de riesgo sexual y estado serológico frente al VIH autoinformado. Resultados: Se entrevistaron 132 travestis y transexuales masculinos, de las cuales 56 por ciento eran españolas. La mediana de edad era de 30 años. El 50 por ciento tenía un nivel de estudios de EGB o inferior. El 11 por ciento se había inyectado drogas ilegales alguna vez. La mediana de años de prostitución era de 8 años y el 66 por ciento había ejercido sólo en la calle. En el último mes, todas dijeron utilizar el preservativo en las prácticas anales insertivas con los clientes, el 98 por ciento en las anales receptivas y el 49 por ciento lo utilizaron siempre con la pareja en el último año. El 39 por ciento tuvieron algún accidente con el preservativo en el último mes. El 73 por ciento se había realizado la prueba del VIH, siendo positivas el 22 por ciento (el 16 por ciento entre las que nunca se habían inyectado drogas y el 58 por ciento entre las que se habían inyectado alguna vez).Conclusiones: En travestis y transexuales que ejercen la prostitución la prevalencia de VIH es elevada, incluso entre las no inyectoras. El uso del preservativo en el medio laboral es alto, pero también su accidentabilidad. Los programas de prevención del VIH en prostitución deberían adaptarse más específicamente a los distintos grupos que la ejercen (AU)

[High-risk sex behavior and HIV prevalence among gay and bisexual men in the community of Madrid]. / Conductas sexuales de riesgo y prevalencia de infección por VIH en hombres con prácticas homosexuales y bisexuales en la Comunidad de Madrid.

BACKGROUND: To analyze high-risk sexual behavior as regards HIV, the use of preventive measures and the patient-reported prevalence of HIV infections among males belonging to one of the leading homosexual associations in the Region of Madrid. METHODS: Cross-sectional study conducted in 1997-1998 by way of mailed anonymous questionnaires. An analysis is made of the sociodemographic characteristics, how often condoms are used for different types of sexual intercourse with regular or casual partners, patient-reported prevalence of HIV and other related aspects. RESULTS: 157 questionnaires were returned by gay/bisexual males. These subjects averaged 32 years of age, 85% having a high school or college education, over the past 3 months, 56% had had intercourse with more than one man; 70.6% practiced insertive anal intercourse with a regular partner and 57.4% with casual partners, solely 32.5% and 61.1% of whom always used a condom. 69.7% had receptive anal intercourse with a regular partner and 39.4% with casual partners, 35.5% and 78.4% of whom respectively always used a condom. 86.6% had oral-genital intercourse, less than 10% having always used a condom. 137 were aware of their serological condition, and 15.2% were HIV positive. 10% had had some STD at some point during the previous year. CONCLUSIONS: A major percentage of those surveyed were involved in high-risk practices (several partners and unprotected high-risk sexual intercourse) which, in conjunction with the major prevalence of infection, can be said to be the same as a major seroconversion rate.

[Social characteristics and risk behaviors for HIV in a group of transvestites and male transsexuals engaging in street prostitution]. / Características sociales y conductas de riesgo para el VIH en un grupo de travestis y transexuales masculinos que ejercen la prostitución en la calle.

OBJECTIVE: To describe life and work conditions, practices associated with HIV transmission, self-informed HIV status and HIV test coverage in a group of male transgender street prostitutes. METHODS: Case descriptive study of male transgender street prostitutes who attended a mobile unit of a harm reduction programme in 1998 in Madrid, Spain Information on sociodemographic characteristics, work conditions, illegal drug use, sexual behaviours and self-informed HIV status was collected. RESULTS: 132 male transgenders were interviewed, of which 56% were Spanish. Median age was 30 years. 50% had primary school education or less. 11% had injected drugs sometime in their lives. Median time in prostitution was 8 years and 66% had worked only in the streets. In the last month, all of them said to use condoms in insertive anal sex with clients, 98% in receptive sex and 49% always used it with their partners in the previous year. 39% referred accidents with condoms within the previous month. 73% had had an HIV test, of which 22% said to be HIV positive (16% in those who had never injected drugs and 58% in the ones who had). CONCLUSIONS: HIV seroprevalence in male transgender street prostitutes is high, even in non-intravenous drug users. They nearly always use condoms with clients but have a high level of accidents. HIV prevention programmes in prostitution should be more specifically adapted to the different groups of commercial sex workers.

[Trend of HIV seroprevalence among mothers of new-born infants from 1996 to 1999]. / Evolución de la seroprevalencia del virus de la inmunodeficiencia humana en madres de recién nacidos entre 1996 y 1999.

BACKGROUND: To analyze the evolution of HIV prevalence in mothers of Spanish new-borns. SUBJECTS AND METHOD: Unlinked anonymous testing of HIV in blood spots for detection of metabolic diseases of all new-borns in 1996-1999 in seven regions: Baleares, Canarias, Castilla-La Mancha, Castilla y León, Galicia, Melilla and Murcia. HIV antibody detection was done with ELISA and confirmation with a immunoblot. RESULTS: The prevalence of HIV antibodies was 0.99 per 1,000 in 1996, 1.29 in 1997, 1.42 in 1998 and 1.54 in 1999. There was an upward trend both in the global sample (p = 0.0015) and in those from Canarias (p < 0.0001) and Castilla y León (p = 0.0389). The prevalence of HIV-1 for the whole period was 1.31 per 1.000 and of 1.13 per 100.000 for HIV-2. CONCLUSIONS: There is a need to offer systematic counselling and HIV testing to all pregnant women.

[Preventing HIV infection: an exercise in evaluating scientific evidence in public health]. / La prevención de la infección por VIH: un ejercicio de evaluación de las evidencias científicas en salud pública.

BACKGROUND: Evidence-based medicine (EBM) analyses scientific evidence for the efficacy/effectiveness of health interventions. It aims to identify and implement available interventions that have proved to be the best. This concept is now soundly established for clinical interventions, but just breaking for prevention, particularly when--as in HIV infection--transmission is associated to private behaviour. METHODS: A search for studies evaluating the effects of HIV prevention interventions. All studies were critically evaluated. RESULTS: Relevant evidence for the effects of the main specific HIV prevention interventions is reviewed, according to transmission group and study design, focusing on its methodological strength and weakness, and paying special attention to experimental research. CONCLUSIONS: A wider debate on scientific evidence for public health interventions is proposed, trying to promote feasible and efficient EBM methods in HIV prevention research.

[Anti-tuberculosis drug consumption as an indicator of the epidemiological situation of tuberculosis in Spain]. / El consumo de fármacos antituberculosos como indicador de la situación epidemiológica de la tuberculosis en España.

OBJECTIVES: To describe anti-tuberculosis drug consumption in Spain for the period, 1985-1995, compare the associated time trend and geographical pattern against case reports of tuberculosis (TB), and estimate the number of persons undergoing anti-tuberculosis therapy in 1995. METHODS: The official Drug Database was used to ascertain consumption of anti-tuberculosis drugs (isoniazid, rifampicin, pyrazinamide and ethambutol) in Spain during the period, 1985-1995. The technical units of measurement used for comparison purposes were daily defined dose (DDD) and DDD rate per day per 100,000 population. Annual trends and geographical patterns of consumption were plotted. The respective numbers of persons treated in 1995 with each of the four drugs were first estimated and then compared against TB case reports. RESULTS: There was an overall decline in the consumption of isoniazid, rifampicin and ethambutol over the period, 1985-1995, though the former two registered rises in 1991 and 1992. Pyrazinamide consumption showed growth throughout the study period. The highest 1995 consumption rates were registered by Galicia, Cantabria, Asturias, the Basque Country, Ceuta and Melilla, and the lowest by the Canary Islands and Navarre. Comparisons run against TB case reports revealed a greater degree of underreporting in certain provinces. In 1995, approximately 18,858 persons (48 per 100,000 population) must be assumed to have undergone pyrazinamide therapy in Spain, indicating that the reported TB rate of 22 per 100,000 population could well represent underreporting in excess of 100%. CONCLUSIONS: The trend in anti-tuberculosis drug consumption reflects shifts in treatment guidelines and is compatible with a rise in TB incidence in recent years. Major underreporting of TB marked by wide inter-regional and -provincial differences was in evidence. Pyrazinamide consumption is probably the best indicator for estimating minimum TB incidence.

Pulmonary and extrapulmonary tuberculosis at AIDS diagnosis in Spain: epidemiological differences and implications for control.

OBJECTIVE: To ascertain the differential factors associated with pulmonary versus extrapulmonary tuberculosis (TB) at AIDS diagnosis in Spain. DESIGN: Analysis of AIDS surveillance data. METHODS: Data about AIDS patients, aged 12 years and over, diagnosed in 1995 were taken from the Spanish AIDS Register. The respective proportions of cases presenting with pulmonary and extrapulmonary TB at AIDS diagnosis were analysed by gender, age, HIV transmission category, prison record, province, country of origin and CD4+ lymphocyte count. A multivariate analysis was carried out using logistic regression analysis. RESULTS: Of 6161 AIDS cases analysed, 20.1% presented with pulmonary TB and 20.4% with extrapulmonary TB. Overall, TB showed association with men, age under 30 years, injecting drug users (IDU), cases of heterosexual HIV transmission, and concurrent or past stay in prison. Frequency of TB proved no different among foreign-born patients. Pulmonary and extrapulmonary TB showed a similar distribution for most of the variables. Current prison inmates registered a high risk of pulmonary TB [adjusted odds ratio (OR), 4.2; 99% confidence interval (CI), 3.1-5.8] compared with patients without prison record, and ex-prison inmates registered an intermediate risk (OR, 2.3; 99% CI, 1.8-3.0). Among patients with TB at AIDS diagnosis, pulmonary TB was associated with subjects currently in prison (OR, 2.1; 99% CI, 1.5-3.0) and injecting drug use (OR, 1.5; 99% CI, 1.0-2.4). Pulmonary TB presented with higher CD4+ lymphocyte counts than extrapulmonary TB (P < 0.001). CONCLUSIONS: The results suggest the importance that recent transmission of TB may be having among young adults, IDU and prison inmates in particular, and calls for a review of control strategies.

Impact of human immunodeficiency virus infection on mortality among young men and women in Spain.

BACKGROUND: This paper describes the impact of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) mortality among young adults in Spain with specific reference to other causes of death. METHODS: Based on death registration data for the period 1980-1993, HIV/AIDS was compared against all other causes of death by gender, using specific rates in the 25-44 age group and standardized rates for potential years of life lost (PYLL). RESULTS: In 1993, HIV/AIDS was the leading cause of death among men aged 25-44 years (21.8% of all deaths) and the second leading cause of death among women (14.9%), exceeded only by cancer. Since 1982, the trend in the overall standardized mortality rate for men in the 25-44 age group has been reversed, showing a progressive increase. Similarly, since 1984 there has been a halt in the decline in female mortality. For both sexes, maintenance of these trends in mortality was largely ascribable to the effect of HIV/AIDS deaths which registered a marked rise, a rise far sharper than that witnessed for variations in all other causes studied. In 1993, the adjusted PYLL rate for HIV/AIDS for ages 1-70 rose to 615 per 100,000 population in men and 156 in women. These values accounted for 9.2% and 5.8% of PYLL for all causes, thereby ranking HIV/AIDS behind motor vehicle accidents as the second leading cause of premature death in men, and behind motor vehicle accidents and breast cancer as the third leading cause in women. For both sexes, the rise in the PYLL rate for HIV/AIDS from 1992 to 1993 proved far greater than that for all other causes of death. CONCLUSION: In Spain, HIV/AIDS has become the leading cause of death among young adults and is counteracting improvements in mortality due to other causes. It should therefore be regarded as a priority public health problem.

[Changes in the spectrum of AIDS-defining diseases in Spain]. / Cambios en el espectro de enfermedades diagnósticas de sida en España.

BACKGROUND: Since the late 1980s the use of prophylaxis against several AIDS-diagnostic diseases has been recommended. In order to detect the impact of these measures we analyzed the shifts in the spectrum of AIDS-diagnostic diseases in Spain. PATIENTS AND METHODS: AIDS cases (CDC-1987) among patients over 12 years of age diagnosed in Spain during the period 1988-1993 were studied. Number and percentage of annual AIDS cases corresponding to each reported AIDS-diagnostic disease were analyzed. Annual percentage trends were assessed by means of chi 2 trend test and logistic regression adjusting for possible changes in distribution by transmission category, sex, and age-group. RESULTS: Annual incidence in most of AIDS-defining diseases rose over the period 1988-1993, although the proportion of cases in which the respective conditions appeared as AIDS-diagnostic diseases exhibited declining trends (p < 0.05) in: invasive candidiasis, Herpes simplex virus infection, isosporidiasis, Pneumocystis carinii pneumonia, extrapulmonary tuberculosis, Salmonella (non-typhoid) septicemia, HIV encephalopathy and wasting syndrome. Increases were observed in the proportion of Mycobacterium avium complex disease and progressive multifocal leukoencephalopathy (p < 0.05). CONCLUSIONS: Some shifts in the spectrum of diseases are noted, which could be due to primary prophylaxis. Efforts should be targeted to improve coverage and compliance, and to develop guidelines of prophylaxis against the remaining diseases.

[The pattern of AIDS-indicative diseases in adults and adolescents in Spain, 1988-1993]. / Patrón de las enfermedades diagnósticas de sida en adultos y adolescentes en España, 1988-1993.

BACKGROUND: The pattern of AIDS-defining diseases in adults and adolescents in Spain from 1988-1993 has been described. METHODS: Twenty-two thousand two hundred thirty-nine cases (CDC, 1987) diagnosed in patients over the age of 12 years from 1988 to 1993 were taken from the National AIDS Registry. The percentage of cases which each of the indicative diseases on registry was evaluated and the differences based on the category of HIV transmission, sex and age were identified. RESULTS: The most frequent AIDS indicative diseases were extrapulmonary tuberculosis (29.7%), Pneumocystis carinii (28.2%) and invasive candidiasis (24.8%). The percentage of cases with extrapulmonary tuberculosis was higher among the intravenous drug users and Kaposi's sarcoma, non Hodgkin's lymphoma (NHL) and cytomegalovirus disease (CMV) among the homosexual males. The disease pattern has demonstrated some differences between sexes on adjustment by transmission category and age. Herpes simplex disease, retinitis by CMV and cerebral toxoplasmosis appeared were more frequent in women and extrapulmonary tuberculosis and NHL in males. On adjustment by transmission category and sex, extrapulmonary tuberculosis was observed with a higher frequency in patients under the age of 30 years while wasting syndrome and progressive multifocal leukoencephalopathy were more often observed in those over the age of 30 years. CONCLUSIONS: The category of HIV transmission plays and important role in the pattern of AIDS-defining diseases. Sex and age also play a role although to in a lesser degree.