Real-life experience of hepatitis C treatment in a Spanish prison.

OBJECTIVE: Hepatitis C virus (HCV) infection is a major public health problem that causes multiple comorbidities. People in prisons who inject intravenous drugs are at increased risk of HCV infection, and HCV infection is 15-fold more prevalent among prisoners compared with the community. The objective of this study was to analyse the clinical and epidemiological characteristics of residents of a Spanish prison with HCV infection who received antiviral treatment. METHODS: An observational, descriptive and retrospective study was performed. All patients with HCV infection diagnosed or followed up in an Infectious Diseases attached to a penitentiary were included in this study. RESULTS: Of 81 patients analysed, sixty-nine (83.1%) patients were male. The mean age was 50.1 (SD8.8) years, and 70% of the inmates had a history of injection drug use. Coinfection with HIV was detected in 30%. In up to 25% of the sample, there were data on chronic liver disease in the degree of liver cirrhosis. The diagnosis of HCV infection had been made more than 15 years earlier in 28% of those studied. Decompensations from liver disease, hepatocellular carcinoma, or hospital admissions were exceptional. Most of the inmates with HCV accepted treatment, and approximately 94% of the patients who completed treatment achieved a sustained virological response without interactions or complications of interest. CONCLUSIONS: The availability of direct-acting antivirals and their exceptional side effects constitute an opportunity to reduce the burden of HCV infection in Spain, particularly in these high-risk populations.

Varicocele, leucocitospermia y su impacto en la fragmentación del ADN espermático / Varicocele, leukocytospermia and its impact on the spermatic DNA fragmentation

Introducción: El estrés oxidativo en una de las causas que puede explicar la presencia de unos niveles elevados de daño en la molécula de ADN. En 2 cuadros clínicos que afectan a la línea germinal del varón, la leucocitospermia y el varicocele, se reconoce la incidencia de niveles elevados de estrés oxidativo. Objetivos: En el presente trabajo se compararon 2 cuadros clínicos, varicocele y leucocitospermia, con objeto de comprobar si existe una intensidad diferencial de la fragmentación del ADN espermático. Material y métodos: Se incluyeron como controles externos donantes de espermatozoides con fertilidad probada y pacientes con factor masculino no determinado. A diferencia de otros estudios de fragmentación del ADN espermático, en este caso, se consideraron tanto los niveles de fragmentación absolutos (SDF), como la proporción de espermatozoides degradados en el total de fragmentados (índice de degradación [ID]) de acuerdo con la información obtenida tras la aplicación del test Halosperm. Resultados: Se demostró un aumento muy significativo de la fragmentación del ADN espermático en las muestras seminales de pacientes con varicocele y con leucocitospermia. Los pacientes con varicocele mostraron un ID 2 veces mayor que el observado en pacientes con factor masculino no determinado o en pacientes con leucocitospermia, y 6 veces mayor que en los donantes. Discusión: La presencia de unos niveles de estrés oxidativo elevados podría ser una explicación asumible para justificar los altos niveles de daño observado en los espermatozoides de los pacientes tanto con varicocele como con leucocitospermia, pero probablemente estos niveles sean más elevados en el caso del varicocele ya que los niveles de degradación del ADN espermático son superiores a los observados en cuadros de leucocitospermia... (AU)

Introduction: High levels of oxidative stress can explain the presence of high levels of damage in the DNA molecule. The impact of high levels of oxidative stress in 2 clinical circumstances affecting the male germ line has been well established: leukocytospermia and varicocele. Objective: To assess sperm DNA fragmentation in patients diagnosed with leukocytospermic and varicocele. Material and methods: Leukocytospermic and varicocele patients and external controls (donors with proven fertility and patients with undetermined male factor). Unlike in other studies of sperm DNA fragmentation, in this study both the proportion of damaged sperm after using the sperm chromatin dispersion test (Halosperm), and the proportion of degraded sperm in total fragmented (degradation index [DI]) were taken into consideration. Results: A highly significant increase in sperm DNA fragmentation has been observed in semen samples of patients with varicocele and leukocytospermia. Varicocele patients showed a DI twice as high as that observed in patients with undetermined male factor or in patients with leukocytospermia, and 6 times as high as that observed in the donors. Discussion: The presence of high levels of oxidative stress could be an acceptable explanation for the high levels of damage observed in the spermatozoa of varicocele patients or with leukocytospermia; the level of sperm degradation is higher in the case of varicocele than those observed in leukocytospermia. Conclusions: SDF levels in patients with leukocytospermia and varicocele are significantly higher than those observed in donors or men with undetermined male factor. The DI in sperm samples from patients with varicocele is the highest of all the samples studied in this analysis. The routine determination of the DI may have a practical value, by guiding the patient towards the potential diagnosis of varicocele, even when this is subclinical (AU)