High Proportion of Blood-Borne and Sexually Transmitted Infections Among People Deprived of Liberty in a Central Male Prison in Thailand: A Cross-Sectional Study 2018-2019.

Data are lacking or outdated on burden of HIV, viral hepatitis infection, and sexually transmitted infections such as syphilis among people deprived of liberty in the Asia-Pacific region. We aimed to evaluate the proportion of viral hepatitis B (HBV), hepatitis C (HCV), HIV, and syphilis infections, and factors associated with HCV, HBV, and HIV infection in a central male prison. A cross-sectional study was performed among 1,028 people deprived of liberty from a central male prison in Bangkok, Thailand. People deprived of liberty were screened for HIV, HBV, HCV, and syphilis infections during 2018-2019. HBV and HCV were defined as positive hepatitis B surface antigen and positive anti-HCV antibody, respectively. Proportions (95% confidence interval [CI]) of infections were calculated based on the binomial distribution. HBV proportion was reported for different age groups. Risk factors associated with HCV infections were evaluated by logistic regression model. The median age was 38 (interquartile range, 32-50) years, and 6.9% reported use of injection drugs. The proportion of HIV, HBV, anti-HCV, HCV RNA, and syphilis was 2.9% (95% CI, 1.9-4.1), 6.4% (5-8.1), 5.9% (4.6-7.6), 4.2% (3-5.6), and 4.8% (3.5-6.3), respectively. One (0.1%), 7 (0.6%), and 2 (3%) were co-infected with HIV/HBV, HIV/HCV, and HDV/HBV, respectively. HBV proportion differed across age groups: 3.7% in <30 years, 7% in 31-40 years, 9.7% in 41-50 years, and 5.5% in >50 years. Factors associated with HCV infection were older age, lower education level, previous incarceration, and injection drug use. In multivariable models, older age was associated with HBV infection, and men having sex with men was associated with HIV infection. The proportion of blood-borne infections was higher among males than among the general population. HBV vaccination, routine HCV screening, and treatment with pan-genotypic direct-acting antivirals with minimal specialist requirements should be implemented in Thai prisons.

Nutritional Status and its Impact on Clinical Outcomes for Patients Admitted to Hospital with Cirrhosis.

BACKGROUND: In patients with cirrhosis, nutritional status is an important predictor of clinical outcomes that can be assessed in clinical practice using conventional methods. Previous studies have shown that malnutrition is associated with increased morbidity and mortality in patients with cirrhosis. However, there have been very few reports from Southeast Asia. OBJECTIVE: To determine the prevalence of malnutrition in patients with cirrhosis who are admitted to hospital and to assess its correlation with mortality, complications, length of stay, and total cost of hospitalization. MATERIAL AND METHOD: This prospective non-interventional study included 60 consecutive patients with cirrhosis admitted to Rajavithi Hospital, Bangkok, Thailand, from August 2013 to February 2014. Baseline demographic and clinical data during their hospitalizations were collected prospectively. Nutritional status was assessed by subjective global assessment (SGA) and anthropometry (body mass index (BMI) and mid-arm circumference (MAC)). Malnutrition was defined as SGA class B/ C and MAC of < 5th percentile of the age- and gender-matched reference population. RESULTS: Of the 60 patients, 70% were male. The most common causes of cirrhosis were alcohol (50%) and hepatitis C infection (35%). Most patients were classified as Child-Pugh class B (41.7%) or C (36.7%). The mortality rate was 26.7%, and the most common complications were infections (60%) and renal failure (43.3%). The median length of stay in hospital was 8.5 (1-51) days, with a median cost of 1,163 (183-9,969) US dollars. The prevalence of malnutrition varied between 18% and 92% depending on the assessment method employed: 18% were considered malnourished when assessed by BMI, 63% by MAC, 78% by serum albumin, 65% by absolute lymphocyte count, and 92% by SGA. Patients with malnutrition showed a trend toward increased mortality, complications, length of hospital stay and cost; however, the differences were not statistically significant. Significant predictors of mortality included Child-Pugh class B (16% mortality) and C (50% mortality), severe malnutrition as assessed by SGA (35% mortality), presence of ascites (relative risk, RR: 2.3), hepatic encephalopathy (RR: 2.5), hepatorenal syndrome (RR: 4.1) and renal failure (RR: 3.3). CONCLUSION: Malnutrition is common in hospitalized patients with cirrhosis, and patients with malnutrition showed a trend toward increased complications and mortality. Severe malnutrition, as identified by SGA, and advanced cirrhosis were predictors of in-hospital mortality.