J. A. Caylà

Smoking in tuberculosis patients increases the risk of infection in their contacts

OBJECTIVE To determine the risk of latent tuberculous infection (LTBI) among contacts of smokers with tuberculosis (TB). METHODS A study was conducted to determine the prevalence of LTBI among contacts of TB cases aged >14 years in Catalonia, Spain. A survey was carried out for each TB case and their contacts. LTBI was diagnosed using the tuberculin skin test (≥5 mm). The risk of LTBI associated with smoking was determined by multi-variate logistic regression analysis, with adjusted odds ratio (aOR) and their 95% confidence intervals (CI). RESULTS The smoking prevalence among TB cases was 40.7% (439/1079). The prevalence of LTBI among their contacts was 29.7% (2281/7673). It was higher among contacts of smoking index cases (35.3%) than among those of non-smokers (25.7%). Smoking was independently associated with an increased risk of LTBI among contacts (aOR 1.5, 95%CI 1.3-1.7), and was estimated to be responsible for 12.8% of infections. CONCLUSIONS Index case smoking increases the risk of LTBI and should be systematically investigated. A reduction in smoking could lower the risk of infection substantially.

Características Diferenciales del Sida en Inmigrantes Extranjeros

Objetivo: Determinar las caracteristicas diferenciales del sida en inmigrantes extranjeros residentes en Barcelona. Metodos: Estudio transversal de los casos de sida en mayores de 15 anos, residentes en Barcelona, incluidos en el registro de la ciudad entre el 1-1-1988 y el 31-12-1998. Se describen caracteristicas diferenciales de los inmigrantes, y se calculan Odds ratio (OR) ajustados con intervalos de confianza del 95% (IC) mediante regresion logistica. Se realizo un analisis de supervivencia. Resultados: De los 4.663 pacientes, 5% eran inmigrantes extranjeros. En el 33% de ellos el diagnostico de sida se hizo cuando llevaban mas de 10 anos de residencia en Espana. En el analisis multivariado, los casos de sida en inmigrantes extranjeros se diferenciaban de los autoctonos en las siguientes variables: sexo (OR [hombre]: 1,70; CI:1,10-2,64), lugar de residencia (OR [distrito I]: 2,07, IC: 1,50-2,87) y modo de transmision (OR [no uso de drogas por via parenteral]: 4,08; IC: 2,77-5,99). No se objetivaron diferencias significativas en el analisis de supervivencia. Conclusiones: El porcentaje de inmigrantes extranjeros entre los casos de sida es bajo, manteniendose estable durante el periodo estudiado. Los casos de sida en inmigrantes extranjeros se diferenciaban de los autoctonos porque eran con mas frecuencia hombres, residian en las zonas mas deprimidas socioeconomicamente de la ciudad, y porque con menor frecuencia eran usuarios de drogas por via parenteral.

Prevalence of latent tuberculosis infection in inmates recently incarcerated in a men's prison in Barcelona.

OBJECTIVE To study the prevalence of latent tuberculosis infection (LTBI) in prisoners. METHODS Among inmates admitted to a mens preventive detention prison in Barcelona during May-June 2009, without a previous positive tuberculin skin test (TST), a ≥ 10 mm TST was considered positive (5 mm in human immunodeficiency virus [HIV] infected persons). A multivariate logistic regression was performed, calculating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS A total of 221 individuals were included. The average age was 33.5 years (± 8.9 SD); 61.6% were foreigners and 45.2% were heroine and/or cocaine users; 40.3% had LTBI. The infection was associated with age >40 years (OR 3.10, 95%CI 1.51-6.35) and having been born in Eastern Europe (OR 4.3, 95%CI 1.4-12.8), North Africa (OR 2.2, 95%CI 1.01-4.7), sub-Saharan Africa (OR 7.6, 95%CI 1.3-44) or Latin America (OR 3.8, 95%CI 1.5-9.3). Subjects infected with HIV had a lower risk of a positive TST (OR 0.22, 95%CI 0.04-1.07). Only 31 (14%) did not present any of these risk factors, and 8 (25.8%) had LTBI. CONCLUSIONS The prevalence of LTBI was very high in this study, and systematic screening of all inmates at the time of entry into the prison is therefore recommended. Excluding those who do not fall in any of the high-risk prevalence groups from the evaluation complicates the screening and is not very effective.

Retraso diagnóstico de la infección por VIH

El retraso en el diagnostico de la infeccion por el VIH es frecuente en nuestro medio y se asocia a un mayor riesgo de progresion, a una menor recuperacion inmunologica, mayor toxicidad y mayor probabilidad de transmision. En este estudio revisamos el impacto de las diferentes definiciones, el impacto en terminos de mortalidad y morbilidad, los factores asociados y las implicaciones economicas. Asi como las estrategias para incrementar el diagnostico.

Delay in diagnosis of HIV infection

Late presentation of HIV is common. It has been associated with greater risk of AIDS, death, lower immunological response, greater toxicity and a higher probability of transmission. In this study we review the impact of different definitions in terms of mortality and morbidity, associated factors, economic implications, as well as strategies for increasing diagnosis.