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Biomedical subjects

J Casabona

Publications and source records attributed to J Casabona.

At least 19 recordsLinked to original sources
PubMed2004

Evaluation of a commercial enzyme immunoassay for HIV screening in urine.

A cross-sectional study was conducted to evaluate the utility of a commercial enzyme immunoassay (EIA) as a screening test for detecting HIV-1 antibody in urine in a population at risk for HIV infection in Catalonia, Spain. Paired urine and serum samples were collected consecutively from 99 patients who attended two drug-dependency treatment centres and 151 patients who attended a sexually transmitted diseases (STD) clinic in Barcelona. Antibodies against HIV in urine samples were detected using the Calypte HIV-1 Urine EIA (Calypte Biomedical Corporation, Berkeley, CA, USA) and confirmed by urine-based Western blot (WB) analysis. Sera were analysed using Bioelisa HIV-1+2 EIA (Biokit Laboratories, Barcelona, Spain), and the results were verified using serum-based WB analysis. Results of both urine and serum testing were available for 246 of 250 participants. For 52 individuals the results of both urine and serum testing were positive and for five the results were discordant (2 with urine-negative/serum-positive results and 3 with urine-positive/serum-negative results). The respective sensitivity and specificity values obtained for the urine EIA were 100% and 96.2% for intravenous drug users (IDUs) and 80% and 99.3% for persons attending the STD clinic. According to the 1997 UNAIDS/WHO strategy I recommendations, these values are acceptable for surveillance purposes, particularly in populations with a high prevalence of HIV infection.

Cross-Sectional Studies↗
PubMed2004

Proposed recommendations for the management of HIV post-exposure prophylaxis after sexual, injecting drug or other exposures in Europe.

Post-exposure prophylaxis (PEP) is the standard of care for a healthcare worker (HCW) accidentally exposed to an HIV infected source person (occupational exposure), but this is not the case for non-occupational exposures. Very few national guidelines exist for the management of non-occupational exposures to HIV in Europe, contrarily to the occupational ones. The administration of non-occupational post-exposure prophylaxis (NONOPEP) for HIV may be justified by: a biological plausibility, the effectiveness of PEP in animal studies and occupational exposures in humans, efficacy in the prevention of mother to child HIV transmission, and cost effectiveness studies. These evidences, the similar risk of HIV transmission for certain non-occupational exposures to occupational ones, and the conflicting information about attitudes and practices among physicians on NONOPEP led to the proposal of these European recommendations. Participant members of the European project on HIV NONOPEP, funded by the European Commission, and acknowledged as experts in bloodborne pathogen transmission and prevention, met from December 2000 to December 2002 at three formal meetings and a two day workshop for a literature review on risk exposure assessment and the development of the European recommendations for the management of HIV NONOPEP. NONOPEP is recommended in unprotected receptive anal sex and needle or syringe exchange when the source person is known as HIV positive or from a population group with high HIV prevalence. Any combination of drugs available for HIV infected patients can be used as PEP and the simplest and least toxic regimens are to be preferred. PEP should be given within 72 hours from the time of exposure, starting as early as possible and lasting four weeks. All patients should receive medical evaluation including HIV antibody tests, drug toxicity monitoring and counseling periodically for at least 6 months after the exposure. NONOPEP seems to be a both feasible and frequent clinical practice in Europe. Recommendations for its management have been achieved by consensus, but some remain controversial, and they should be updated periodically. NONOPEP should never be considered as a primary prevention strategy and the final decision for prescription must be made on the basis of the patient-physician relationship. Finally, a surveillance system for these cases will be useful to monitor NONOPEP practices in Europe.

Anti-HIV Agents↗
PubMed2001

Prevalence and distribution of HHV-8 in different subpopulations, with and without HIV infection, in Spain.

OBJECTIVE: To estimate the seroprevalence of HHV-8 in several Spanish subpopulations with different risk levels of acquiring HIV-1 infection and from different geographical regions. DESIGN: Cross-sectional seroprevalence study. METHODS: A total of 1699 serum samples from blood donors (613), children under the age of 12 years (100), injecting drug users (IDU) (382), heterosexuals attending a sexually transmitted disease (STD) clinic (273) and homosexual men attending a STD clinic or a HIV-based hospital unit (331) were analysed for anti-HHV-8 antibodies. The presence of antibodies against HHV-8 was tested with an indirect immunofluorescence assay (IFA). A subsample of HHV-8-positive samples was also tested for antibody titre against HHV-8. RESULTS: The overall seroprevalence of antibodies against HHV-8 for the blood donor population was 6.5% (7.0% in Andalusia, 8.0% in Catalonia and 4.5% in the Basque Country). None of the children tested positive for HHV-8. The HHV-8 prevalence was 86.7% in HIV-positive homosexual men and 28.0% in HIV-negative homosexual men (P < 0.001). Of heterosexual men attending STD clinics, 17.2% tested positive for HHV-8; 11.5% of IDU tested positive for HHV-8. HHV-8 antibody titres by groups parallel the distribution of HHV-8 prevalence. No association between HHV-8 antibody titres and CD4 cell count or HIV viral load was identified. CONCLUSIONS: The HHV-8 prevalence among blood donors in Spain is higher than in Northern Europe and the USA, but is similar to that in Northern Italy. The distribution of HHV-8 is compatible with a sexually transmitted agent. The distribution of HHV-8 correlates with that of Kaposi's sarcoma but factors other than HHV-8 seem to explain the Kaposi sarcoma distribution.

AIDS-Related Opportunistic Infections↗
PubMed2001

HIV surveillance among injecting drug users.

Injecting drug users (IDUs) should be considered a 'partially hidden population' at high risk for HIV infection. In almost all locations it should be possible to locate and conduct research with IDUs, but it will probably never be possible to enumerate or draw random samples from an IDU population. Surveillance research studies with IDUs should include risk behaviors, as surveillance of HIV infection only will not be sufficiently time sensitive, and be used to develop and refine HIV prevention programming for the population. Contacts with IDUs can be developed at multiple settings, including voluntary treatment programs, law enforcement settings, and through 'street outreach.' Each type of setting has different advantages, disadvantages and ethical concerns. HIV testing as part of surveillance also raises additional important ethical concerns. The primary risk behaviors that should be included in surveillance studies are 'sharing' of drug injection equipment, the potential for rapid partner change among risk partners, and sexual risk behavior. Additional important objectives for surveillance research include: (1) the size of the local IDU population, (2) patterns of drug use, (3) availability injection equipment, (4) participation in prevention activities, and (5) access to and use of anti-retroviral treatments. HIV incidence is an ultimate objective for surveillance research, but there are no currently available cost-efficient methods for studying HIV incidence, so estimation from indirect measurements is usually required.

HIV Infections↗
PubMed1999

Disproportionate high incidence of invasive cervical cancer as an AIDS-indicative disease among young women in Catalonia, Spain.

BACKGROUND: Spain has the highest rate of AIDS in Europe since 1990, mainly at the expenses of the intravenous drug user (IDU) transmission group, and women account for 20% of all the cases. Because cervical lesions may be altered by HIV, invasive cervical cancer (ICC) is included in the AIDS case definition worldwide. GOAL OF STUDY: To assess the impact of the HIV epidemic on the incidence of ICC and to describe the characteristics of ICC in the spectrum of AIDS-defining diseases in Catalonia, Spain. STUDY DESIGN: Descriptive study of women notified through the AIDS surveillance system during 1994 to 1996. Age-specific ICC incidence rates from a population-based Cancer Registry were used to calculate the population attributable risk percent (PAR%). RESULTS: Fifty-six cases (6.8%) with ICC were reported to the AIDS Registry, 64.3% of those women were IDU with a mean age of 32. Among women aged 20 to 49, the PAR% was 12.2% (95% CI: 7.9-16.5%) and the incidence rate ratio was 18.5 (95% CI: 11.2-29.2). CONCLUSIONS: HIV is having an impact on ICC epidemiology among young women in Catalonia. The policy of cervical screening should be modified and offered every 6 to 12 months to women at risk for or with HIV infection.

Adult↗
PubMed1998

[The epidemiological surveillance of human immunodeficiency virus (HIV) infection in a hospital population of Catalonia. Collaborators in the VIHHOSP project].

BACKGROUND: AIDS is one of the most important problems of public health in our setting. The surveillance of HIV infection in sentinel population is an important alternative to the use of the AIDS cases registries, to obtain a dynamic and updated information about HIV/AIDS epidemic. The objective of this study was to determine the prevalence of HIV infection among the patients from 5 sentinel hospitals in Catalonia, Spain. PATIENTS AND METHODS: Unlinked anonymous screening of serum from patients aged 15-49 from 5 sentinel hospitals in Catalonia, Spain. Samples were broken by age, sex, in-patients or out-patients and clinical specialities related to HIV/AIDS or not related. Samples were analyzed in pools of five and were tested by the OMS strategy II, for the epidemiological surveillance purposes. RESULTS: HIV testing was developed in 9,524 patients, with a prevalence of 1.6% (153 samples). The overall prevalence in men was twice that of women (2.3% vs. 1.1%). Ages between 25 to 34 had the higher prevalence (3.1%). Clinical specialities related with HIV/AIDS had a prevalence twice that of non related (2.3% vs. 1.2%). CONCLUSIONS: The HIV prevalence found in this population is the highest compared to similar studies performed in other western european countries. Our data confirm the pattern of HIV infection for age and sex observed in other studies in Catalonia, Spain. This is the first study of sentinel surveillance in sentinel hospitals in Spain and give us the base line which will serve as a reference to assess the evolution of HIV infection in further studies in sentinel hospital populations in Catalonia.

Adolescent↗
PubMed1998

Analytical considerations in the use of capture-recapture to estimate prevalence: case studies of the estimation of opiate use in the metropolitan area of Barcelona, Spain.

Capture-recapture, an indirect method widely used to estimate undetected populations, has been criticized because it causes problems due to a lack of compliance with several important assumptions and model selection strategies. This paper expands on the problems encountered when applying this methodology to drug abuse estimations, specifically the prevalence of opiate use in the metropolitan area of Barcelona, Spain, in 1993. Three samples of opiate users (from hospital emergency rooms, treatment centers, and prisons) were available in the area studied; an additional sample (mortality data) was analyzed for the city of Barcelona. Log-linear models that provided a good fit were considered, to which further model selection strategies were applied. A total of 3,207 unique individuals aged 15-44 years were identified in the three samples from the greater Barcelona area; the mortality sample from the city of Barcelona contained an additional 83 individuals. Heterogeneity was observed in different age, sex, and residence area subgroups. Population estimates differed widely according to the log-linear model chosen. Minimum Akaike's information criterion model and saturated model estimates were used to produce population prevalence rates. The main problems the authors encountered in this study were related to population definition, source heterogeneity, and assessment of an adequate model, a problem associated with sample size.

Adolescent↗
PubMed1998

[Prevalence of human immunodeficiency virus infection and behaviors associated with its transmission among parenteral drug users selected on the street].

BACKGROUND: To estimate the prevalence of HIV infection and the associated risk behaviours among intravenous drug users not receiving treatment for their drug dependence. PATIENTS AND METHODS: A cross-sectional study of 200 intravenous drug users recruited from the streets of Barcelona in 1993. Information about the socio-demographic aspects and behaviours was obtained through a personal interview using a standardised questionnaire which was carried out by three ex-drug users. Saliva samples were used to determine anti HIV antibodies. RESULTS: The prevalence of HIV infection was 51%. 57% borrowed used syringes, 65% lended their syringes, and 41% practised back of frontloading. 85% if those who shared syringes always cleaned them, however 59% only used water. 78% had heterosexual relations, in 33% of the cases with a non-injecting sexual partner. 65% always used condoms with sexual clients although only 26% always used them with stable sexual partners and 36% with casual sexual partners. 78% had performed the HIV test and among those who knew they were seropositive, 40% had received some kind of health control in the last 6 months. Not having a legal income, injecting speedball or barbiturates, unknowing self HIV negative status and practicing forms of indirect sharing were found to be independently associated with syringe sharing. CONCLUSIONS: The high prevalence of HIV infection and associated risk behaviours highlights the need to increase and adapt the prevention efforts and investigation to this group. Social marginalization and poliuse of drugs should be addressed in HIV prevention programs.

Adult↗
PubMed1998

[Prevalence of maternal HIV infection in Catalonia (1994): results of non-related anonymous neonatal screening. VIHNADO Group].

BACKGROUND: Spain has the highest incidence rate of AIDS in Europe. Catalonia contributes with around 30% of the AIDS cases detected in Spain. From 1990 to 1994 the AIDS heterosexual transmission category increased from 9.6% to 14.6% in Catalonia. The objective of the study was to determine the HIV prevalence in a heterosexual population of pregnant women. SUBJECTS AND METHODS: Unlinked anonymous HIV screening by means of an agglutination assay and an enzyme immunoassay of eluates of dried blood spots from nearly half of the neonates born in Catalonia during 1994. RESULTS: HIV testing was done on 21,074 neonates. Overall HIV prevalence was 0.32% (95% CI: 0.25-0.40). It varied from 0.45% in Barcelona, 0.38-0.29% in the health regions around Barcelona, to 0.20-0.09% in the rest. The mean age of HIV infected women was younger (27) than that of the seronegative ones (29) (p < 0.001). The highest prevalence was 0.61% in women aged 20-24 years. CONCLUSIONS: The HIV prevalence in the heterosexual population of pregnant women in Catalonia is among the highest in Europe. Preventive efforts must begin with schoolchildren and be directed to adolescents and young women. It is convenient that women who want to become pregnant and mothers receiving antenatal care have access to voluntary confidential HIV testing.

Adult↗
PubMed1997

CCR5del32 in perinatal HIV-1 infection.

CCR5, a chemokine receptor, serves as a coreceptor for macrophage-tropic HIV-1 (1-3). A 32-bp deletion within the gene encoding CCR5, CCR5del32, has been shown to prevent HIV-1 infection of T cells in the absence of a wild-type allele. This alteration is present in low frequency in Caucasian populations (4-6). To investigate the effect of CCR5del32 in perinatal HIV-1 transmission and disease progression, two cohorts of perinatally exposed infected and uninfected children were analyzed for the presence of the allele. Polymerase chain reaction (PCR) was used to identify CCR5del32 in prevalent and prospective cases among 144 African American children from New York City and 73 Caucasian children from Barcelona, Spain. HIV-1 transmission; clinical manifestations of disease, including encephalopathy, opportunistic infections, and death before 2 years of age; survival; Centers for Disease Control and Prevention (CDC) classification; and degree of immunosuppression were compared in children with and without CCR5del32. The allele frequency in HIV-1-infected African Americans (0.016) was lower than in Catalan children (0.041). No evidence for a dominant protective effect of CCR5del32 for HIV-1 transmission or disease progression was found in these cohorts.

Black People↗
PubMed1997

The spread of AIDS and the re-emergence of tuberculosis in Catalonia, Spain.

OBJECTIVE: To assess the impact of HIV/AIDS on the incidence of tuberculosis (TB) and to analyse the determinants of TB presenting as the first indicative disease of AIDS. DESIGN: Analysis of TB and AIDS surveillance data. SETTING: Catalonia, north-east Spain. PATIENTS: Two separate sources were used: (i) TB cases reported to the Catalan TB registry diagnosed between January 1982 and December 1993; (ii) AIDS cases reported to the AIDS Catalan registry diagnosed between January 1982 and December 1994. MAIN OUTCOME MEASURES: Expected and observed TB cases, and number and characteristics of AIDS cases presenting with TB. RESULTS: From 1987 to 1993 the annual TB crude incidence rate increased by 50% to a rate of 49.7 per 100,000, with a least 60% of the increase directly due to AIDS. During that period specific rates among children aged 0-4 years remained high at around 40 per 100,000. A total of 7,010 AIDS cases were diagnosed between 1988 and 1994, of whom 24.3% had TB. Multivariate analysis from those AIDS cases showed that besides male sex, young age, and urban residence, the strongest predictors of TB among AIDS cases were history of imprisonment (odds ratio, 2.16; P < 0.001) and intravenous drug use (odds ratio, 1.65; P < 0.001). CONCLUSIONS: The high rates of TB among children and young adults suggest that TB transmission has increased during this period, especially among people at high risk of AIDS. The determinants of individual risk of TB among AIDS patients act together, especially in prisons. The HIV/TB coepidemic is an emerging threat potentially for all and requires expanding targeted measures to prevent and control both disease in our setting.

AIDS-Related Opportunistic Infections↗
PubMed1997

HIV testing history among gay/bisexual men recruited in Barcelona: evidence of high levels of risk behavior among self-reported HIV + men.

As part of the first quantitative study of men who have sex with men (MSM) and HIV/ AIDS in Spain, anonymous, self-administered questionnaires were distributed via gay/lesbian organization mailings, bathhouses, and sex shops in Barcelona. We analyzed 547 gay/bisexual men along self-reported HIV testing history-i.e. untested, previously tested HIV-, and previously tested HIV +. Eleven variables discriminated significantly between the three groups in multivariable analysis. HIV- men were over-represented in the mailing subsample. While untested men exhibited potentially protective behaviors (e.g. least likely to have had stable and casual sex partners with HIV/AIDS and to practice anal intercourse), they were also least likely to be out with their homosexuality and most likely to never use condoms when they practiced anal intercourse. HIV + men were most likely to report insertive and receptive anal intercourse with a condom and least likely to practice insertive anal intercourse without a condom in the past month, yet they were also most likely to report the highest interpersonal barriers to safer sex, recent cocaine use with sex, meeting sex partners in public restrooms, and recent episodes of STD. A potentially volatile combination of higher sexual activity (e.g. more sex partners and casual sex activity) coupled with the presence of safer sex barriers (e.g. poor scores on indices measuring safer sex disposition, elevated drug use accompanying sex) was evidenced among HIV + men. There were no statistically significant differences between the three groups for anal intercourse without a condom, but with 37.5% of this collective reporting one such episode in the past month, all groups can be considered equally risky. Against the backdrop of a 20.5% self-reported HIV prevalence, there is considerable need for enhanced prevention efforts among gay/bisexual men in general and targeted strategies among HIV + men in particular.

AIDS Serodiagnosis↗
PubMed1997

Cross-sectional survey of hospital paediatric HIV/AIDS care in Catalonia, 1992. Hospital Contributors.

A cross-sectional survey to assess the impact of the paediatric HIV/AIDS epidemic on the hospital-based health care system was performed in state-financed hospitals in Catalonia during 1992, raising issues of relevance today. Out of the 27 hospitals contacted, 20 responded. A considerable proportion of the health care to children with an HIV-related condition was provided by four hospitals. The average length of stay of the 176 HIV patients who were admitted was 10.8 days; these patients were admitted to the hospital twice a year on average. Nearly half of the out-patients who attended with an HIV-related condition were either seropositive without a confirmed diagnosis of an HIV infection (class P-0) or seronegative. Thirteen per cent of the overall admissions to paediatric day care hospitals were attributable to an HIV-related condition. By ownership status of the hospitals, HIV/AIDS paediatric in-patients of public hospitals generated the majority of admissions per patient per year, and had the shortest lengths of stay. Unlike the HIV/AIDS epidemic in adults, the magnitude and characteristics of the epidemic in children may not require the shift of hospital-based health care to primary health care.

Ambulatory Care↗
PubMed1997

Potential risk factors for vertical HIV-1 transmission in Catalonia, Spain: the protective role of cesarean section. The Working Group on HIV-1 Vertical Transmission in Catalonia.

OBJECTIVE: To evaluate the roles of certain potential risk factors on the vertical transmission of HIV-1. DESIGN: Prospective registry of infants born to HIV-1-infected women in Catalonia (north-east Spain) from 1987 to 1992. METHODS: A total of 599 infants, born in Catalan hospitals to 520 women who were identified as being HIV-1-infected during gestation or at delivery, were included. Data on mode of delivery, birth weight, gestational age and breast-feeding as well as the mother's age, her route of HIV-1 infection, clinical stage and p24 antigenaemia, were recorded. HIV-1 infection status of 489 (82%) of the infants was determined according to the criteria of the US Centers for Disease Control and Prevention. Risk estimates and odds ratio (OR) were calculated and logistic regression was performed. RESULTS: The overall rate of vertical transmission was 18.6% (95% confidence interval, 15.2-22.0%). Multivariate analyses revealed that Cesarean section was associated with a lower rate of vertical transmission (OR = 0.3; P = 0.001), as was maternal HIV-1 infection via injecting drug use (OR = 0.44; P = 0.02). Breast-feeding (OR = 6.9; P = 0.001), very low birth weight (< 1500 g; OR = 6.3; P = 0.001) and p24 antigenaemia (OR = 4.6; P = 0.04) were all related to increased risk. The crude rate of HIV-1 transmission was 6% among Cesarean births compared with 21% for infants born via vaginal deliveries. The population-attributable risk for vaginal deliveries was 61.7%. CONCLUSIONS: The results show a protective effect of Cesarean section in the absence of zidovudine prophylaxis. However, current research should be directed towards the individual and combined effects that antiretroviral agents and Cesarean section may have on mother-to-child HIV-1 infection.

Adult↗
PubMed1997

[Analysis of the microbiological information derived from the sentinel laboratory network for the monitoring of the human immunodeficiency virus infection in Catalonia (1989-1995)].

BACKGROUND: The epidemiologic information on AIDS derived exclusively from the AIDS case registry presents a series of limitations. To solve some of these epidemiologic surveillance systems of HIV infection have been designed. The information of the microbiology laboratories in which anti-HIV antibody detection tests are performed has been one of the most commonly used sources of information. MATERIAL AND METHOD: The detection activity of the anti-HIV antibodies from a surveillance laboratory network in Catalonia from 1989 to 1995 was collected. RESULTS: A continuous increase was observed in the number of tests performed in the network laboratories (30012 in 1989 up to 63323 in 1995) as was a significant decrease in the number of tests which were reactive (20.7% in 1989 to 6.1% in 1995). Great variability was found in the results among the different laboratories as well as in the diagnostic algorythms used. CONCLUSIONS: Laboratories are an important source to take into account to perform epidemiologic surveillance of HIV infection. The collaboration among the laboratories and public health care officials allows information to be obtained that aids in better defining the characteristics of people who currently have HIV infection and in designing preventive activities directed at the needs of each community. This collaboration also allows homogeneous diagnostic algorythmns and common criteria to be established to ensure quality control.

Acquired Immunodeficiency Syndrome↗