Andres Marco - Academia.edu (original) (raw)
Papers by Andres Marco
Diagnóstico
El glaucoma primario de ángulo abierto se caracteriza por la pérdida progresiva e irreversible de... more El glaucoma primario de ángulo abierto se caracteriza por la pérdida progresiva e irreversible de las fibras nerviosas retinales y las células ganglionares de la retina, siendo la primera causa de ceguera irreversible en el mundo. El principal factor de riesgo es la presión intraocular elevada, causada por el aumento en la resistencia de salida del humor acuoso a través de la malla trabecular; que provoca la compresión, deformación y remodelación de la lámina cribosa con el consiguiente daño mecánico y disrupción del transporte axonal. Otros factores de riesgo son la herencia familiar, la edad, la raza, un grosor corneal central delgado y la miopía. La transmisión genética puede ser de herencia compleja sin embargo los genes identificados hasta el momento solo están presentes en menos del 10% de los casos. El diagnóstico requiere la evaluación de la cabeza del nervio óptico la capa de fibras nerviosas retinales a través de la oftalmoscopía y por medio de la tomografía de coherencia ...
![Research paper thumbnail of [Is the availability of buprenorphine/naloxone therapy for opioid-dependent inmates a necessity? ]](https://attachments.academia-assets.com/94541136/thumbnails/1.jpg)
](Revista española de sanidad penitenciaria, 2013
Agonist therapy (OAT) programs in combination with a psychosocial approach are the most effective... more Agonist therapy (OAT) programs in combination with a psychosocial approach are the most effective way to prevent relapse in opioid-dependent patients. These programs reduce morbidity and risk behaviours for HIV transmission and other infections, improve quality of life and retention in treatment, and have a positive impact on antisocial behaviour. They are therefore very useful for prisoners with a history of opiate use. OATs based on buprenorphine/naloxone (B/N), along with others using methadone, are currently available in Spain. Diversified treatment offers an alternative treatment for opioid dependence that is more personalized and tailored to the patient's characteristics. As regards effectiveness, both drugs are very similar, but B/N shows a better safety profile and fewer drug-drug interactions and can be dispensed in pharmacies once the patient is released, which can assist with the patient' social reintegration. B/N treatment is more expensive than methadone. It is ...
An outbreak of SARS-CoV2 infection in a Barcelona prison was studied after seven cases appeared i... more An outbreak of SARS-CoV2 infection in a Barcelona prison was studied after seven cases appeared in nine days. One hundred and eighty-four people (148 inmates and 36 prison staff) were evaluated by rt-PCR. Thirty-nine (24.1%) were positive: 33 inmates and six staff members. The inmates were isolated in prison module 4, which was converted into an emergency COVID unit. Two people (one inmate and one health worker) were admitted to hospital for clinical deterioration. There were no deaths. Outbreaks pose a huge risk, must be detected early, are difficult to manage, and require optimal coordination between health and prison authorities.
Background. AIDS is among the leading causes of death in prisons, but there is little information... more Background. AIDS is among the leading causes of death in prisons, but there is little information about AIDS patients with a history of imprisonment. Methods. AIDS patients diagnosed in Barcelona between 1988 and 1993 were studied. Those with prison histories were compared to those without, with respect to epidemiological variables, including survival analysis. Results. 28.5 % of 2336 AIDS patients, 49.4 % of intravenous drug users (IVDU) and only 2.6 % of homosexuals who were not IVDU had a prison history. Those with prison histories, compared to those without, were younger (median age of 30.6 versus 36.4, P< 0.0001), more often IVDU than homosexuals (87.8 % versus 35.8%, OR = 36.9, 95 % Cl: 22.6-60.8, P< 0.0001), and diagnosed with AIDS because of extrapulmonary tuberculosis (32.0 % versus 14.7%, P< 0.001). Among IVDU, those with prison histories were more frequently males (OR: 2.2; 95 % Cl: 1.6-2.9), lived in the poorest district of Barcelona more frequently than in the ...
Background: Early diagnosis of HIV infection can prevent morbidity and mortality as well as reduc... more Background: Early diagnosis of HIV infection can prevent morbidity and mortality as well as reduce HIV transmission. The aim of the present study was to assess prevalence, describe trends and identify factors associated with late presentation of HIV infection in Barcelona (Spain) during the period 2001-09.
Current Opinion in Genetics & Development
Journal of Antimicrobial Chemotherapy
Background: New direct-acting antiviral agents (DAAs) have shown great efficacy and tolerability ... more Background: New direct-acting antiviral agents (DAAs) have shown great efficacy and tolerability in clinical trials and real-life cohorts. However, data are scarce regarding efficacy and safety in cirrhotic HCV/HIV-coinfected patients. Methods: A multicentre prospective analysis was performed in 13 Spanish hospitals, including all cirrhotic HCV/ HIV-coinfected patients starting DAA combinations from January to December 2015. Sustained virological response 12 weeks after treatment (SVR12) was analysed. Withdrawal due to toxicity and/or hepatic decompensation and change in liver stiffness measurement (LSM) after HCV treatment were evaluated. Results: Patients (n " 170) were mostly male (n " 125; 74.3%) with the following HCV genotype (Gt) distribution:
PLOS ONE, 2015
182 deaths were found [14.0/1000 person-years of follow-up (py); 95% confidence interval (CI):12.... more 182 deaths were found [14.0/1000 person-years of follow-up (py); 95% confidence interval (CI):12.0-16.1/1000 py], 81.3% of them had a known cause of death. Mortality rate by HIVrelated causes and non-HIV-related causes was the same (4.9/1000 py;
Psychiatry research, Jan 10, 2015
The purpose of this study was to assess the prevalence of personality disorders (PDs) and their a... more The purpose of this study was to assess the prevalence of personality disorders (PDs) and their associated factors in prisoners who initiate chronic hepatitis C (CHC) treatment in 25 Spanish prisons. The Personality Diagnostic Questionnaire-4 was used to diagnose PDs according to DSM-IV criteria. Factors potentially associated with a PD diagnosis were evaluated by logistic regression analysis. Two hundred and fifty-five patients were initially assessed and 62 (24.3%) were excluded due to an incomplete or invalid self-report screening questionnaire. PD prevalence was 70.5%, with antisocial PD being the most prevalent (46.1%). In terms of PD clusters, the most prevalent was cluster-B (55.4%). PD diagnosis was associated with HCV genotypes 1, 2, or 3 (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.02-4.49). Patients with a cluster-B PD were more likely to be infected with HCV genotypes 1, 2, or 3 (OR 2.37, 95% CI 1.08-5.23) and be HIV-infected (OR 2.20, 95% CI 1.10-4.39), to repo...
BMC Public Health, 2015
Background: The aim of this study was to determine the evolution of HIV infection, gonorrhea, syp... more Background: The aim of this study was to determine the evolution of HIV infection, gonorrhea, syphilis and lymphogranuloma venereum (LGV), and their epidemiological characteristics in Barcelona city. Methods: Population-based incidence study of all newly occurring diagnoses of HIV infection, syphilis, gonorrhea and LGV detected in Barcelona between January 2007 and December 2011. A descriptive analysis was performed. The annual incidence rates per 100,000 inhabitants were calculated by sex, sexual conduct and educational level. To estimate global sex-specific rates we used the Barcelona city census; for the calculation of rates by sexual conduct and educational level we used estimates of the Barcelona Health Interview Survey. Trends were analysed using the chi-squared test for linear trend. Results: HIV. 66.8 % of the HIV cases were men who had sex with men (MSM). The incidence rates in MSM over the study period were from 692.67/100,000 to 909.88/100,000 inh. Syphilis. 74.2 % of the syphilis cases were MSM. The incidence rates in MSM were from 224.9/100,000 to 891.97/100,000 inh. and the MSM with a university education ranged from 196.3/100,000 to 1020.8/100,000. Gonorrhea. 45.5 % of the gonorrhea cases were MSM. The incidence rates in MSM were from 164.24/100,000 to 404.79/100,000 inh. and the MSM with university education ranged from 176.7/100,000 to 530.1/100,000 inh.. Lymphogranuloma venereum (LGV). 95.3 % of the LGV cases are MSM. The incidence rates in MSM were from 24.99/100,000 to 282.99/100,000 inh. and the MSM with university education ranged from 9.3/100,000 to 265/100,000 inh. Conclusion: An increase in cases of STI was observed. These STI mainly affected MSM with a university education. Continuing to monitor changes in the epidemiology of STI, and identifying the most affected groups should permit redesigning preventive programs, with the goal of finding the most efficient way to reach these population groups.
BMC Infectious Diseases, 2015
Background: The link between infection with hepatitis C virus (HCV) and personality disorders (PD... more Background: The link between infection with hepatitis C virus (HCV) and personality disorders (PD) has not been investigated in detail. The aim of this study was to compare the effectiveness of HCV treatment in prisoners with and without PD. Methods: We performed a prospective multicentre study in inmates from 25 Spanish prisons who had been treated with pegylated interferon alfa-2a plus ribavirin in 2011. PD diagnosis was based on the Personality Diagnostic Questionnaire-4+. We calculated adjusted Odds Ratios (AOR) and 95 % confidence intervals (95 % CI) using logistic regression. Results: The sample included 236 patients (mean age: 40.3 years, 92.8 % male, 79.2 % intravenous drug users, and 26.3 % HIV-coinfected). The prevalence of PD was 72.5 %. 32.2 % of patients discontinued treatment; this percentage was higher in patients with HCV genotypes 1/4 (AOR = 3.55; CI:1.76-7.18) and those without PD (AOR = 2.51; 1.23-5.11). Treatment discontinuation was mainly for penitentiary reasons (40.3 %): release or transfer between prisons. The rate of sustained viral response (SVR) was 52.1 % by ITT and 76.9 % by observed treatment (OT). SVR was higher among patients with genotype 2 or 3, and those with low baseline HCV-RNA. We did not observe any differences between individuals with and without PD in term of SVR, HCV genotype or HIV infection. Conclusions: Our results support the safety and clinical effectiveness of the treatment of chronic HCV infection in correctional facilities, both in prisoners with PD and those without. Our data support non-discrimination between patients with and without PD when offering treatment for HCV infection to prison inmates. Trial registration: Trial registration number (TRN) NCT01900886.
Human Vaccines & Immunotherapeutics, 2015
From the first day of imprisonment, prisoners are exposed to and expose other prisoners to variou... more From the first day of imprisonment, prisoners are exposed to and expose other prisoners to various communicable diseases, many of which are vaccine-preventable. The risk of acquiring these diseases during the prison sentence exceeds that of the general population. This excess risk may be explained by various causes; some due to the structural and logistical problems of prisons and others to habitual or acquired behaviors during imprisonment. Prison is, for many inmates, an opportunity to access health care, and is therefore an ideal opportunity to update adult vaccination schedules. The traditional idea that prisons are intended to ensure public safety should be complemented by the contribution they can make in improving community health, providing a more comprehensive vision of safety that includes public health.
Medicina clínica, Jan 10, 2006
Patients on methadone maintenance therapy who are administered nelfinavir show a decrease in meth... more Patients on methadone maintenance therapy who are administered nelfinavir show a decrease in methadone plasma levels. However, the clinical relevance of this fact is seldom significant because it does not correlate with the appearance of opioid withdrawal symptoms (OWS). The objective of this study was to assess the clinical and pharmacokinetic interactions between methadone and nelfinavir. A prospective multicenter study of human immunodeficiency virus (HIV) positive patients on stable methadone therapy who initiated nelfinavir was performed. To determine the presence of OWS, 2 questionnaires, objective and subjective, were administered at weeks 1, 2, 3 and 4. A pharmacokinetic study measuring the minimal plasmatic concentration of methadone was done at baseline and at week 4. 29 patient were included. In 7 patients who underwent pharmacokinetic studies, the minimal plasmatic concentration of methadone decreased after 4 weeks of nelfinavir treatment from 6.889 ng/ml to 4.354 ng/ml ...
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2002
Different bodies have emphasised the need for prisons to implement and evaluate their own tubercu... more Different bodies have emphasised the need for prisons to implement and evaluate their own tuberculosis prevention and control programmes (TPCP), with the aims of evaluating TPCP in Barcelona prisons and obtaining conclusions that would allow any necessary modifications to be introduced to improve their effectiveness. An assessment was carried out for the period 1987-2000, using the exhaustive retrospective method. The quantitative indicators used were defined in the same way as those employed by the Barcelona TPCP, which were taken as the gold standard. The assessment studied trends in the indicators and evaluated the impact by comparing the results with the gold standard. Statistically significant trends (P < 0.0001) were found for incidence rates, infection prevalence, treatment adherence rates among smear-positive cases and percentage of cases on directly observed treatment (DOT). When impact was assessed, only the decline in the average annual incidence rate (25.2%) and desir...
Journal of Translational Medicine, 2015
Background: None of the HIV T-cell vaccine candidates that have reached advanced clinical testing... more Background: None of the HIV T-cell vaccine candidates that have reached advanced clinical testing have been able to induce protective T cell immunity. A major reason for these failures may have been suboptimal T cell immunogen designs. Methods: To overcome this problem, we used a novel immunogen design approach that is based on functional T cell response data from more than 1,000 HIV-1 clade B and C infected individuals and which aims to direct the T cell response to the most vulnerable sites of HIV-1. Results: Our approach identified 16 regions in Gag, Pol, Vif and Nef that were relatively conserved and predominantly targeted by individuals with reduced viral loads. These regions formed the basis of the HIVACAT T-cell Immunogen (HTI) sequence which is 529 amino acids in length, includes more than 50 optimally defined CD4 + and CD8 + T-cell epitopes restricted by a wide range of HLA class I and II molecules and covers viral sites where mutations led to a dramatic reduction in viral replicative fitness. In both, C57BL/6 mice and Indian rhesus macaques immunized with an HTI-expressing DNA plasmid (DNA.HTI) induced broad and balanced T-cell responses to several segments within Gag, Pol, and Vif. DNA.HTI induced robust CD4 + and CD8 + T cell responses that were increased by a booster vaccination using modified virus Ankara (MVA.HTI), expanding the DNA.HTI induced response to up to 3.2% IFN-γ T-cells in macaques. HTI-specific T cells showed a central and effector memory phenotype with a significant fraction of the IFN-γ + CD8 + T cells being Granzyme B + and able to degranulate (CD107a +). Conclusions: These data demonstrate the immunogenicity of a novel HIV-1 T cell vaccine concept that induced broadly balanced responses to vulnerable sites of HIV-1 while avoiding the induction of responses to potential decoy targets that may divert effective T-cell responses towards variable and less protective viral determinants.
Revista Española de Salud Pública, 2011
Diagnóstico
El glaucoma primario de ángulo abierto se caracteriza por la pérdida progresiva e irreversible de... more El glaucoma primario de ángulo abierto se caracteriza por la pérdida progresiva e irreversible de las fibras nerviosas retinales y las células ganglionares de la retina, siendo la primera causa de ceguera irreversible en el mundo. El principal factor de riesgo es la presión intraocular elevada, causada por el aumento en la resistencia de salida del humor acuoso a través de la malla trabecular; que provoca la compresión, deformación y remodelación de la lámina cribosa con el consiguiente daño mecánico y disrupción del transporte axonal. Otros factores de riesgo son la herencia familiar, la edad, la raza, un grosor corneal central delgado y la miopía. La transmisión genética puede ser de herencia compleja sin embargo los genes identificados hasta el momento solo están presentes en menos del 10% de los casos. El diagnóstico requiere la evaluación de la cabeza del nervio óptico la capa de fibras nerviosas retinales a través de la oftalmoscopía y por medio de la tomografía de coherencia ...
Revista española de sanidad penitenciaria, 2013
Agonist therapy (OAT) programs in combination with a psychosocial approach are the most effective... more Agonist therapy (OAT) programs in combination with a psychosocial approach are the most effective way to prevent relapse in opioid-dependent patients. These programs reduce morbidity and risk behaviours for HIV transmission and other infections, improve quality of life and retention in treatment, and have a positive impact on antisocial behaviour. They are therefore very useful for prisoners with a history of opiate use. OATs based on buprenorphine/naloxone (B/N), along with others using methadone, are currently available in Spain. Diversified treatment offers an alternative treatment for opioid dependence that is more personalized and tailored to the patient's characteristics. As regards effectiveness, both drugs are very similar, but B/N shows a better safety profile and fewer drug-drug interactions and can be dispensed in pharmacies once the patient is released, which can assist with the patient' social reintegration. B/N treatment is more expensive than methadone. It is ...
An outbreak of SARS-CoV2 infection in a Barcelona prison was studied after seven cases appeared i... more An outbreak of SARS-CoV2 infection in a Barcelona prison was studied after seven cases appeared in nine days. One hundred and eighty-four people (148 inmates and 36 prison staff) were evaluated by rt-PCR. Thirty-nine (24.1%) were positive: 33 inmates and six staff members. The inmates were isolated in prison module 4, which was converted into an emergency COVID unit. Two people (one inmate and one health worker) were admitted to hospital for clinical deterioration. There were no deaths. Outbreaks pose a huge risk, must be detected early, are difficult to manage, and require optimal coordination between health and prison authorities.
Background. AIDS is among the leading causes of death in prisons, but there is little information... more Background. AIDS is among the leading causes of death in prisons, but there is little information about AIDS patients with a history of imprisonment. Methods. AIDS patients diagnosed in Barcelona between 1988 and 1993 were studied. Those with prison histories were compared to those without, with respect to epidemiological variables, including survival analysis. Results. 28.5 % of 2336 AIDS patients, 49.4 % of intravenous drug users (IVDU) and only 2.6 % of homosexuals who were not IVDU had a prison history. Those with prison histories, compared to those without, were younger (median age of 30.6 versus 36.4, P< 0.0001), more often IVDU than homosexuals (87.8 % versus 35.8%, OR = 36.9, 95 % Cl: 22.6-60.8, P< 0.0001), and diagnosed with AIDS because of extrapulmonary tuberculosis (32.0 % versus 14.7%, P< 0.001). Among IVDU, those with prison histories were more frequently males (OR: 2.2; 95 % Cl: 1.6-2.9), lived in the poorest district of Barcelona more frequently than in the ...
Background: Early diagnosis of HIV infection can prevent morbidity and mortality as well as reduc... more Background: Early diagnosis of HIV infection can prevent morbidity and mortality as well as reduce HIV transmission. The aim of the present study was to assess prevalence, describe trends and identify factors associated with late presentation of HIV infection in Barcelona (Spain) during the period 2001-09.
Current Opinion in Genetics & Development
Journal of Antimicrobial Chemotherapy
Background: New direct-acting antiviral agents (DAAs) have shown great efficacy and tolerability ... more Background: New direct-acting antiviral agents (DAAs) have shown great efficacy and tolerability in clinical trials and real-life cohorts. However, data are scarce regarding efficacy and safety in cirrhotic HCV/HIV-coinfected patients. Methods: A multicentre prospective analysis was performed in 13 Spanish hospitals, including all cirrhotic HCV/ HIV-coinfected patients starting DAA combinations from January to December 2015. Sustained virological response 12 weeks after treatment (SVR12) was analysed. Withdrawal due to toxicity and/or hepatic decompensation and change in liver stiffness measurement (LSM) after HCV treatment were evaluated. Results: Patients (n " 170) were mostly male (n " 125; 74.3%) with the following HCV genotype (Gt) distribution:
PLOS ONE, 2015
182 deaths were found [14.0/1000 person-years of follow-up (py); 95% confidence interval (CI):12.... more 182 deaths were found [14.0/1000 person-years of follow-up (py); 95% confidence interval (CI):12.0-16.1/1000 py], 81.3% of them had a known cause of death. Mortality rate by HIVrelated causes and non-HIV-related causes was the same (4.9/1000 py;
Psychiatry research, Jan 10, 2015
The purpose of this study was to assess the prevalence of personality disorders (PDs) and their a... more The purpose of this study was to assess the prevalence of personality disorders (PDs) and their associated factors in prisoners who initiate chronic hepatitis C (CHC) treatment in 25 Spanish prisons. The Personality Diagnostic Questionnaire-4 was used to diagnose PDs according to DSM-IV criteria. Factors potentially associated with a PD diagnosis were evaluated by logistic regression analysis. Two hundred and fifty-five patients were initially assessed and 62 (24.3%) were excluded due to an incomplete or invalid self-report screening questionnaire. PD prevalence was 70.5%, with antisocial PD being the most prevalent (46.1%). In terms of PD clusters, the most prevalent was cluster-B (55.4%). PD diagnosis was associated with HCV genotypes 1, 2, or 3 (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.02-4.49). Patients with a cluster-B PD were more likely to be infected with HCV genotypes 1, 2, or 3 (OR 2.37, 95% CI 1.08-5.23) and be HIV-infected (OR 2.20, 95% CI 1.10-4.39), to repo...
BMC Public Health, 2015
Background: The aim of this study was to determine the evolution of HIV infection, gonorrhea, syp... more Background: The aim of this study was to determine the evolution of HIV infection, gonorrhea, syphilis and lymphogranuloma venereum (LGV), and their epidemiological characteristics in Barcelona city. Methods: Population-based incidence study of all newly occurring diagnoses of HIV infection, syphilis, gonorrhea and LGV detected in Barcelona between January 2007 and December 2011. A descriptive analysis was performed. The annual incidence rates per 100,000 inhabitants were calculated by sex, sexual conduct and educational level. To estimate global sex-specific rates we used the Barcelona city census; for the calculation of rates by sexual conduct and educational level we used estimates of the Barcelona Health Interview Survey. Trends were analysed using the chi-squared test for linear trend. Results: HIV. 66.8 % of the HIV cases were men who had sex with men (MSM). The incidence rates in MSM over the study period were from 692.67/100,000 to 909.88/100,000 inh. Syphilis. 74.2 % of the syphilis cases were MSM. The incidence rates in MSM were from 224.9/100,000 to 891.97/100,000 inh. and the MSM with a university education ranged from 196.3/100,000 to 1020.8/100,000. Gonorrhea. 45.5 % of the gonorrhea cases were MSM. The incidence rates in MSM were from 164.24/100,000 to 404.79/100,000 inh. and the MSM with university education ranged from 176.7/100,000 to 530.1/100,000 inh.. Lymphogranuloma venereum (LGV). 95.3 % of the LGV cases are MSM. The incidence rates in MSM were from 24.99/100,000 to 282.99/100,000 inh. and the MSM with university education ranged from 9.3/100,000 to 265/100,000 inh. Conclusion: An increase in cases of STI was observed. These STI mainly affected MSM with a university education. Continuing to monitor changes in the epidemiology of STI, and identifying the most affected groups should permit redesigning preventive programs, with the goal of finding the most efficient way to reach these population groups.
BMC Infectious Diseases, 2015
Background: The link between infection with hepatitis C virus (HCV) and personality disorders (PD... more Background: The link between infection with hepatitis C virus (HCV) and personality disorders (PD) has not been investigated in detail. The aim of this study was to compare the effectiveness of HCV treatment in prisoners with and without PD. Methods: We performed a prospective multicentre study in inmates from 25 Spanish prisons who had been treated with pegylated interferon alfa-2a plus ribavirin in 2011. PD diagnosis was based on the Personality Diagnostic Questionnaire-4+. We calculated adjusted Odds Ratios (AOR) and 95 % confidence intervals (95 % CI) using logistic regression. Results: The sample included 236 patients (mean age: 40.3 years, 92.8 % male, 79.2 % intravenous drug users, and 26.3 % HIV-coinfected). The prevalence of PD was 72.5 %. 32.2 % of patients discontinued treatment; this percentage was higher in patients with HCV genotypes 1/4 (AOR = 3.55; CI:1.76-7.18) and those without PD (AOR = 2.51; 1.23-5.11). Treatment discontinuation was mainly for penitentiary reasons (40.3 %): release or transfer between prisons. The rate of sustained viral response (SVR) was 52.1 % by ITT and 76.9 % by observed treatment (OT). SVR was higher among patients with genotype 2 or 3, and those with low baseline HCV-RNA. We did not observe any differences between individuals with and without PD in term of SVR, HCV genotype or HIV infection. Conclusions: Our results support the safety and clinical effectiveness of the treatment of chronic HCV infection in correctional facilities, both in prisoners with PD and those without. Our data support non-discrimination between patients with and without PD when offering treatment for HCV infection to prison inmates. Trial registration: Trial registration number (TRN) NCT01900886.
Human Vaccines & Immunotherapeutics, 2015
From the first day of imprisonment, prisoners are exposed to and expose other prisoners to variou... more From the first day of imprisonment, prisoners are exposed to and expose other prisoners to various communicable diseases, many of which are vaccine-preventable. The risk of acquiring these diseases during the prison sentence exceeds that of the general population. This excess risk may be explained by various causes; some due to the structural and logistical problems of prisons and others to habitual or acquired behaviors during imprisonment. Prison is, for many inmates, an opportunity to access health care, and is therefore an ideal opportunity to update adult vaccination schedules. The traditional idea that prisons are intended to ensure public safety should be complemented by the contribution they can make in improving community health, providing a more comprehensive vision of safety that includes public health.
Medicina clínica, Jan 10, 2006
Patients on methadone maintenance therapy who are administered nelfinavir show a decrease in meth... more Patients on methadone maintenance therapy who are administered nelfinavir show a decrease in methadone plasma levels. However, the clinical relevance of this fact is seldom significant because it does not correlate with the appearance of opioid withdrawal symptoms (OWS). The objective of this study was to assess the clinical and pharmacokinetic interactions between methadone and nelfinavir. A prospective multicenter study of human immunodeficiency virus (HIV) positive patients on stable methadone therapy who initiated nelfinavir was performed. To determine the presence of OWS, 2 questionnaires, objective and subjective, were administered at weeks 1, 2, 3 and 4. A pharmacokinetic study measuring the minimal plasmatic concentration of methadone was done at baseline and at week 4. 29 patient were included. In 7 patients who underwent pharmacokinetic studies, the minimal plasmatic concentration of methadone decreased after 4 weeks of nelfinavir treatment from 6.889 ng/ml to 4.354 ng/ml ...
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2002
Different bodies have emphasised the need for prisons to implement and evaluate their own tubercu... more Different bodies have emphasised the need for prisons to implement and evaluate their own tuberculosis prevention and control programmes (TPCP), with the aims of evaluating TPCP in Barcelona prisons and obtaining conclusions that would allow any necessary modifications to be introduced to improve their effectiveness. An assessment was carried out for the period 1987-2000, using the exhaustive retrospective method. The quantitative indicators used were defined in the same way as those employed by the Barcelona TPCP, which were taken as the gold standard. The assessment studied trends in the indicators and evaluated the impact by comparing the results with the gold standard. Statistically significant trends (P < 0.0001) were found for incidence rates, infection prevalence, treatment adherence rates among smear-positive cases and percentage of cases on directly observed treatment (DOT). When impact was assessed, only the decline in the average annual incidence rate (25.2%) and desir...
Journal of Translational Medicine, 2015
Background: None of the HIV T-cell vaccine candidates that have reached advanced clinical testing... more Background: None of the HIV T-cell vaccine candidates that have reached advanced clinical testing have been able to induce protective T cell immunity. A major reason for these failures may have been suboptimal T cell immunogen designs. Methods: To overcome this problem, we used a novel immunogen design approach that is based on functional T cell response data from more than 1,000 HIV-1 clade B and C infected individuals and which aims to direct the T cell response to the most vulnerable sites of HIV-1. Results: Our approach identified 16 regions in Gag, Pol, Vif and Nef that were relatively conserved and predominantly targeted by individuals with reduced viral loads. These regions formed the basis of the HIVACAT T-cell Immunogen (HTI) sequence which is 529 amino acids in length, includes more than 50 optimally defined CD4 + and CD8 + T-cell epitopes restricted by a wide range of HLA class I and II molecules and covers viral sites where mutations led to a dramatic reduction in viral replicative fitness. In both, C57BL/6 mice and Indian rhesus macaques immunized with an HTI-expressing DNA plasmid (DNA.HTI) induced broad and balanced T-cell responses to several segments within Gag, Pol, and Vif. DNA.HTI induced robust CD4 + and CD8 + T cell responses that were increased by a booster vaccination using modified virus Ankara (MVA.HTI), expanding the DNA.HTI induced response to up to 3.2% IFN-γ T-cells in macaques. HTI-specific T cells showed a central and effector memory phenotype with a significant fraction of the IFN-γ + CD8 + T cells being Granzyme B + and able to degranulate (CD107a +). Conclusions: These data demonstrate the immunogenicity of a novel HIV-1 T cell vaccine concept that induced broadly balanced responses to vulnerable sites of HIV-1 while avoiding the induction of responses to potential decoy targets that may divert effective T-cell responses towards variable and less protective viral determinants.
Revista Española de Salud Pública, 2011