People who use drugs (PWUD) are at high risk of hepatitis C virus (HCV) infection, and HCV patients often have psychiatric disorders requiring nervous system drugs, including antipsychotics. These medicines can interact with HCV treatment-related metabolic pathways producing DDIs (drug-drug interactions). This analysis focused on potential DDIs between direct-acting antivirals (DAAs) and concomitant medications used in PWUD/antipsychotics-treated HCV patients, alongside associated adverse events (AEs) and clinical interventions in Spain. Electronic medical records (BIG-PAC® database) were used to analyse adult HCV patients treated with glecaprevir/pibrentasvir (GLE/PIB) or sofosbuvir/velpatasvir (SOF/VEL) between 2017-2020. The study included 1,620 HCV patients, 985 identified as PWUD and 187 as antipsychotic users, 75% of whom were also PWUD. In the PWUD cohort, cardiovascular (CV) comorbidities were the most frequent; 22.7% patients were at risk of DDIs with CV, with the risk being higher in GLE/PIB-treated (36.8%) versus SOF/VEL (13.7%) (p<0.001). Cardiovascular AEs were more common in the GLE/PIB group. In the antipsychotic cohort, quetiapine was the most prescribed antipsychotic comedication (26.2%), followed by paliperidone (17.6%) and olanzapine (17.1%). Fifty-one per cent of those on GLE/PIB were at risk of DDIs versus 23% on SOF/VEL (p<0.001). Two AEs were reported in the GLE/PIB group (n=37): one patient on quetiapine at a dose <300mg/day experienced extrapyramidal symptoms, leading to DAA discontinuation, and another paliperidone-treated experienced sedation, necessitating a dose reduction. The findings highlight DDIs risks in HCV patients on antipsychotics or with substance addiction, particularly with GLE/PIB. Comprehensive clinical follow-up is essential to optimise treatment and improve patient safety. Electronic medical records (BIG-PAC® database) were used to analyse adult HCV patients treated with glecaprevir/pibrentasvir (GLE/PIB) or sofosbuvir/velpatasvir (SOF/VEL) between 2017-2020. The study included 1,620 HCV patients, 985 identified as PWUD and 187 as antipsychotic users, 75% of which were also PWUD. In the PWUD cohort, cardiovascular (CV) comorbidities were the most frequent; 22.7% patients were at risk of DDIs with CV, being the risk higher in GLE/PIB-treated (36.8%) versus SOF/VEL (13.7%) (p<0.001). Cardiovascular AEs were more common in the GLE/PIB group. In the antipsychotic cohort, quetiapine was the most prescribed antipsychotic comedication (26.2%), followed by paliperidone (17.6%) and olanzapine (17.1%). Fifty-one per cent of those on GLE/PIB were at risk of DDIs versus 23% on SOF/VEL (p<0.001). Two AEs were reported in the GLE/PIB group (n=37): one patient on quetiapine at a dose <300mg/day experienced extrapyramidal symptoms, leading to DAA discontinuation, and another paliperidone-treated experienced sedation, necessitating a dose reduction. The findings highlight DDIs risks in HCV patients on antipsychotics or with substance addiction, particularly with GLE/PIB. Comprehensive clinical follow-up is essential to optimise treatment and improve patient safety.
Migrant populations face a disproportionate risk of undiagnosed HIV and viral hepatitis, posing a major challenge to elimination goals. The HEPINMIGRA study evaluated the acceptability, feasibility, and effectiveness of an integrated community-based screening program for migrants in Alicante, Spain. Between March 2024 and February 2025, nine outreach campaigns were conducted in community settings with the support of intercultural mediators. Screening was performed using finger-prick dried blood spots. Among 535 attendees, 529 migrants were screened (acceptance rate 98.9
PURPOSE:The Iberian Registry of Ocular Syphilis aims to describe the epidemiology, clinical manifestations and treatment outcomes of ocular syphilis in Spain and Portugal. This re-emerging condition, associated with rising global syphilis rates and HIV coinfection, presents with diverse ocular and systemic features. The study seeks to fill knowledge gaps regarding incidence, presentation and therapeutic response. METHODS:This multicentre, observational cohort study includes patients aged ≥18 years with newly diagnosed ocular syphilis confirmed by treponemal and nontreponemal serological tests. Conducted across 23 centres, data collection followed routine clinical practice and included demographics, ocular/systemic findings, treatment regimens and outcomes at 3-6 months post-treatment. RESULTS:In the first year, 41 patients met the inclusion criteria, of whom 39 consented to participate in the registry, with an incidence of 0.57 cases per 100 000 persons/year. Most were male (94.9%), especially men who have sex with men (66.7%) and HIV coinfection (20.5%). Bilateral ocular involvement was observed in 64.1% of patients, with anterior segment inflammation in 64.1%, vitritis in 53.8%, retinal or choroidal involvement in 69.2% and optic nerve involvement in 59.0%. Systemic syphilis stage included primary (7.7%), secondary (25.6%) and tertiary or quaternary (15.4%). Treatment was initiated after a mean of 6.2±9.3 weeks after the onset of symptoms, and 2.6±6.0 weeks after the initial presentation at the hospital. Intravenous penicillin G was used in 65.8%, and 61.3% achieved a four-fold titre reduction in the reaginic test at the final visit (3 to 6 months after antibiotic therapy). Final visual acuity improved to 0.17 LogMAR (p<0.001), with 56% of eyes gaining ≥0.1 LogMAR. CONCLUSIONS:Ocular syphilis in the Iberian Peninsula shows a wide clinical spectrum and frequent posterior segment involvement. Most patients achieved favourable serological and visual outcomes. These findings support the effectiveness of standard therapies and highlight the need for early diagnosis, especially in high-risk populations.
Background/Objectives: Artificial Nutrition and Hydration (ANH) at the end of life remains a clinically and ethically complex intervention. Although international guidelines exist, data regarding the awareness of them and their perceived applicability across different population groups remain limited. This study aimed to evaluate and compare perceptions and attitudes regarding ANH among healthcare professionals, medical students, and lay respondents. Methods: A cross-sectional, questionnaire-based comparative survey was conducted between July 2025 and March 2026, including 470 respondents (338 healthcare professionals, 46 medical students, and 86 lay respondents). The survey assessed perceptions of ANH, factors influencing decision-making, and familiarity with clinical guidelines and legislation. Results: General perceptions regarding ANH were broadly similar across groups. Significant differences were observed for the importance assigned to estimated life expectancy (p < 0.001) and family opinion (p = 0.017). Associations were identified between study group and opinions on clinical guidelines (χ2(6) = 16.366, p = 0.012) and legislation (χ2(6) = 14.712, p = 0.023), with lack of knowledge more frequent among lay respondents and students. Within healthcare professionals, physicians and nurses showed significantly different responses regarding guidelines (p < 0.001). Conclusions: In this cross-sectional survey, perceptions of ANH at the end of life were largely shared, but differed in relation to prognostic factors, family involvement, and awareness of guidelines and legislation, suggesting the presence of relevant knowledge gaps in end-of-life decision-making.
Background/Objetives: The objective of this study was to determine the in vitro susceptibility profiles of clinical Clostridioides difficile isolates to metronidazole (MTZ), vancomycin (VAN), fidaxomicin (FDX), tigecycline (TGC), and eravacycline (ERV) in a multicenter Spanish cohort, and to evaluate their association with clinical factors. Methods: Strains were obtained from prospectively included patients in the ICD-ANCRAID-SEICV cohort (ClinicalTrials.gov ID: NCT04801862) in Andalucía and the Valencian Community between 1 January 2020 and 30 April 2023. Antimicrobial susceptibility testing was performed using E-test for MTZ, VAN, TGC, and ERV, and agar dilution for FDX. Results: The results were interpreted following EUCAST clinical breakpoints and ECOFF criteria. A total of 107 patients were included (median age 70 years; 65.4% women). Nearly half of the cases were community-acquired, 30% nosocomial, and the remainder healthcare-associated. Most infections were non-severe, and 32.7% experienced recurrence. Overall resistance levels were low: VAN and TGC each showed resistance in 2.8% of isolates, followed by MTZ (1.9%). Only one isolate was resistant to FDX (0.9%), and none to ERV. MIC90 values were low for all agents. Some resistant isolates displayed co-resistance and were recovered from patients with prior antibiotic exposure. Among the seven patients carrying resistant strains, most were women, and the cases were predominantly community-acquired. Clinical characteristics, including age, comorbidity, infection origin, and severity, did not differ from those with susceptible isolates. All patients achieved clinical cure without recurrent infection. No association was found between elevated MIC values and recurrence or greater severity. Conclusions: FDX and ERV demonstrated excellent in vitro activity. Resistance to MTZ, VAN, and TGC was uncommon but detectable. Findings highlight the need for continued antimicrobial resistance surveillance and evaluation of its potential clinical impact.
