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In order to know the prevalence and risk factors for coinfections by human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) among injecting drug users (IDUs), a cross-sectional study was carried out in two prisons of the province of Cantabria, northern Spain. Three hundred and sixty-two IDU inmates were recruited. All inmates were interviewed and their blood tested for HIV, HBV and HCV. Crude and multiple risk factor adjusted for (by polychotomous logistic regression) odds ratios were calculated. Prevalence of HBV-HCV coinfection (42.5%) was higher than HIV-HBV-HCV coinfection (37.3%), whereas monoinfections were very uncommon (overall: 13%). Long-term injectors and reincarceration were the foremost risk factors for both coinfections, showing a trend between the degree of association and the number of viruses infecting a patient. No significant relationship between coinfection status and sexual practices was observed. The results related to coinfections are consistent with previous studies of prevalence and risk factors for HIV, HBV and HCV, in indicating that the high rates of coinfections among IDU inmates emphasise the need to harm-reduction policy across prisons in Spain.

Objective: To analyze the relationship between presentation with a community-acquired infection (CAI) and the risk of subsequent nosocomial infection, and the assessment of a likely diagnostic bias in this association., Design: A prospective cohort study. APACHE-II and TISS were used to assess severity and therapeutic intensity, respectively. Nosocomial infection (NI) was diagnosed according to SENIC and CDC diagnostic criteria. The relative risk and its 95% confidence interval were estimated., Setting: The intensive care unit (ICU) of the University of Granada Hospital (Spain). It is a ten-bed multidisciplinary unit., Patients: 448 patients admitted to the intensive care unit (ICU) between December-1986 and April-1988 who stayed at the ICU for at least 24 hours were included in the study., Results: The crude analysis suggests that CAI may prevent NI. When data were stratified by other variables a previous infection acted as a preventive factor in patients admitted to the ICU from emergency room, in patients with lower severity level and in those with shorter stay lengths at ICU. Patients with a CAI showed higher severity; they were treated more aggressively, they had a longer stay at ICU before a NI was diagnosed and they remained at ICU longer. In multivariate analysis the NI risk in patients with a CAI compared with those not infected previously and controlling for other variables was of 0.36., Conclusion: The presence of a CAI may introduce a differential information bias in the study of NI.