Complicaciones médicas asociadas al abuso de alcohol y drogas

Abstract

Addiction to alcohol and drugs is a chronic condition that is associated with a broad spectrum of clinical complications. In this Thesis we aim to present three specific topics related to the diversity of these complications. The first study refers to a common infectious disease among drug users such as tuberculosis. Detection techniques of gamma interferon (IFN- γ) release have proven to be useful in the diagnosis of Mycobacterium Tuberculosis infection in general population. The aim of this study is based on describing the usefulness of IFN-γ techniques in a population at high risk of tuberculosis infection and disease regardless their HIV status. Results show a good concordance between the new in vitro tests. Results indicate also that IGRAs test can remain positive for years after the developing TB disease. The second aspect is related to serum patterns of HBV infection in a population of intravenous drug users recruited for 20 years. Profiles of HBV infection included absence of HBV markers (i.e., susceptible to infection), Anti-HBc alone, HBsAg positive (including acute and chronic infection), immunity due to natural infection and HBV vaccine-induced immunity, with special attention to the last one in order to analyze the uptake of preventive HBV vaccination in this population. We have shown that immunity to HBV infection due to vaccination had a substantial upward trend from 1987 to 2006. Another finding in this study was the relatively large decline in HBsAg prevalence during the study period (from 9.3% to 1.8% in last period); on the other hand, prevalence of those unexposed to HBV and those with naturally acquired HBV infection remained fairly high and stable over time. Finally, third topic of the Thesis was developed in the last 2 studies and aimed at addressing the effects of alcoholism in terms of morbidity and mortality in a series of patients with alcohol use disorders. The first objective was to analyze gender differences in the hepatic, nutritional and metabolic complications of alcoholism and the second one, aimed at assessing medical co-morbidity with an index (CIRS) and to describe the risk factors for premature death. The results show that nutritional and metabolic complications of alcoholism are more frequent in women than in men. We also observed that overall medical co-morbidity, as measured by a version of CIRS adapted to Substance Abuse (CIRS-SA) was mild or moderate at admission and that overall mortality was almost 20 times higher in this patients than in age-adjusted general population. The results of above mentioned studies have been published in biomedical journals through four original manuscripts; research has been disseminated to the scientific community and society through specialized channels reporting biomedical research.

Date of Award	14 Jul 2014
Original language	Spanish
Supervisor	Roberto Muga Bustamante (Director)