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Objective: To determine the extent of transmission of hepatitis C virus in sexual partners of intravenous drug misusers and to examine the relation between the prevalences of HIV, hepatitis B virus, and hepatitis C virus infections in homosexual men and intravenous drug misusers and their sexual partners., Design: Serum samples collected between 1984 and 1988 were tested for hepatitis B virus markers and antibodies against hepatitis C virus by enzyme linked immunosorbent assay (ELISA) and for HIV antibody by enzyme immune analysis and western blotting., Setting: Large referral university hospital with an external AIDS clinic in the metropolitan area of Barcelona, Spain., Subjects: 243 Intravenous drug misusers, 143 of their regular heterosexual partners, and 105 homosexual men., Main Outcome Measures: Prevalences of hepatitis C virus, hepatitis B virus, and HIV infections., Results: In all, 178 of the 243 (73%) intravenous drug misusers, 16 out of 143 (11%) of their partners, and 17 of the 105 (16%) homosexual men had antibodies against hepatitis C virus. The presence of hepatitis C virus infection was unrelated to sex, age, the presence of HIV or hepatitis B virus infections, or the Centers for Disease Control stage of HIV. In sexual partners of intravenous drug misusers there were strong correlations between the presence of hepatitis C virus infection and that of HIV (p = 0.001) and hepatitis B virus (p = 0.013) infections., Conclusions: Intravenous drug misusers have a high risk of acquiring hepatitis C virus, hepatitis B virus, and HIV infections, but the presence of hepatitis C virus infection seems to be unrelated to the presence of the other two viruses. Homosexual men have a high prevalence of HIV and hepatitis B virus infections with a low prevalence of hepatitis C virus infection, the presence of which is not related to that of the other two infections. Conversely, heterosexual partners of intravenous drug misusers have low prevalences of the three virus infections, but the presence of hepatitis C virus infection correlates significantly with the presence of HIV and hepatitis B infections. The rate of sexual transmission of hepatitis C virus seems to be low, even in partners of people known to be seropositive for this virus.

Heterosexual couples of individuals infected by HIV represent a group of high risk of virus infection. We have investigated the presence of fragments of the HIV genome with a new nucleic acid amplification technique (PCR or polymerase chain reaction) in lymphocytes from 33 seronegative couples with anti-HIV antibodies, most of which were heroin addicts. 12 of the 33 couples (36%) had positive PCR for a gag HIV amplimer in the absence of antibodies. 4 of them (12%) also showed reactivity for sequences from an env amplimer. A control group of 7 patients with AIDS and 4 seropositive couples showed reactivity to gag and env in all. It is concluded that silent HIV infection may frequently develop in heterosexual couples of infected individuals.

The effectiveness of different methodologies to identify antigenemia and antibodies against HIV at the time of viral primary infection was evaluated. To this end, 6 consecutive serum samples of a patient who had had symptomatic seroconversion were assessed. The detection of antigenemia was earlier than that of antibodies, although the sensitivity of the three evaluated assays varied greatly. An enzyme immunoassay (EIA) designed with synthetic peptides from the HIV envelope (third generation EIA) was the most sensitive test for antibody detection. Five other tests elaborated with antigenic material from a viral lysate (first generation) or with recombinant proteins (second generation) were reactive later, although the second generation EIA were more sensitive. A rapid immunofiltration test (HIV-Check) had good sensitivity, similar to that of the second generation EIA. Western blotting (WB) identified antibodies against the viral core later than the third generation EIA, and all the bands required for the diagnosis only appeared three weeks later. Therefore, although WB is an excellent method to confirm results from other tests, it may not be definitive for the results at the primary infection period when other particularly sensitive techniques are already diagnostic. We think that the higher sensitivity of EIA tests using synthetic peptides justifies its generalization for sample screening in blood banks.

The progress of 298 heroin addicts treated for different reasons in a general hospital from 1984 to 1987 is followed, in order to know the remission degree of parenteral drug use and mortality rates in heroin abusers, after being treated for organic diseases or undergoing quick detoxification treatment. After an average of 25 months since their first visit or admission, information was obtained in 90% of the cases, and of these, it was confirmed that 4% (11/266) had died and that 6% (15/255) were in prison. Of the remainder, reliable information was obtained from 66% (158/240), of whom 40% were no longer endovenous drug users, while 54% were still addicted to parenteral drugs. The results showed a higher percentage of remission in patients that had been admitted for organic diseases (39/65; 60%) than in those that had been treated for detoxification (30/93; 35%) (p less than 0.05).

We report 7 individuals in whom HIV seroconversion developed, in 6 associated with symptoms and in one without any symptom at all. The most florid and sustained symptoms appeared in the oldest patients: a female and her heterosexual partner, who was a promiscuous male with recent seroconversion. A heroin abuser had oral muguet, and another had esophageal candidiasis. Rash was absent in all cases. Antigenemia was demonstrated in 6 of the 7 patients. In one case, a third generation ELISA was more sensitive than Western blot for the identification of seroconversion.

The usefulness of two alpha-2 adrenergic agonists (clonidine and guanfacine) and their comparative effectiveness were evaluated regarding the control of the opiates abstinence syndrome and the secondary effects, including development of cardiovascular abnormalities, in 88 parenteral heroin abusers admitted to two hospital units for the treatment of addiction. The patients were treated in a random, double blind fashion, with clonidine or guanfacine. In the study dosages, both drugs proved to be useful to control the abstinence syndrome. Nearly 70% of those treated with any of the two agonists were able to complete the treatment. When both drugs were compared, a higher degree of restlessness (p less than 0.01) was found among those treated with clonidine, although there were no differences in any other evaluated parameters to compare the degree of abstinence in each drug. The most commonly found side effects were orthostatism, lassitude, mental torpor and oral xerosis. These were independent of the drug used. There were no differences between both drugs regarding heart rate or blood pressure, although both parameters were significantly modified with the doses used in the study.

HTLV-1 was the first human retrovirus to be isolated. It has been shown that it is the causative agent of T cell leukemia in the adult and some types of subacute myelopathies. The virus is transmitted by similar routes as the AIDS virus. HTLV-1 infection is endemic in South Japan, the Caribbean countries and some African areas. The prevalence of HTLV-1 infection in our country is unknown in the general population and in the groups at high risk. We report the preliminary results of a study of 1279 serum samples from high risk individuals from the Barcelona area. ELISA and Western blotting were used to detect antibodies. We found evidence of anti-HTLV-1 only in 4 of 905 (0.44%) parenteral drug abusers and in 1 of 102 western Africans. Anti-HTLV-1 were not found in the remaining sera from 62 homosexuals, 53 patients with leukemia and/or lymphoma, 3 with idiopathic spastic paraparesis and 154 with multiple blood transfusions. These results suggest that HTLV-1 has a very low diffusion in our area. The 4 positive heroin addicts are the first reported in our country with evidence of HIV and HTLV-1 coinfection.

We have studied retrospectively the presence of serologic markers of type 1 and type 2 human immunodeficiency virus infection in 102 subjects coming from West Africa and living in Catalonia. We have proven the presence of specific antibodies to type 2 human immunodeficiency virus in three asymptomatic subjects among whose epidemiologic antecedents the unique risk factor was heterosexual promiscuity. These three subjects are the first seropositive to type 2 human immunodeficiency virus reported in our country. In none of the studied cases serologic markers of type 1 human immunodeficiency virus infection were detected.

Penetrating wounds of the cornea require immediate repair, generally within 24 hours. Tight closure of the wound and a reformed anterior chamber are the primary goals of surgery. However, there is no guarantee that further surgery will not be required for maintaining the healthy function of the anterior segment. At the second operation the effect of the procedure on the previously repaired wound is of prime importance, since in many cases the operation needs to be done before corneal healing is completed. In our series the lens, which was either partially or completely cataractous at the initial operation, became intumescent at different times afterwards, and an immediate removal was necessary. No change in the preoperative wound sealing or transparency of the cornea could be detected after lens surgery performed between 24 hours and 21 days from the initial corneal repair.

The presence of antibodies against human immunodeficiency virus type 2 (HIV-2) was retrospectively investigated in serum samples from 433 parenteral drug abusers from Barcelona. A third generation ELISA was used for the initial screening of sera, and a specific western blot technique for the definitive confirmation of the results. The presence of anti-HIV-2 was demonstrated in 9 samples (prevalence 2.1%). All of them belonged to patients also infected with HIV-1. The 9 cases reported here are the first seropositive patients for HIV-2 described in native individuals from this country.

Lens damage is present in 30% of perforating injuries of the anterior segment of the eye. There is no consensus on whether the cataractous lens should be removed at the initial repair of the corneal laceration or later, when the eye has recovered from injury. Twenty-seven consecutive cases with a perforating corneal injury and lens damage were alternatively treated either with simultaneous corneal suturing and cataract removal or with corneal suturing and delayed cataract removal several weeks later. The difference in the frequency of complications between the 2 groups was significant. The 1-step procedure was technically easier to perform, the period of postoperative irritation was shorter, complications due to the presence of an injured lens were prevented, and visual rehabilitation occurred earlier.