We studied the prevalence of antibodies against hepatitis C virus (anti-HCV) among 530 household contacts of 225 anti-HCV-positive subjects (index cases). Twenty-six (4.9%) relatives had anti-HCV, a proportion higher than that found among blood donors (175 of 22,435; 0.78%) (p less than 0.001). We did not find any differences regarding the type of relation with the index case (sexual or nonsexual). The prevalence of anti-HCV increased with the age of the relatives, with the contact time with the index case, and with the time of exposure to HCV. On the other hand, the anti-HCV was associated mainly with the existence of cirrhosis or hepatocellular carcinoma in the patient. We concluded that intrafamilial transmission may be an important mechanism in the spread of HCV.

The syndrome of inappropriate secretion of antidiuretic hormone is a common consequence of neurologic and pulmonary infections as well as drug intake and many other clinical situations. Its association with herpes varicella-zoster virus infections is scarcely reported in the literature. It generally appears in immunosuppressed patients suffering from serious underlying diseases. There are also a few cases of syndrome of inappropriate secretion of antidiuretic hormone related to vidarabine use. We report the case of a man infected by human immunodeficiency virus who developed a disseminated herpes varicella-zoster virus infection and symptoms due to hyponatremia caused by antidiuretic hormone excess. The patient was cured with saline hypertonic infusion, water restriction, and intravenous administration of acyclovir. To the best of our knowledge, this is the first case of this association in a human immunodeficiency virus infected patient. We propose the use of acyclovir instead of vidarabine in the management of these situations.

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INTRODUCCIÓNEl avance de la ciencia médica conlleva el descubrimiento de nuevos fármacos o nuevos usos de los ya conocidos. En la práctica clínica diaria tienden a aplicarse estos hallazgos automáticamente, sin valorar las consecuencias que pueden tener. Sobra decir que el problema se acrecienta si por un lado el enfermo es un anciano, grupo de edad que se suele caracterizar por la presencia de múltiples patologías, y de otro si éste es evaluado por diversos médicos que, perdiendo la visión global del paciente, añaden un medicamento sobre otro sin tener en consideración los que ya está consumiendo.Este pensamiento motivó la realización de un estudio preliminar, germen de un estudio más amplio, en el que evaluamos las características del consumo de fármacos en la población mayor de 65 años. PACIENTES Y MÉTODOEstudio observacional, prospectivo, que se realizó entre el 1 de febrero y el 31 de mayo de 2002 en el Hospital Puerta de Hierro de Madrid. La población estudiada fueron los pacientes ancianos que ingresaron en el Servicio de Medicina Interna II en ese periodo de tiempo. El único requisito para su inclusión en el estudio era tener una edad igual o superior a los 65 años. Un total de 53 pacientes fueron admitidos de los que se recogieron sus datos personales, procedencia (residen-25 [0212-7199 (2004)

ABSTRACT— We have studied the prevalence of antibody against hepatitis C virus (anti‐HCV) and its relation to the time of onset of the symptoms in 57 patients with acute non‐A, non‐B hepatitis: 16 post‐transfusion, 25 drug addicts and 16 sporadic cases. In the 1st month after the onset of illness, anti‐HCV was positive in 25% of patients with post‐transfusion hepatitis, 44% of drug addicts and 25% of sporadic hepatitis. In the 3rd month this antibody was detected in 75%, 88% and 31.2%, and in the 6th month in 87.5%, 96% and 31.2%, respectively. The prevalence in the 3rd and 6th months was significantly higher in post‐transfusion patients and drug addicts than in sporadic cases. In the 6th month the prevalence of anti‐HCV in patients who progressed towards chronicity was also significantly higher than in those with acute resolving non‐A, non‐B hepatitis (94% vs 50%, p<0.001). These results show that HCV is probably the main agent in acute post‐tranfusion non‐A, non‐B hepatitis and in those occurring in drug addicts, and that in a high proportion of these patients the anti‐HCV can be detected in the 3rd month after the beginning of the symptoms. On the other hand, the relation of hepatitis C virus with sporadic acute non‐A, non‐B hepatitis may be doubtful.