-
Hepatology 03/2011; 53(3):1056-7. · 11.66 Impact Factor
-
Christine Larsen,
Marie-Laure Chaix,
Yann Le Strat,
Annie Velter,
Anne Gervais,
Isabelle Aupérin,
Laurent Alric,
Xavier Duval,
Patrick Miailhes,
Corinne Pioche,
Stanislas Pol,
Lionel Piroth, Elisabeth Delarocque-Astagneau
[show abstract]
[hide abstract]
ABSTRACT: The HEPAIG study was conducted to better understand Hepatitis C virus (HCV) transmission among human immuno-deficiency (HIV)-infected men who have sex with men (MSM) and assess incidence of HCV infection among this population in France.
Acute HCV infection defined by anti-HCV or HCV ribonucleic acid (RNA) positivity within one year of documented anti-HCV negativity was notified among HIV-infected MSM followed up in HIV/AIDS clinics from a nationwide sampling frame. HIV and HCV infection characteristics, HCV potential exposures and sexual behaviour were collected by the physicians and via self-administered questionnaires. Phylogenetic analysis of the HCV-NS5B region was conducted. HCV incidence was 48/10 000 [95% Confidence Interval (CI):43-54] and 36/10 000 [95% CI: 30-42] in 2006 and 2007, respectively. Among the 80 men enrolled (median age: 40 years), 55% were HIV-diagnosed before 2000, 56% had at least one sexually transmitted infection in the year before HCV diagnosis; 55% were HCV-infected with genotype 4 (15 men in one 4d-cluster), 32.5% with genotype 1 (three 1a-clusters); five men were HCV re-infected; in the six-month preceding HCV diagnosis, 92% reported having casual sexual partners sought online (75.5%) and at sex venues (79%), unprotected anal sex (90%) and fisting (65%); using recreational drugs (62%) and bleeding during sex (55%).
This study emphasizes the role of multiple unprotected sexual practices and recreational drugs use during sex in the HCV emergence in HIV-infected MSM. It becomes essential to adapt prevention strategies and inform HIV-infected MSM with recent acute HCV infection on risk of re-infection and on risk-reduction strategies.
PLoS ONE 01/2011; 6(12):e29322. · 4.09 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Although risk factors for cirrhosis in chronic hepatitis C virus (HCV) infection have been identified, the role of HCV-genotype 3 remains controversial, and limited data are available in drug users. The aim of the study was to assess risk factors for severe liver disease (cirrhosis/hepatocellular carcinoma) in HCV-infected drug users between 2001 and 2007 in France. Patients who reported drug use and who had been referred for HCV infection to hepatology centers from a national surveillance system were identified. The severity of liver disease was assessed clinically and histologically (Metavir score). Factors associated with severe liver disease were analyzed after estimating missing values by multiple imputation (MI). Of the 4,065 drug users naive to anti-HCV treatment who were referred to the 26 participating centers, 8.0% had severe liver disease, 25.7% were infected with HCV-genotype 3. Factors associated independently with an increased risk of severe liver disease were HCV-genotype 3 (adjusted odds ratio, multiple imputation (aOR(MI)) = 1.6, [95% confidence interval, 95% CI: 1.2-2.1]), HIV infection (aOR(MI) = 1.8, [1.2-2.8]), male sex (aOR(MI) = 2.0, [1.4-2.8]), age over 40 years (aOR(MI) = 2.1, [1.6-2.9]), history of excessive alcohol consumption (aOR(MI) = 2.8, [2.1-3.7]), and duration of infection ≥18 years (aOR(MI) = 2.9, [2.0-4.3]). This analysis shows that HCV-genotype 3 is associated with severe liver disease in drug users, independently of age, sex, duration of infection, alcohol consumption, and co-infection with HIV. These results are in favor of earlier treatment for drug users infected with HCV- genotype 3 and confirm the need for concomitant care for excessive alcohol consumption.
Journal of Medical Virology 10/2010; 82(10):1647-54. · 2.82 Impact Factor
-
Lionel Piroth,
Christine Larsen,
Christine Binquet,
Laurent Alric,
Isabelle Auperin,
Marie-Laure Chaix,
Stéphanie Dominguez,
Xavier Duval,
Anne Gervais,
Jade Ghosn, Elisabeth Delarocque-Astagneau,
Stanislas Pol
[show abstract]
[hide abstract]
ABSTRACT: Acute hepatitis C continues to be a concern in men who have sex with men (MSM), and its optimal management has yet to be established. In this study, the clinical, biological, and therapeutic data of 53 human immunodeficiency virus (HIV)-infected MSM included in a multicenter prospective study on acute hepatitis C in 2006-2007 were retrospectively collected and analyzed. The mean hepatitis C virus (HCV) viral load at diagnosis was 5.8 ± 1.1 log(10) IU/mL (genotype 4, n = 28; genotype 1, n = 14, genotype 3, n = 7). The cumulative rates of spontaneous HCV clearance were 11.0% and 16.5% 3 and 6 months after diagnosis, respectively. Forty patients were treated, 38 of whom received pegylated interferon and ribavirin. The mean duration of HCV therapy was 39 ± 17 weeks (24 ± 4 weeks in 14 cases). On treatment, 18/36 (50.0%; 95% confidence interval 34.3-65.7) patients had undetectable HCV RNA at week 4 (RVR), and 32/39 (82.1%; 95 confidence interval 70.0-94.1) achieved sustained virological response (SVR). SVR did not correlate with pretreatment parameters, including HCV genotype, but correlated with RVR (predictive positive value of 94.4%) and with effective duration of HCV therapy (64.3% for 24 ± 4 weeks versus 92.0% for longer treatment; P = 0.03). Conclusion: The low rate of spontaneous clearance and the high SVR rates argue for early HCV therapy following diagnosis of acute hepatitis C in HIV-infected MSM. Pegylated interferon and ribavirin seem to be the best option. The duration of treatment should be modulated according to RVR, with a 24-week course for patients presenting RVR and a 48-week course for those who do not, irrespectively of HCV genotype.
Hepatology 09/2010; 52(6):1915-21. · 11.66 Impact Factor
-
Christine Meffre,
Yann Le Strat, Elisabeth Delarocque-Astagneau,
Fréderic Dubois,
Denise Antona,
Jean-Marie Lemasson,
Josiane Warszawski,
Josiane Steinmetz,
Dominique Coste,
Jean-François Meyer,
Sandrine Leiser,
Jean-Pierre Giordanella,
René Gueguen,
Jean-Claude Desenclos
[show abstract]
[hide abstract]
ABSTRACT: To monitor the prevalence of hepatitis B and hepatitis C a cross-sectional survey was conducted in 2004 among French metropolitan residents. A complex sampling design was used to enroll 14,416 adult participants aged 18-80 years. Data collected included demographic and social characteristics and risk factors. Sera were tested for anti-HCV, HCV-RNA, anti-HBc and HBsAg. Data were analyzed with SUDAAN software to provide weighted estimates for the French metropolitan resident population. The overall anti-HCV prevalence was 0.84% (95% CI: 0.65-1.10). Among anti-HCV positive individuals, 57.4% (95% CI: 43.2-70.5) knew their status. Factors associated independently with positive anti-HCV were drug use (intravenous and nasal), blood transfusion before 1992, a history of tattoos, low socioeconomic status, being born in a country where anti-HCV prevalence >2.5%, and age >29 years. The overall anti-HBc prevalence was 7.3% (95%: 6.5-8.2). Independent risk factors for anti-HBc were intravenous drug use, being a man who has sex with men, low socioeconomic status, a stay in a psychiatric facility or facility for the mentally disabled, <12 years of education, being born in a country where HBsAg prevalence >2%, age >29 and male sex. The HCV RNA and HBsAg prevalence were 0.53% (95% CI: 0.40-0.70) and 0.65% (95% CI: 0.45-0.93), respectively. Among HBsAg positive individuals, 44.8% (95% CI: 22.8-69.1) knew their status. Anti-HCV prevalence was close to the 1990s estimates whereas HBsAg prevalence estimate was greater than expected. Screening of hepatitis B and C should be strengthened and should account for social vulnerability.
Journal of Medical Virology 02/2010; 82(4):546-55. · 2.82 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The current French hepatitis C virus infection screening programme is not yet reaching all populations at risk. In order to better identify individuals that would benefit from a screening test, we investigated an expanded combination of personal characteristics as potential screening criteria for this infection.
We constructed two multiple-regression models predicting hepatitis C antibody seropositivity using the population sample from the 2004 French national hepatitis C antibody seroprevalence survey (SPS) (n = 14 416): one representing current screening guidelines and another constructed from personal characteristics collected for the SPS. Performance of the two predictive models was statistically compared and we internally validated the better performing model.
The expanded screening criteria model better discriminated seropositive and seronegative individuals [area under the ROC curve (AUC) 0.869 (95% CI 0.861-0.873)] than the current screening guidelines model [AUC 0.821 (95% CI 0.810-0.824)]. This performance difference was statistically significant (P < 0.00001). The expanded criteria model contains the variables age, sex, pre-1992 blood transfusion, intra-venous drug use, receipt of medical welfare for precarious individuals, previous surgeries, illicit nasal drug use, previous hepatitis C screening, tattoo, raised alanine aminotransferase level and birth in a hepatitis C high/moderate-prevalence country.
Results indicate that an expanded combination of screening criteria better predicted hepatitis C antibody status and thus individuals needing screening than the current French-screening guidelines. The proposed combination of screening criteria could more effectively target hepatitis C risk-populations in France and could serve as the basis for a decision-making screening tool for the general population.
The European Journal of Public Health 09/2009; 19(5):527-33. · 2.73 Impact Factor
-
Patrick Marcellin,
Françoise Pequignot, Elisabeth Delarocque-Astagneau,
Jean-Pierre Zarski,
Nathalie Ganne,
Patrick Hillon,
Denise Antona,
Martine Bovet,
Murielle Mechain,
Tarik Asselah,
Jean-Claude Desenclos,
Eric Jougla
[show abstract]
[hide abstract]
ABSTRACT: Mortality related to HCV and HBV infections was estimated in France.
A random sample (n=999) of death certificates was obtained from all death certificates listing HBV, HCV, hepatitis, liver disease, possible complication of cirrhosis, bacterial infection, HIV, or transplantation (n=65,000) in France in 2001. Physicians who reported the deaths were sent a questionnaire to identify how many deaths were related to HBV/HCV infection. Completed forms were independently analyzed by a panel of hepatologists. Death rates were estimated according to national population census data.
Estimated annual number of deaths associated with HCV and HBV infection was 3618 and 1507, respectively (6.1 and 2.5 deaths per 100,000 inhabitants, respectively). Estimated number of deaths attributable to HCV or HBV infection was 2646 and 1327, respectively (4.5 and 2.2 deaths per 100,000 inhabitants, respectively). In the HCV infection group, 95 percent had cirrhosis; 33 percent had hepatocellular carcinoma (HCC). In the HBV infection group, 93 percent had cirrhosis; 35 percent had HCC. Eleven percent of deaths occurred in patients with HIV coinfection. Deaths related to HBV or HCV infection occurred at an earlier age in patients with a history of excessive alcohol consumption.
In France, 4000-5000 deaths related to HCV and HBV infection occurred in 2001. Alcohol consumption and HIV infection were important co-factors. These data emphasize the need for ongoing, efficient public health programs that include screening, management, and counseling for HCV- and HBV-infected individuals.
Journal of Hepatology 03/2008; 48(2):200-7. · 9.26 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Risk factors for hepatitis C virus (HCV) infection have rarely been estimated using incident case-control studies in the "general" population. We undertook a case-control study of incident HCV infection to identify persistent modes of transmission in France.
Two types of case-patients were included: (1) repeat blood donors who seroconverted between 1998 and 2001 (with a last negative third-generation test reported from 1995 or after) and (2) seroconverters referred to hepatology departments in 2000 through 2001. For each case-patient, four age- and sex-matched controls were randomly selected from the population of occurrence. Data on risk factors were recorded for each case-patient's and matched control's referent exposure period (between last negative and first positive tests).
Sixty-four case-patients and 227 controls were included. In univariate analysis, endoscopy (matched odds ratios [mORs] = 8.0; 95% confidence intervals [CI] = 2.3-27.2), general anesthesia (mOR = 5.6; 95% CI = 2.2-14.7), tattooing or body piercing (mOR = 8.8; 95% CI = 1.7-44.1), and intravenous (IV) drug use (p < 0.0001; mOR not defined) were associated with HCV seroconversion. In multivariate analysis, risk factors associated with HCV seroconversion were drug use (adjusted OR [aOR] = 109.0; 95% CI = 11.7-1015.8), digestive endoscopy (aOR = 5.7; CI = 1.4-23.8), and invasive radiology procedures (aOR = 11.6; CI = 1.7-78.5).
The results showed the continuing major role of IV drug use and suggested that transmission related to invasive health care remained a potential source of new HCV infection between 1995 and 2001.
Annals of Epidemiology 10/2007; 17(10):755-62. · 3.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We investigated the source of infection in a patient who developed acute hepatitis C virus infection after cardiothoracic surgery. A healthcare worker was found to be infected with hepatitis C virus, and molecular analysis indicated the strain was similar to that found in the patient. The exact mode of transmission was not identified; however, atopic eczema on the healthcare worker's hands may have contributed to the transmission.
Infection Control and Hospital Epidemiology 03/2007; 28(2):227-9. · 3.67 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Our study aimed to identify factors associated with the occurrence of severe liver disease in hepatitis C virus (HCV) positive patients at first referral to hepatology reference centers in France in 2001.
Patients reported through the national hospital-based hepatitis C surveillance system in 2001 were included. The definition of severe liver disease was based on clinical, biological, and morphological evaluation; cirrhosis (+/- complication) and primary liver cancer were classified as severe liver disease. Patient characteristics were compared for those with and without severe liver disease.
Of the 3404 newly referred patients in the 26 participating centers, 391 (11.5%) had severe liver disease. Male gender (adjusted odds ratios [aOR]=1.4; 95% confidence interval [CI], 1.0-1.9), age over 39 years at referral (aOR=3.8; 95% CI, 2.7-5.3), past excessive alcohol consumption (aOR=2.6; 95% CI, 1.9-3.5), and HIV seropositivity (aOR=1.9; 95% CI, 1.1-3.3) were each independently associated with an increased risk of severe liver disease. In the subgroup of patients with known age at time of HCV exposure, age over 39 years at time of exposure (aOR=1.6; 95% CI, 1.1-2.4), duration of HCV infection over 15 years (aOR=2.6; 95% CI, 1.8-3.7), known HBs antigen positivity (aOR=2.4; 95% CI, 1.1-5.2), and past excessive alcohol consumption (aOR=2.7; 95% CI, 1.8-3.9) were each associated with increased risk of severe liver disease.
Our findings underscore the important role of past excessive alcohol consumption on the development of severe liver disease for HCV patients.
Annals of Epidemiology 10/2005; 15(8):551-7. · 3.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To identify the routes of transmission during an outbreak of infection with hepatitis C virus (HCV) genotype 2a/2c in a hemodialysis unit.
A matched case-control study was conducted to identify risk factors for HCV seroconversion. Direct observation and staff interviews were conducted to assess infection control practices. Molecular methods were used in a comparison of HCV infecting isolates from the case-patients and from patients infected with the 2a/2c genotype before admission to the unit.
A hemodialysis unit treating an average of 90 patients.
A case-patient was defined as a patient receiving hemodialysis with a seroconversion for HCV genotype 2a/2c between January 1994 and July 1997 who had received dialysis in the unit during the 3 months before the onset of disease. For each case-patient, 3 control-patients were randomly selected among all susceptible patients treated in the unit during the presumed contamination period of the case-patient.
HCV seroconversion was associated with the number of hemodialysis sessions undergone on a machine shared with (odds ratio [OR] per additional session, 1.3; 95% confidence interval [CI95], 0.9 to 1.8) or in the same room as (OR per additional session, 1.1; CI95, 1.0 to 1.2) a patient who was anti-HCV (genotype 2a/2c) positive. We observed several breaches in infection control procedures. Wetting of transducer protectors in the external pressure tubing sets with patient blood reflux was observed, leading to a potential contamination by blood of the pressure-sensing port of the machine, which is not accessible to routine disinfection. The molecular analysis of HCV infecting isolates identified among the case-patients revealed two groups of identical isolates similar to those of two patients infected before admission to the unit.
The results suggest patient-to-patient transmission of HCV by breaches in infection control practices and possible contamination of the machine. No additional cases have occurred since the reinforcement of infection control procedures and the use of a second transducer protector.
Infection Control and Hospital Epidemiology 07/2002; 23(6):328-34. · 3.67 Impact Factor
-
Christine Larsen,
Corinne Pioche,
Cécile Brouard,
Stéphane Chevaliez,
Patrice Couzigou, Elisabeth Delarocque-Astagneau,
François Denis,
Odile Goria,
Dominique Guyader,
Patrick Hillon,
P. Marcellin,
Dominique Roulot,
Françoise Roudot-Thoraval,
Christine Silvain,
Jean-Pierre Zarski,
Caroline Semaille,
Groupe Des Pôles De Référence Et Laboratoires De Virologie
[show abstract]
[hide abstract]
ABSTRACT: La surveillance nationale de l'hépatite B chronique a été mise en place en 2008, en collaboration avec les pôles de ré- férence (services hospitalo-universitaires d'hépatologie), pour décrire les caractéristiques épidémiologiques et clinico- biologiques des patients nouvellement pris en charge pour une hépatite B chronique. L'hépatite B chronique est définie par le portage de l'antigène HBs (AgHBs) depuis plus de six mois. Les caractéristiques des patients qui sont recueillies incluent les modalités de découverte de l'AgHBs et leurs expositions à risque vis-à-vis du virus de l'hépatite B (VHB). Nous présentons certaines caractéristiques des patients naïfs de traitement antiviral, selon le niveau de prévalence de l'AgHBs du pays de naissance (endémicité faible vs. moyenne/forte). Entre janvier 2008 et août 2009, 1 016 patients ont été pris en charge, dont 78% sont nés dans une zone de moyenne ou forte endémicité VHB. La découverte de l'AgHBs est fortuite pour 69% des patients. Le délai entre le dépistage et la prise en charge, déterminé pour 837 patients, est supérieur à trois ans pour 41% des patients nés en zone de faible endémicité et pour 22% de ceux nés ailleurs. Ces résultats préliminaires suggèrent des pratiques de dépistage de l'AgHBs imparfaites et un retard à la prise en charge des personnes dépistées, en particulier celles nées dans une zone de faible endémicité VHB.
Bulletin Epidémiologique Hebdomadaire Web.
