Séroprévalence de l’hépatite E chez les PVVIH au Pays Basque

Abstract : Objectives: the aim of the study was to assess the seroprevalence of hepatitis E in patient with HIV in the Basque Country and to identify the factors associated with the infection and impact on the liver. Methods: a sample of 307 HIV patients aged 19 to 84 years was examined by a Wantai serological test with anti-HEV IgG and IgM antibodies. Positive serology was tested for HEV RNA. The transmission factors of the virus were detected by a self-administered questionnaire. Hepatic impairment was assessed by fibrotest in HIV / HCV co-infected patients. A univariate and then multivariate analysis of the association between factors and exposure to the virus was carried out. Results: a total of 307 patients were included and had a median of 52 years, 220 of whom were men (71.6%). The median number of T4 was 744 cells / mm3 and T8 819 cells / mm3. 282 patients (91.9%) had HIV viral load <50 copies / ml. The seroprevalence of anti-HEV IgG was 20.8%. Only 2 patients had positive HEV IgM and no positive PCR in the blood. In univariate analysis, the presence of anti-HEV IgG was associated with the purchase of meat from individuals and the presence of TPHA / VDRL markers. In multivariate analysis, 2 models confirmed a significant association with serological markers of syphilis. In the model based on the VDRL presence, was also associated the age of more than 50 years. Seafood consumed at least once a week (OR = 2.12 ; 0.96-4.67) (p = 0.06) and drug use (OR = 2.21 ; 0.75-6.5) (p = 0.15) would tend to be a risk factor for exposure to HEV. Furthermore, living in rural areas, a nadir score of less than 200 cells / mm3 and a CD4 count> 800 cells / mm3 were considered as independent variables, associated with the absence of anti-HEV antibodies At the biological level, patients with anti-HEV IgG had higher transaminases, lower T4 and T8 but a conserved ratio. 7.5% of HIV were co-infected with HBV / HEV, 2.6% were HCV / HEV and 1.63% HBV / HCV / HEV. Among patients co-infected with HCV, fibrotest was not higher in HIV/HEV +. Conclusion: exposure to HEV among HIV in the Basque Country is common and increases with age. The association between the presence of syphilis markers, particularly VDRL and anti-HEV IgG may suggest a similar mode of transmission, most likely particularly sexual. Further studies are needed to determine the potential for sexually transmitted HEV transmission, particularly in a population at high risk of IST.
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Master Thesis
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Charlotte Le Guennec. Séroprévalence de l’hépatite E chez les PVVIH au Pays Basque. Médecine humaine et pathologie. 2017. ⟨dumas-01622903⟩



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