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Master Thesis

Analyse épidémiologique, virologique et comportementale de l’hépatite C sexuelle dans la communauté HSH VIH + à Bordeaux

Abstract : Objectives: sexual hepatitis C is increasingly reported but little is known about behavioural and virological risk factors for this route of transmission. Our objective was to analyse the sexual behaviour of HIV+ MSM who sexually acquired hepatitis C and to highlight the presence of transmission clusters. Methods: this was a monocentric longitudinal observational, three-part study : (i) biological and demographic data (collected from January 1st 2013 to January 31st 2017) were extracted from the ANRS CO3 Aquitaine cohort database and clinicians declarative reports ; (ii) clusters of HCV transmission were identified through phylogenetic analysis of HCV RNA sequences ; (iii) socio-behavioural data were collected through semi-directed interviews (conducted from November 2017 to March 2018). Results: 58 patients were included. Median age at HCV diagnosis was 45.4 years. The incidence cumulative rate of HCV diagnosis in the HIV+ MSM population for the period 2013-2016 was 1.32/100 py. The predominant genotype was 1a. Ten cases of spontaneous viral clearance were observed. Forty-five patients were treated, and six reinfections were diagnosed. The phylogenetic analysis revealed three clusters: Cluster 1, involved 23 patients; Cluster 2 and 3, three patients each. Twenty-eight (48%) patients agreed to participate in the interviews. They were all exclusive MSM, with a median age of 50.5 years. The average number of partners was 4.6 in the last 3 months. 79% declared practicing chemsex, 14% SLAM, and 68% practiced fist-fucking. The association of fist-fucking, relations in group and chemsex during the potentially contaminant intercourse was described by 46% of patients. All patients declared unprotected intercourse. 54% of patients thought that the prevention strategies established by public authorities were ineffective. Conclusion: we identified socio-sexual networks and high-risk sexual practices (chemsex and fist) in a population of HIV+ MSM who sexually acquired hepatitis C. Preventive measures must be adapted to this specific population at high risk of STI acquisition and recontamination.
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Master Thesis
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Nathalie Fournier. Analyse épidémiologique, virologique et comportementale de l’hépatite C sexuelle dans la communauté HSH VIH + à Bordeaux. Médecine humaine et pathologie. 2019. ⟨dumas-02512383⟩



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