Acute hepatitis C infection in HIV positive men who have sex with men in Paris, France, 2001-2004.
In mid-2004, three Parisian hospital wards informed the Institut de veille sanitaire of recent acute hepatitis C in HIV-infected (HIV+) men who had sex with men (MSM). These cases for whom none of the usual bloodborne routes for hepatitis C (HCV) transmission was found, reported having had unprotected sex. In October 2004, we conducted a retrospective investigation in Parisian hospital wards to explore HCV modes of transmission in recent acute hepatitis C in HIV+ MSM. Patient demographics, clinical and biological status of HIV infection, reasons for HCV testing, sexual behaviour and risk factors for HCV transmission within the 6 months before hepatitis onset were collected from medical records. An anonymous self-administered questionnaire on sexual behaviour within the six months before hepatitis onset was also offered to all cases. We identified 29 cases of acute hepatitis C in HIV+ MSM with onset from April 2001 to October 2004. HIV infection was asymptomatic for 76%. Median age at hepatitis C onset was 40 (28-54) years. In all records, were noted unprotected anal sex, fisting in 21% and a concomitant sexually transmitted infection (STI) in 41%. Median time between HIV diagnosis and HCV infection was 6.5 years (0-22). From the 11 self-administered questionnaires completed, 10 reported an STI, 8 'hard' sexual practices, 6 bleeding during sex and 5 fisting. HCV transmission probably occurred through bleeding during unprotected traumatic anal sex among HIV+ MSM and may be facilitated by STI mucosal lesions. This report stresses the continuous need to strongly advocate safer sex to MSM.
Gambotti
L
L
Institut de veille sanitaire, Saint-Maurice, France.
Batisse
D
D
Colin-de-Verdiere
N
N
Delaroque-Astagneau
E
E
Desenclos
J C
JC
Dominguez
S
S
Dupont
C
C
Duval
X
X
Gervais
A
A
Ghosn
J
J
Larsen
C
C
Pol
S
S
Serpaggi
J
J
Simon
A
A
Valantin
M A
MA
Velter
A
A
D000208:Acute Disease; D000328:Adult; D015897:Comorbidity; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D018562:Disease Transmission, Infectious / Q000706:statistics & numerical data*; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D006526:Hepatitis C / Q000453:epidemiology* / Q000635:transmission; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D019529:Sexuality / Q000706:statistics & numerical data; D015229:Sexually Transmitted Diseases, Viral / Q000453:epidemiology*