Hepatitis A outbreak in HIV-infected patients in Southeastern France: questions and responses?

Abstract

During the 2017 European hepatitis A (HA) outbreak we assessed HA incidence in our cohort of 2300 HIV-infected patients, implemented preventive measures and evaluated practices and knowledge on sexually transmitted diseases (STD). HA incidence was assessed between 1 January 2017 and 31 December 2017 and included all symptomatic patients with virologically confirmed HA. Preventive measures consisted in identifying at risk and not immunised patients to propose them a free HAV vaccination, and an anonymous survey related to transmission routes of STD and to sexual behaviours. Twenty HA were diagnosed. All were homosexual men recently diagnosed with HIV and another STD. None were vaccinated against hepatitis A virus (HAV). Hospitalisation was required for 52%. We identified 250 patients at risk to acquire HAV and invited them to a free immunisation program. A total of 110 (44%) were vaccinated, of whom 74 responded to our survey. A majority of them (84%) reported recent active anal and oral sexuality with multiple (52%) male partners (81%), and ChemSex consumption (14%). Internet was the meeting link for 58%. Another STD history was found in 69%. One third of these individuals had no idea about STD transmission modes. This HA outbreak pointed the insufficient vaccine coverage against HAV and knowledge on STD, which may be improved by Internet.

Fatal Fulminant Hepatitis E in a Diabetic Patient on Metformin

“…The other major causes of hepatitis, including hepatitis B, C, and D viruses, cytomegalovirus, Epstein–Barr virus, and herpes simplex virus were excluded by serology and/or PCR. Anti-hepatitis A virus (HAV) IgM (Architect assay: index, 5.46 (positivity threshold, 1.2) (Abbott Laboratories, IL, USA); Vidas assay: index, 0.91 (positivity threshold, 0.5) (bioMérieux, Meylan, France) and IgG (Architect assay: ODR = 7.9) were detected, but HAV RNA testing (in house real-time reverse transcriptase PCR [ 6 ]) was negative. This suggested either recent resolved HAV infection or false-positivity of anti-HAV IgM; no information was obtained regarding prior anti-HAV vaccine immunization.…”

“…Anti-HAV IgM was also determined with the Vidas assay (bioMérieux, Meylan, France). HAV RNA in the serum was determined using an in house real-time reverse transcriptase PCR procedure [ 6 ]. The HEV genotype was determined through phylogenetic analysis and through the Hepatitis E Virus Genotyping Tool v0.1 ( , accessed on 17 September 2022) after Sanger sequencing was performed using an in-house procedure [ 5 ].…”

Hepatitis A Outbreak in Men Who Have Sex with Men Using Pre-Exposure Prophylaxis and People Living with HIV in Croatia, January to October 2022

“…Hepatitis A outbreaks were described among PLWH and PrEP users during the 2017/2018 European epidemic [ 8 , 9 , 10 , 11 , 12 , 13 ]. In a report from two tertiary centers in northern Italy during the HAV outbreak, MSM status and HIV infection did not have an impact on the clinical course nor severity of illness [ 14 ].…”

“…The European outbreak of hepatitis A during 2017/2018 was reported from a number of countries. The increase in HAV cases was observed mostly among younger MSM ( Table 3 ) [ 4 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. In a study from the Netherlands among MSM visiting the Sexually Transmitted Infection Clinic in Amsterdam, HAV seropositivity determinants in a multivariable analysis were older ( p < 0.001), came from an HAV endemic country ( p < 0.001) and were HBV seropositive ( p = 0.001) [ 35 ].…”

Delays in Hepatitis A vaccination in people with HIV in Houston, Texas between 2010 and 2018

“…While HAV infection is most commonly acquired through ingestion of fecally contaminated food or water or through the fecal-oral route, infection may also occur through sexual transmission, particularly in men who have sex with men (MSM), and through injection drug use (IDU) [6] , [7] , [8] , [9] . HAV outbreaks have increased worldwide over the past decade, notably among persons experiencing homelessness, those who inject drugs, MSM, and PWH [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] .…”