男男性行为者中丙型肝炎感染、筛查及相关因素的流行情况：一项横断面调查（PREVAGAY），法国，2015 年。
Prevalence of hepatitis C infection, screening and associated factors among men who have sex with men attending gay venues: a cross-sectional survey (PREVAGAY), France, 2015.
机构信息
Department of Infectious Diseases - Santé publique France, French national public health agency, 12 rue du Val d'Osne, 94415, Saint-Maurice, Cedex, France.
National Reference Center for Viral Hepatitis B, C and Delta, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France.
出版信息
BMC Infect Dis. 2019 Apr 11;19(1):315. doi: 10.1186/s12879-019-3945-z.
BACKGROUND
Over the last 20 years, Hepatitis C virus (HCV) infection prevalence has dramatically increased among HIV-infected men who have sex with men (MSM) in many countries worldwide. It is suspected that this increase is primarily driven by sexual behaviours linked to blood exposure. Monitoring these behaviours is crucial to understand the drivers of the epidemic. This study assessed the prevalence of chronic HCV infection among MSM attending gay venues and associated chronic HCV risk factors. HCV screening and associated factors were described.
METHODS
The cross-sectional survey PREVAGAY, based on time-location sampling, was conducted in 2015 among MSM attending gay venues in 5 French metropolitan cities. A self-administered questionnaire was completed and capillary whole blood on dried blood spots (DBS) collected. Possible factors associated with chronic HCV prevalence and with HCV screening in the previous year were investigated using Poisson regression.
RESULTS
Chronic HCV infection prevalence from DBS analysis was 0.7% [IC95%: 0.3-1.5] in the study's 2645 participants and was 3.0% [1.5-5.8] in HIV-positive MSM. It was significantly higher in those who reported the following: (lifetime) slamming (with or without the sharing of injection equipment); (during the previous year) fisting and chemsex, unprotected anal intercourse with casual partners, using gay websites and/or of mobile-based GPS applications, and having more than 10 sexual partners. Only 41.3% [38.2-44.5] of the participants reported HCV screening during the previous year. Screening was significantly more frequent in MSM under 30 years of age, those who were HIV-positive, those vaccinated against hepatitis B and meningococcus C, and those who reported the following (during the previous year): more than 10 sexual partners, at least one sexually transmitted infection and fisting.
CONCLUSION
Chronic HCV infection prevalence in MSM attending gay venues was significantly higher in HIV-positive MSM and in those with risky sexual behaviours. Reflecting current screening recommendations for specific populations, previous HCV screening was more frequent in HIV-positive individuals and those with risky sexual behaviours. Nevertheless, HCV screening coverage needs to be improved in these populations. Comprehensive medical management, which combines screening and linkage to care with prevention strategies, is essential to control HCV among MSM.
背景
在过去的 20 年中，在全球许多国家，感染艾滋病毒的男男性行为者（MSM）中丙型肝炎病毒（HCV）感染的流行率显著增加。据推测，这种增加主要是由与血液接触相关的性行为驱动的。监测这些行为对于了解疫情的驱动因素至关重要。本研究评估了在参加同性恋场所的 MSM 中慢性 HCV 感染的流行率，并评估了与慢性 HCV 相关的危险因素。描述了 HCV 筛查和相关因素。
方法
2015 年，基于时间-地点抽样，在法国 5 个大都市的同性恋场所对 MSM 进行了横断面调查 PREVAGAY。参与者完成了一份自我管理问卷，并采集了毛细血管全血的干血斑（DBS）。使用泊松回归分析了与慢性 HCV 流行率和前一年 HCV 筛查相关的可能因素。
结果
在研究的 2645 名参与者中，通过 DBS 分析检测到慢性 HCV 感染的流行率为 0.7%[95%CI：0.3-1.5]，在 HIV 阳性的 MSM 中为 3.0%[1.5-5.8]。在报告以下情况的参与者中，感染率显著更高：（终身）猛击（有或没有共用注射设备）；（在过去一年中）拳交和化学性行为、与偶然伴侣进行无保护肛交、使用同性恋网站和/或基于移动的 GPS 应用程序、以及有 10 多个性伴侣。只有 41.3%[38.2-44.5]的参与者在前一年接受了 HCV 筛查。在年龄在 30 岁以下、HIV 阳性、乙型肝炎和脑膜炎球菌 C 疫苗接种的 MSM 中，以及在报告以下情况的参与者中，筛查更为频繁：有 10 多个性伴侣、至少一种性传播感染和拳交。
结论
在参加同性恋场所的 MSM 中，慢性 HCV 感染的流行率在 HIV 阳性 MSM 和有风险性行为的 MSM 中显著更高。反映当前针对特定人群的筛查建议，在 HIV 阳性个体和有风险性行为的个体中，HCV 筛查更为频繁。然而，这些人群的 HCV 筛查覆盖率仍有待提高。全面的医疗管理，将筛查与护理联系起来，并结合预防策略，对于控制 MSM 中的 HCV 至关重要。
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