13 th International Workshop on HIV & Hepatitis Co-infection June 2017 Lisbon, Portugal

Transcription

1 13 th International Workshop on HIV & Hepatitis Co-infection June 2017 Lisbon, Portugal Outbreak of acute hepatitis A in men who have sex with men in Experience with 26 patients Serviço de Doenças Infecciosas Hospital de Curry Cabral - CHLC, Lisboa, Portugal Authors: Garrote A 1, Simões P 1, Caeiro A 1, Pinheiro H 1, Ramirez F 1, Betkova S 1, Gonçalves R 1, Cabo J 1, Alves L 1,Cardoso S 2, Lino S 2, Póvoas D 2, Seixas D 2, Cardoso O 2, Martins T 2, Garrido N 2, Manata M 2, Sousa R 3, Maltez F 4 1- Resident at Infectious Diseases Department, Hospital de Curry Cabral 2- Hospitalar Assistent at Infectious Diseases Department, Hospital de Curry Cabral 3- Researcher at Instituto Nacional de Saúde Dr. Ricardo Jorge 4- Director of Infectious Diseases Department, Hospital de Curry Cabral

2 Background Hepatitis A (HA) remains one of the most frequently reported infectious diseases that is preventable by vaccine. Most commonly acquired through contaminated food via the faecal-oral route. Risk groups: persons working in institutions international travelers men who have sex with men (MSM) Periodic acute HA outbreaks among MSM have been reported since early 90 s. Between 1 st January and 24 th April 2017, 211 acute hepatitis A cases were notified in Portugal, mainly in the metropolitan region of Lisbon. 1 1 Hepatite A em Portugal: Resumo epidemiológico de 8 de maio de 2017; Direção-Geral da Saúde e Instituto Nacional de Saúde Dr. Ricardo Jorge

3 Objectives, materials and methods Objectives Characterization of acute HA cases in human immunodeficiency virus (HIV) infected persons observed in Infectious Diseases Department Materials and methods Observational study, including all cases of acute HA in patients with HIV Data were collected by reviewing the clinical files from 1 st January until 24 th April 2017 Confirmed case 1) symptoms onset after 1 st January ) specific serology 3) outbreak specific genomic viral sequence (strain VRD_521_2016) Probable case 1); 2) and history of contact with a confirmed case and/or who self identifies as MSM

4 Results Number of patients with acute hepatitis A (n=52) 21% 29% 50% 52 cases of acute HA 26 (50%) HIV + 15 confirmed cases 11 probable cases 5 HIV new diagnostic HA HIV+HA (probable) HIV+HA (confirmed) 100% MSM (19,23%)

5 N er patients N er patients Results 26 co-infected HAV/HIV patients Nationality Portugal Brazil France Age (years old) Portugal- 69,23% Brazil- 26,92% France- 3,85% Age Minimum Maximum Average Years

6 Results 26 co-infected HAV/HIV patients Provenance Emergency service Infectious diseases outpatient clinic 16 (61,54%) 10 (38,46%) After the diagnosis Hospitalization Outpatient clinic 11 (42,31%) 15 (57,69%) 11 hospitalizations (42.30%) 1 abandonment hospital 0 fulminant hepatitis 0 death

7 Results 26 co-infected HAV/HIV patients > 50% had past history of sexually transmitted diseases: Syphilis Genital herpes Human papillomavirus infection Chlamydia trachomatis proctitis Additive substances Habits Smoking Alcoholic Recreational drugs Yes * No *None reported intravenous drug use

8 N er patients Results 26 co-infected HAV/HIV patients Nausea and vomiting- 77% Anorexia and malaise- 69 % Fever- 65 % 25 Symptoms and signs Anorexia and malaise Nausea and vomiting Abdominal Pain Jaundice Pruritus Coluria Acolia Fever Hepatomegaly 3

9 Results 26 co-infected HAV/HIV patients Average of laboratory values AST (U/L) ALT (U/L) GGT (U/L) AP (U/L) T Bil (mg/dl) Platelets * (x 10^9/L) PT** (seconds) Maximum ,40-18,4 Minimum , Average (HA***/HIV) Average (HA***) * 3 patients; ** 14 patients , , Serologies ***Acute hepatitis A HAV IgM/IgG antibodies N er patients +/+ 24 +/- 2 HBsAg Neg 26 Pos 0 Anti-HCV Ab Neg 26 Pos 0

10 N er patients Results 26 co-infected HAV/VIH [ [ T CD4 + lymphocytes/µl 76,92% New diagnosis Chronic diagnosis T CD4 + lymphocytes/µl

11 N er patients Results 26 co-infected HAV/VIH patients HIV RNA <50 cp/ml 53,85% New diagnosis Chronic diagnosis < 50 [ [ [10^3-10^4[ [10^4-10^5[ [10^5-10^6[ Viral load cp/ml

12 Conclusions Essential to promote: MSM are in particular risk for HAV infection active information and education in safe sexual practices personal hygiene measures HAV vaccination post exposure prophylaxis measures in close contacts Finally, it is important to exclude other sexually transmitted diseases in acute HAV infection cases