Seroprevalencija i faktori rizika za infekciju virusom hepatitisa C u skupinama rizičnog spolnog ponašanja

Vilibić Čavlek, Tatjana (2009) Seroprevalencija i faktori rizika za infekciju virusom hepatitisa C u skupinama rizičnog spolnog ponašanja. PhD thesis, Sveučilište u Zagrebu.

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Abstract

We analyzed the seroprevalence, genotypes and risk factors for HCV infection in groups with high-risk sexual behavior: persons with multiple sexual partners, men who have sex with men (MSM), commercial sex workers and their clients (CSW) and persons with sexually transmitted diseases (STDs). Control group consisted of pregnant females. A total of 821 patients were enrolled in the study: 716 (87.2%) males and 105 (12.8%) females. The mean age was 35.8+11.5 years. Median age was 32 years (range 18-77 years). Seventy-one point five percent of participants reported one risk sexual behavior, 25.2% reported two, 3.2% reported three and 0.1% of participants reported four risk sexual behaviors. Median number of sexual partner in the preceding year was 2 (range 0-100). A prior history of STDs had 25.3% participants. Hepatitis B virus (HBV) infection was the most frequently reported (12.8%) followed by gonorrhea (4.6%), C. trachomatis (2.7%) and HPV infection (2.7%), genital/anal herpes (1.6%) and syphilis (1.0%). The overall HCV seroprevalence was 4.6%: 6.3% in persons with multiple sexual partners, 2.9% in MSM, 4.0% in CSW and their clients and 8.5% in persons with STDs compared to 0.5% in control group. HCV seroprevalence was significantly higher than in controls in all risk groups except MSM [persons with multiple sexual partners: OR=13.49; 95% CI (OR)=1.81-100.4; CSW and their clients: OR=8.39; 95% CI (OR)=1.07-65.5; persons with STDs: OR=18.59; 95% CI (OR)=2.4-141.1; MSM OR=6.00; 95% CI (OR)=0.72-50.2]. The difference of HCV seroprevalence between age groups was not statistically significant (p=0.230). The highest seroprevalence was reported in the 20-29 age group (5.8%) and in the 30-39 age group (5.7%). Neither marital status (p=0.681) nor level of education (p=0.978) were associated with HCV seropositivity. The prior HBV infection (p=0.002) and gonorrhea (p=0.011) were the only risk factors significantly associated with anti-HCV prevalence. No other factors reflecting risk sexual behavior such as sexual orientation (p=0.355), the number of sexual partners (p=0.318) and the number of risk factors (p=0.079) were associated with HCV seroprevalence. HCV-RNA was detected in 73.1% seropositive participants. Three of the seronegative cases (2.1%) were also found to be HCV-RNA positive (“window period”). The majority of participants were infected with genotype 1 (55.6%), 38.9% with genotype 3 and 5.6% with genotype 4. The most prevalent subtypes were 1a (38.9%) and 3a (38.9%). According to the risk groups, in persons with multiple sexual partners all three genotypes (subtypes 1a and 3a) were detected. MSM were infected with genotypes 3a and 4, CSW and their clients with genotypes 1a and 3a and persons with STDs were infected with genotypes 1 (subtypes 1a and 1b) and 3a.

Abstract in Croatian

Analizirana je seroprevalencija, genotipovi i rizični faktori za HCV infekciju u populacijama rizičnog spolnog ponašanja: osoba koje često mijenjaju spolne partnere (PROM), muškaraca koji imaju seksualne odnose s muškarcima (MSM), prodavatelja/ica seksualnih usluga i njihovih korisnika (PSU) te osoba koje u anamnezi imaju spolno prenosive bolesti (SPB). Kontrolnu su skupinu sačinjavale trudnice. U istraživanje je bio uključen 821 ispitanik: od toga 716 (87,2%) muškaraca i 105 (12,8%) žena prosječne životne dobi od 35,8+11,5 godina. Medijan dobi iznosio je 32 godine (raspon 18-77 godina). Skupini s jednom vrstom rizičnog spolnog ponašanja pripadalo je 71,5% ispitanika, dok je 25,2% imalo dvije vrste, 3,2% tri vrste te 0,1% ispitanika četiri vrste rizičnog spolnog ponašanja. Medijan broja spolnih partnera u posljednjih 12 mjeseci iznosio je 2 (raspon 0-100). SPB u anamnezi imalo je 25,3% ispitanika slijedećom učestalošću: HBV 12,8%, gonoreju 4,6%, C. trachomatis 2,7%, HPV 2,7%, genitalni/analni herpes 1,3% te sifilis 1%. Ukupna seroprevalencija HCV infekcije u ispitanika rizičnog spolnog ponašanja iznosila je 4,6% (95% CI=3,2-6,1%): 6,3% (95% CI=3,9-8,8%) u skupini PROM ispitanika; 2,9% (95% CI=0,6-5,2%) u skupini MSM; 4,0% (95% CI=1,7-6,4%) u skupini PSU i korisnika PSU; 8,5% (95% CI=4,7-12,4%) u skupini ispitanika sa SPB te 0,5% (95% CI=0.0-1,5%) u kontrolnoj skupini. Dokazana je statistički značajna razlika HCV seroprevalencije u ispitanika rizičnog spolnog ponašanja u odnosu na kontrolnu skupinu u svim ispitivanim skupinama [PROM: OR=13,49, 95% CI (OR)=1,81-100,4; PSU: OR=8,39, 95% CI (OR)=1,07-65,5; SPB: OR=18,59, 95% CI (OR)=2,4-141,1] osim MSM [OR=6,00, 95% CI (OR)=0,72-50,2]. S obzirom na spol, seropozitivno je bilo 4,9% (95% CI=0,0-6,0) muškaraca te 2,9% (95% CI=3,3-6,0) žena (p=0,350). HCV seroprevalencija nije se značajno razlikovala između dobnih skupina ispitanika (p=0,230). Najviše seropozitivnih ispitanika bilo je u dobi od 20-29 godina (5,8%; 95% CI=3,2-8,4%) te 30-39 godina (5,7%; 95% CI=2,8-8,6%). Bračni/intimni status (p=0,681) te stručna sprema (p=0,978) ispitanika nisu bili povezani s HCV seropozitivitetom. Od preboljelih SPB, značajno viša HCV seroprevalencija dokazana je u ispitanika s preboljelom HBV infekcijom (p=0,002) te gonorejom (p=0,01). HCV-RNA dokazana je u 73,1% seropozitivnih te 2,1% seronegativnih ispitanika (novozaraženi ispitanici u periodu "imunološkog prozora"). Najviše ispitanika bilo je inficirano genotipom 1 (55,6%), genotipom 3 38,9% te genotipom 4 5,6% ispitanika. Najčešći dokazani podtipovi bili su 1a (38,9%) te 3a (38,9%). Ovisno o rizičnim skupinama, u skupini PROM ispitanika dokazana su sva tri genotipa (podtipovi 1a i 3a), u MSM genotipovi 3a i 4, u skupini PSU i korisnika PSU genotipovi 1a i 3a te u ispitanika sa SPB genotipovi 1 (podtipovi 1a i 1b) i 3a.

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