Julien Emmanuelli

Incidence and risk factors of HCV and HIV infections in a cohort of intravenous drug users in the North and East of France.

In order to evaluate the incidence and risk factors of infection by hepatitis C virus (HCV) among injecting drug users (IDUs), we conducted a prospective cohort study of HCV- and human immunodeficiency virus (HIV)-negative IDUs in the North and East of France. A total of 231 HCV and HIV IDUs who had injected drugs at least once in their lifetime were followed up every 3 months over a 12-month period. Serum anti-HCV and anti-HIV were tested at inclusion in the study and at the end of the follow-up. Data on injecting practices were collected at inclusion and at each visit. Of the 231 participants included, 165 (71.4%) underwent a final HCV and HIV serum test. The incidence was nil for HIV infection and 9/100 person-years (95% CI 4.6-13.4) for HCV infection. In a multivariable analysis, we found that syringe and cotton sharing were the only independent predictive factors of HCV seroconversion.

A national cross-sectional study among drug-users in France: epidemiology of HCV and highlight on practical and statistical aspects of the design

BackgroundEpidemiology of HCV infection among drug users (DUs) has been widely studied. Prevalence and sociobehavioural data among DUs are therefore available in most countries but no study has taken into account in the sampling weights one important aspect of the way of life of DUs, namely that they can use one or more specialized services during the study period. In 2004–2005, we conducted a national seroepidemiologic survey of DUs, based on a random sampling design using the Generalised Weight Share Method (GWSM) and on blood testing.MethodsA cross-sectional multicenter survey was done among DUs having injected or snorted drugs at least once in their life. We conducted a two stage random survey of DUs selected to represent the diversity of drug use. The fact that DUs can use more than one structure during the study period has an impact on their inclusion probabilities. To calculate a correct sampling weight, we used the GWSM. A sociobehavioral questionnaire was administered by interviewers. Selected DUs were asked to self-collect a fingerprick blood sample on blotting paper.ResultsOf all DUs selected, 1462 (75%) accepted to participate. HCV seroprevalence was 59.8% [95% CI: 50.7–68.3]. Of DUs under 30 years, 28% were HCV seropositive. Of HCV-infected DUs, 27% were unaware of their status. In the month prior to interview, 13% of DUs shared a syringe, 38% other injection parapharnelia and 81% shared a crack pipe. In multivariate analysis, factors independently associated with HCV seropositivity were age over 30, HIV seropositivity, having ever injected drugs, opiate substitution treatment (OST), crack use, and precarious housing.ConclusionThis is the first time that blood testing combined to GWSM is applied to a DUs population, which improve the estimate of HCV prevalence. HCV seroprevalence is high, indeed by the youngest DUs. And a large proportion of DUs are not aware of their status. Our multivariate analysis identifies risk factors such as crack consumption and unstable housing.

Introduction of SARS in France, March–April, 2003

We describe severe acute respiratory syndrome (SARS) in France. Patients meeting the World Health Organization definition of a suspected case underwent a clinical, radiologic, and biologic assessment at the closest university-affiliated infectious disease ward. Suspected cases were immediately reported to the Institut de Veille Sanitaire. Probable case-patients were isolated, their contacts quarantined at home, and were followed for 10 days after exposure. Five probable cases occurred from March through April 2003; four were confirmed as SARS coronavirus by reverse transcription–polymerase chain reaction, serologic testing, or both. The index case-patient (patient A), who had worked in the French hospital of Hanoi, Vietnam, was the most probable source of transmission for the three other confirmed cases; two had been exposed to patient A while on the Hanoi-Paris flight of March 22–23. Timely detection, isolation of probable cases, and quarantine of their contacts appear to have been effective in preventing the secondary spread of SARS in France.

Incidence et facteurs de risque de la séroconversion au virus de l’hépatite C dans une cohorte d’usagers de drogue intraveineux du nord-est de la France

Position du probleme Le but de cette etude prospective etait d’evaluer l’incidence et les facteurs de risque de l’infection par le virus de l’hepatite C (VHC) dans un groupe de toxicomanes du Nord et de l’Est de la France. Methodes Un suivi trimestriel pendant 12 mois ou jusqu’a seroconversion VHC a ete propose a 231 sujets toxicomanes ayant des Ac anti-VHC, anti-VIH et l’AgHBs negatifs et ayant utilise la voie intra-veineuse au moins une fois dans la vie. Une recherche des Ac anti-VHC, de l’AgHBs et des Ac anti-VIH seriques etait effectuee a l’inclusion et en fin de suivi. Un controle des Ac anti-VHC ELISA seriques etait effectue en cas de positivite des Ac anti-VHC dans la salive. A l’inclusion et a chaque suivi, un questionnaire comportant des donnees demographiques et detaillant les pratiques de consommation et d’injection des drogues etait administre et une recherche d’Ac anti-VHC sur prelevement salivaire effectuee. Resultats Parmi les 231 sujets inclus, 165 (71,4%) ont beneficie d’un suivi et d’une serologie VHC finale. L’incidence de la seroconversion VIH etait nulle et celle du VHC etait de 9% (IC 95% ; 4,6-13,4) personnes-annees. L’incidence etait de 11% (IC 95%; 4,7-17,1) personnes-annees dans la sous-population des usagers actuels (ayant injecte au moins une fois dans les 6 mois precedant l’inclusion). L’analyse multivariee a partir des donnees d’inclusion montre que seul le sexe feminin etait un facteur predictif independant de seroconversion VHC. A partir des donnees de suivi, l’analyse multivariee montre que seuls les partages de seringue et de coton etaient des facteurs predictifs independants de seroconversion VHC. Le risque relatif ajuste de seroconversion etait estime a 16,4 (IC 95% ; 1,4-190,6 : p Conclusion L’incidence de l’hepatite C reste elevee malgre les mesures de prevention. Cette etude rappelle le role du partage de seringue et confirme celui du partage du coton.