{"id":1954,"date":"2012-10-01T01:00:00","date_gmt":"2012-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/depistage-et-prise-en-charge-des-hepatites-virales-b-et-c-chez-les-personnes-en-situation-de-precarite-en-hopital-general-etude-prospective-chez-1812-consultants\/"},"modified":"2018-10-20T18:40:04","modified_gmt":"2018-10-20T16:40:04","slug":"depistage-et-prise-en-charge-des-hepatites-virales-b-et-c-chez-les-personnes-en-situation-de-precarite-en-hopital-general-etude-prospective-chez-1812-consultants","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/depistage-et-prise-en-charge-des-hepatites-virales-b-et-c-chez-les-personnes-en-situation-de-precarite-en-hopital-general-etude-prospective-chez-1812-consultants\/","title":{"rendered":"D\u00e9pistage et prise en charge des h\u00e9patites virales B et C chez les personnes en situation de pr\u00e9carit\u00e9 en h\u00f4pital g\u00e9n\u00e9ral : \u00e9tude prospective chez 1812 consultants"},"content":{"rendered":"

2012<\/strong><\/p>\n

I Rosa 1, F Roudot-Thoraval 2, L Costes 1, T Lons 1, V Garrait 3, I Delacroix Szmania 3, B Staedel 4,5, B Elghozi 5,6, H Hag\u00e8ge 1, M Chousterman 4,6
\net le Groupe PRECAVIR*
\n1 Service d\u2019H\u00e9pato-gastroent\u00e9rologie, Centre Hospitalier Intercommunal de Cr\u00e9teil, 2 Service de Sant\u00e9 Publique, H\u00f4pital Henri Mondor, 3 Service de M\u00e9decine Interne, Centre Hospitalier Intercommunal de Cr\u00e9teil, 4 R\u00e9seau ville h\u00f4pital Cr\u00e9teil, 5 R\u00e9seau de Sant\u00e9 de Cr\u00e9teil Solidarit\u00e9, 6 Unit\u00e9 Permanence d\u2019Acc\u00e8s aux Soins de Sant\u00e9 et R\u00e9seaux, Centre Hospitalier Intercommunal de Cr\u00e9teil, * Centre Hospitalier Intercommunal de Cr\u00e9teil,<\/em><\/p>\n

H\u00e9patologie <\/strong>– \u00a02012-05-07 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

En France, la pr\u00e9valence de l\u2019infection par les virus des h\u00e9patites est faible : 0,65 % pour l\u2019h\u00e9patite B (VHB) et 0,84 % pour l\u2019h\u00e9patite C (VHC). Chez les personnes en situation de pr\u00e9carit\u00e9, la pr\u00e9valence estim\u00e9e est deux \u00e0 six fois plus \u00e9lev\u00e9e que dans la population g\u00e9n\u00e9rale. Les migrants cumulent les obstacles \u00e0 l\u2019acc\u00e8s au d\u00e9pistage et aux soins. Les h\u00f4pitaux g\u00e9n\u00e9raux jouent un r\u00f4le important dans l\u2019accueil des populations fragilis\u00e9es. Depuis 2002, des permanences d\u2019acc\u00e8s aux soins de sant\u00e9 (PASS) ont \u00e9t\u00e9 mises en place dans certains h\u00f4pitaux pour permettre l\u2019acc\u00e8s aux soins des populations en situation irr\u00e9guli\u00e8re ou en grande pr\u00e9carit\u00e9.
\nNotre but est de d\u00e9crire l\u2019exp\u00e9rience d\u2019un h\u00f4pital g\u00e9n\u00e9ral dans le d\u00e9pistage du VHB et du VHC chez les migrants et dans l\u2019acc\u00e8s aux soins des personnes d\u00e9pist\u00e9es positives.
\nM\u00e9thode : Un d\u00e9pistage des infections par le VHB, le VHC et le VIH a \u00e9t\u00e9 propos\u00e9 syst\u00e9matiquement \u00e0 chaque nouveau consultant adulte de la PASS d\u2019un h\u00f4pital et d\u2019un centre de consultation associatif, situ\u00e9s dans la m\u00eame ville, quel que soit le motif de consultation. Le pr\u00e9l\u00e8vement \u00e9tait fait au centre de d\u00e9pistage anonyme et gratuit de l\u2019h\u00f4pital. L\u2019acc\u00e8s \u00e0 une consultation d\u2019h\u00e9patologie \u00e9tait organis\u00e9 pour les personnes d\u00e9pist\u00e9es positives.
\nR\u00e9sultats. \u2013 De juin 2007 \u00e0 d\u00e9cembre 2011, un d\u00e9pistage a \u00e9t\u00e9 propos\u00e9 cons\u00e9cutivement \u00e0 1812 personnes parmi lesquelles 93% \u00e9taient \u00e9trang\u00e8res (Afrique subsaharienne : 65%, Afrique du Nord : 9%, Europe de l\u2019Est : 4,5%, Asie : 4,5%, Am\u00e9rique : 4,5%). 91% d\u2019entre elles \u00e9taient en s\u00e9jour irr\u00e9gulier ou demandeurs d\u2019asile. Le d\u00e9pistage a \u00e9t\u00e9 r\u00e9alis\u00e9 chez 1394 consultants. Cent trente-neuf consultants, soit 10% des personnes pr\u00e9lev\u00e9es, avaient au moins une s\u00e9rologie d\u2019h\u00e9patite positive [IC : 8,94-14,35]. S\u2019agissant de l\u2019h\u00e9patite B, la pr\u00e9valence globale \u00e9tait de 6,7% [IC95 : 5,03-9,39], (94 cas), l\u2019\u00e2ge moyen \u00e9tait de 31 ans et 53% \u00e9taient des hommes. Un traitement \u00e9tait indiqu\u00e9 chez 12 des 73 patients ayant b\u00e9n\u00e9fici\u00e9 d\u2019un bilan et il avait pu \u00eatre d\u00e9but\u00e9 chez 6 d\u2019entre eux. S\u2019agissant de l\u2019h\u00e9patite C, la pr\u00e9valence globale de la positivit\u00e9 de la s\u00e9rologie \u00e9tait de 3,4% [IC95 : 2,85-6,39], soit 47 cas, l\u2019\u00e2ge moyen \u00e9tait de 42 ans et 44% \u00e9taient des hommes. L\u2019ARN du VHC \u00e9tait positif chez 20 des 40 patients test\u00e9s. Un traitement avait pu \u00eatre d\u00e9but\u00e9 chez 9 des 14 patients encore suivis. Les donn\u00e9es actualis\u00e9es concernant les traitements et leur efficacit\u00e9 dans cette population seront pr\u00e9sent\u00e9es au congr\u00e8s.<\/p>\n

Conclusion. \u2013 Notre programme montre la forte pr\u00e9valence des h\u00e9patites virales B et C au sein des populations pr\u00e9caires et\/ou migrantes. La proposition syst\u00e9matique de d\u00e9pistage d\u00e8s la premi\u00e8re consultation est r\u00e9alisable, bien accept\u00e9e et utile . Lorsqu\u2019il \u00e9tait indiqu\u00e9, le traitement avait pu \u00eatre initi\u00e9 dans 58% des cas. Les h\u00f4pitaux g\u00e9n\u00e9raux peuvent \u00eatre un lieu privil\u00e9gi\u00e9 d\u2019incitation au d\u00e9pistage dans cette population et faciliter l\u2019acc\u00e8s au suivi et au traitement de leur h\u00e9patite. N\u00e9anmoins, le suivi des patients reste difficile dans cette population et requiert la mise en place d\u2019un dispositif adapt\u00e9.<\/p>\n","protected":false},"excerpt":{"rendered":"

2012 I Rosa 1, F Roudot-Thoraval 2, L Costes 1, T Lons 1, V Garrait 3, I Delacroix Szmania 3, B Staedel 4,5, B Elghozi 5,6, H Hag\u00e8ge 1, M Chousterman 4,6 et le Groupe PRECAVIR* 1 Service d\u2019H\u00e9pato-gastroent\u00e9rologie, Centre Hospitalier Intercommunal de Cr\u00e9teil, 2 Service de Sant\u00e9 Publique, H\u00f4pital Henri Mondor, 3 Service de […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[23],"class_list":["post-1954","post","type-post","status-publish","format-standard","hentry","category-hepatologie","tag-23"],"yoast_head":"\nD\u00e9pistage et prise en charge des h\u00e9patites virales B et C chez les personnes en situation de pr\u00e9carit\u00e9 en h\u00f4pital g\u00e9n\u00e9ral : \u00e9tude prospective chez 1812 consultants - 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