Epidemiology of Viral Hepatitis in Men Who Have Sex with Men in Mediterranean Europe: A Region-Wide Sero-Surveillance in Rome (Italy)

Abstract

BACKGROUND: Viral hepatitis caused by HAV, HBV and HCV are a major public health problem worldwide. Men who have sex with men (MSM) are at increased risk of viral hepatitis. In 2017, a voluntary screening and prevention campaign for viral hepatitis was started in Lazio, a Region of central Italy, following a vast epidemic of HAV mainly affecting young MSM. Here we present the results of the sero-surveillance study carried out as a component of the campaign. METHODS: The study enrolled 1,100 MSM people aged 18-45 years participating to the campaign. Eighteen exposure variables were assessed for potential association with outcomes (i.e. serology for HAV, HBV, and HCV). FINDINGS: We found a very low prevalence of immunity against HAV and a significant exposure to high-risk behaviours, suggesting that gay community of Lazio is an ideal setting for HAV outbreaks. Prevalence of different serology profiles for HBV suggests that waning immunity and escape to mandatory vaccination still represent a significant issue in patients older than 35 years. Moreover, waning immunity suggests that patients who were vaccinated at birth may show low antibody levels. Consistently with other studies, prevalence of HCV infection was very low among young MSM. INTERPRETATION: Tailored vaccine programme aimed at immunizing MSM are critical to improve control of HAV in our setting. Findings on HBV epidemiology suggest that there is a need to define a clear strategy to recover patients who escaped vaccination and inform clinicians on the need to booster subjects with low immunity and high risk of exposure, such as MSM. Finally, MSM in Lazio do not represent a special group for HCV neither in terms of risk of infection nor in terms of potential issues for therapy access. FUNDING STATEMENT: The study was funded by Lazio Region Health Authority and Italian ministry of Health “Ricerca Corrente” INMI-Spallanzani. CONFLICT OF INTERESTS: All authors declared no conflict of interest. ETHICS APPROVAL STATEMENT: INMI Spallanzani ethical board approved the study (ethical clearance N.1 of January 24th 2017). Patients were required to sign an informed consent.