Limites de l’étude

Cette étude a plusieurs limites. La méthodologie utilisée ne permet pas correctement d’étudier les liens de causalité.

L’utilisation d’auto-questionnaire est associée à plusieurs inconvénients. En premier lieu, l’incertitude sur la juste compréhension des questions posées et ensuite sur les biais de prévarication ou d’omission.

En l’absence de formes aiguës retrouvées, l’incidence du VHE au Pays Basque n’a pas pu être déterminée.

Pour finir, la principale limite de notre étude est que l'ARN-VHE n'a été testé que chez les patients ayant des IgM anti-VHE positifs. Par conséquent, la prévalence de l'ARN-VHE pourrait être sous-estimée. De plus, il a été vu que les IgG anti-VHE sont parfois indétectables dans certains essais (131), mais également que la virémie pourrait persister malgré l’absence d’anticorps chez les PVVIH avec des CD4 < 500 cellules/mm3(157). Il existe un possible manque de sensibilité dans le fait de rechercher la prévalence du VHE par le recours à la sérologie.

81 Cette étude rapporte pour la première fois la prévalence du VHE en région Aquitaine, et plus particulièrement au Pays Basque.

Elle fournit une preuve que l’exposition au VHE dans le Pays Basque est élevée chez les PVVIH.

Il a été démontré que le contact avec le VHE est lié à l’âge, à l’achat de la viande chez des particuliers et à la consommation de fruits de mer au moins une fois par semaine. De plus il a été constaté que les patients VIH/VHE ont tendance à avoir un taux de transaminases plus élevé, ainsi qu’un nombre de CD4 et de CD8 diminué avec un rapport T4/T8 similaire.

La découverte majeure de cette étude est l’association hautement significative entre le VHE et les marqueurs sériques de la syphilis. Ces résultats soulèvent la question de la transmission du VHE à travers les pratiques sexuelles. En outre, elle invite à rechercher si des pratiques oro-anales auraient tendance à favoriser l’exposition au VHE.

En conclusion, la présence d’une cytolyse hépatique chez les PVVIH doit faire rechercher un VHE. De plus qu’un antécédent de syphilis, doit faire proposer une surveillance pour le VHE et peut être une stratégie de dépistage et de prévention systématique dans cette population. Une étude de prévalence et d’incidence du VHE dans une population à très haut risque d’IST, tel que les HSH ayant recours à la PREP, serait intéressante pour confirmer et étudier les modes d’acquisition sexuelle du VHE.

82

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