Prevalence of Hepatitis B Virus Infection Among US Adults Aged 20-59 Years With a History of Injection Drug Use: National Health and Nutrition Examination Survey, 2001-2016

Background. Hepatitis B virus (HBV) can transmit through needle sharing. The national HBV infection prevalence in persons who inject drugs remains ill-defined. We estimated the prevalence of total HBV core antibody (anti-HBc) positivity, indicating a previous or ongoing HBV infection, among adults aged 20-59 years with an injection drug use (IDU) history. We compared select characteristics by anti-HBc status. Methods. Using 2001-2016 National Health and Nutrition Examination Survey data, we calculated the anti-HBc positivity prevalence among adults with IDU histories and among the general US population. For adults with IDU histories, we compared sex, age group, birth cohort, race/ethnicity, health insurance coverage, and hepatitis A immunity by anti-HBc status. Using marginal structural models, we calculated model-adjusted prevalence rates and ratios to determine the characteristics associated with anti-HBc positivity among adults with IDU histories. Results. From 2001-2016, the anti-HBc positivity prevalence was 19.7% (95% confidence interval [CI] 16.0-24.0%) among those with IDU histories, compared with 4.6% (95% CI 4.3-5.0%) in the general population. The HBV surface antigen positivity prevalence was 0.4% (95% CI 0.3-0.5%) in the general population. Among adults with IDU histories, 19.8% reported prior-year IDU and 28.5% had a hepatitis A immunity. Conclusions. One-fifth of adults with IDU histories had a previous or ongoing HBV infection: a rate over 4 times higher than the prevalence in the general population. One-fifth of adults with IDU histories reported prior-year use. Programs promoting safe IDU practices, drug treatment, and hepatitis A and B vaccinations should be key components of viral hepatitis prevention.