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

Abstract 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. From 2001–2016, 4.6% of 163 million US adults, and 19.7% of 4.9 million with an injection drug use (IDU) history, had histories of hepatitis B virus infection. This represents 7.6 million adults, including 970 000 with IDU histories.