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American Journal of Epidemiology Vol. 142, No. 3: 331-341
Copyright © 1995 by The Johns Hopkins University School of Hygiene and Public Health

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Seroepidemiology of Hepatitis B Virus in a Population of Injecting Drug Users

Association with Drug Injection Patterns

Orin S. Levine1,2, David Vlahov1, Jane Koehler3, Sylvia Cohn1, Adrian M. Spronk4 and Kenrad E. Nelson1,

1Department of Epidemiology, School of Hygiene and Public Health, The Johns Hopkins University Baltimore, MD
2Childhood and Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention Current address: Atlanta, GA
3Alameda County Health Care Services Agency Oakland, CA
4Abbott Laboratories North Chicago, IL

Reprint requests to Dr. Kenrad E. Nelson, Department of Epidemiology, School of Hygiene and Public Health, The Johns Hopkins University, 624 North Broadway, Room 884, Baltimore, MD 21205.

To investigate the epidemiology of hepatitis B virus (HBV) infection among injecting drug users, the authors assessed the prevalence of HBV seromarkers among 2,558 injecting drug users recruited through street outreach in Baltimore, Maryland, in 1988–1989. Eighty percent of the drug users had at least one HBV seromarker. HBV seropositivity was associated with increasing age, duration of injecting drug use, African-American ethnicity, injecting drugs at least once daily, and sharing needles or visiting "shooting galleries" during the previous 11 years, but not with high-risk sexual behaviors or a history of sexually transmitted disease. This finding is possibly due to the relative inefficiency of sexual transmission as compared with parenteral transmission in injecting drug users. In addition, HBV seropositivity was strongly associated with seropositivity for hepatitis C virus and human immunodeficiency virus. The authors conclude that HBV transmission among injecting drug users occurs primarily through the sharing of contaminated drug injecting equipment rather than through sexual relations, and that efforts to prevent HBV infection must target injecting drug users early in their injecting careers.

hepatitis B virus; hepatitis C viruses; HIV; primary prevention; substance abuse, intravenous


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