Multiple viral hepatitis in injection drug users and associated risk factors

BACKGROUND: While infections due to hepatitis B virus (HBV) and hepatitis C virus (HCV) have been well-studied in injection drug users (IDUs), hepatitis A virus (HAV) infection and coinfection with multiple hepatitis viruses have received less attention. METHODS: Hepatitis serology as well as sociodemographic and drug-related parameters were explored in patients (n = 1512) admitted for opiate detoxification. RESULTS: Antibodies to HAV were positive in 57.7%, to HBV in 53.0%, and to HCV in 75.0% of the sample. Lack of any hepatic marker was reported in 11.2%; one marker was positive in 24.7%; two markers were positive in 31.2%; and all markers were positive in 32.9%. In patients with one positive marker, 58.8% had had exposure to HCV, and 27% had exposure to HAV. In patients with two positive markers, 46.7% were HAV/HCV and 41.8% HBV/HCV antibody positive. Presence of HBV and HCV antibodies was associated with older age, longer duration of (i.v.) heroin use, and a higher number of rehabilitation treatment episodes (anova), current coconsumption of cocaine was associated with presence of antibodies to either HAV, HBV, and HCV. CONCLUSIONS: Coinfection with hepatic viruses is highly relevant in IDUs, although HAV does not necessarily share the same risk factors relevant for HBV or HCV transmission. The need for outreach vaccination programs is emphasized for HAV and HBV in the target population. Primary prevention should be implemented before initiation or at early stages of a drug career. Epidemiology and transmission of HAV in IDUs requires further research.