Hepatitis B Virus Infection among People Who Use Illicit Drugs: Prevalence, Genotypes and Risk Factors in the State of Amapá, Northern Brazil

Abstract

Background: Several records of high prevalence of HBV have been made in northern Brazil. Among risk groups for viral infection, people who use illicit drugs (PWUDs) stand out, especially if they inject drugs and engage in risky sexual behavior. Objectives: In this study, the prevalence, genotype distribution and factors associated with hepatitis B virus (HBV) exposure in PWUDs were estimated. Methods: This cross-sectional study used snowball sampling from nine different sites. Socio-demographic, economic, drug use and health-related information were collected of 308 PWUDs from nine municipalities in the state of Amapá, northern Brazil. Blood samples were tested for the presence of HBV using enzyme-linked immunosorbent assay (ELISA) and real-time polymerase chain reaction (PCR). Logistic regressions were run to identify factors independently associated with HBV exposure. Results: In total, seventy (22.7%) PWUDs were exposed to HBV, and 12 (3.9%) had DNA HBV. Genotypes A (58.4%), D (33.3%) and F (8.3%) were identified. Age ≥35 years, use of injectable drug, daily use of drugs, use of drugs over 12 years, unprotected sex, exchange sex for money/drugs, and >12 sexual partners in the last 12 months were associated with exposure to HBV. Conclusions: This study identified important information on the epidemiological scenario of HBV infection in PWUDs, highlighting the high prevalence of HBV exposure and the urgent need for measures for control and prevention, especially vaccination against this hepatotropic virus.

Keywords:

• HBV
• epidemiology
• people who used illicit drugs
• amazon
• Brazil

Acknowledgments

The authors are grateful for the generous assistance of the facilitators who collaborated with the recruitment of the PWUDs in the study sites. ABOF acknowledges research support from Universidade Federal do Pará, Brazil. RLR acknowledges research support from Universidade Federal do Amapá, Brazil. BF acknowledges research support from the Hugh Green Chair in Addiction Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand, and from the Chair in Addiction, Department of Psychiatry, University of Toronto, Canada.

Ethical approval

All participants were included after providing informed and written consent. This study was approved by the Committee for Ethics in Research of the Núcleo de Medicina Tropical of the UFPA in Belém, Brazil (CAAE: 37536314.4.0000.5172).

Additional information

Funding

This study was supported by Ministério da Saúde/Secretaria de Vigilância em Saúde (MS/SVS – TC 318/2013), and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ – Proc. 475142/2013-6). The authors JNFP and CCSC received Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) fellowships to develop the study. The authors YMNC, JFFDM and RJSS received CNPQ fellowships to develop the study.