Hepatitis B Virus in People who Inject Drugs and Men who Have Sex With Men With HIV in India: A Cross-sectional Study

Abstract

Background People with HIV (PWH) who are co-infected with hepatitis B virus (HBV) have a higher risk of mortality compared to PWH alone. Populations such as people who inject drugs (PWID) and men who have sex with men (MSM) are particularly at high-risk for HBV acquisition; yet, limited epidemiological data from these populations exist on HBV prevalence from low- and middle-income country settings (LMICs). Methods We characterized the prevalence and correlates of HBV serological markers in a sample of PWIDs and MSM living with HIV recruited across 15 Indian cities using hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), and hepatitis B surface antibody (anti-HBs). Testing of stored specimens for the presence of these markers was performed on the Abbott ARCHITECT i1000 as per manufacturer’s instructions. Correlates of ever being infected with HBV (reactive for anti-HBc and/or HBsAg) and chronic HBV (reactive for HBsAg) among those ever infected were assessed using univariable and multivariable multilevel logistic regression models accounting for site-level clustering. Results 2198 (95%) of the 2314 participants recruited for the trial were screened for HBV markers. The median age among the PWID and MSM participants were 30 and 32 years, respectively. The prevalence of ever being infected with HBV was 75.6% vs. 46.9% in the PWID vs. MSM, respectively (p < 0.01); prevalence of chronic infection was also higher in PWID vs. MSM (14.1% vs. 9.5%; p < 0.01). Correlates of ever being infected with HBV among PWID included unstable housing (aOR: 5.02) and sharing injection paraphernalia (aOR: 2.70), and among MSM, correlates included history of injection drug use (aOR: 4.87) and gender identity. The prevalence of isolated core (anti-HBc in the absence of anti-HBs) was 34.7% vs. 29.4% in PWID vs. MSM (p < 0.05). Vaccination was <10% in both populations. Conclusions In this large sample of PWID and MSM living with HIV, we observed a high prevalence of serology consistent with HBV infection and low vaccination highlighting the need for routine screening and catch-up vaccination. The high prevalence of isolated anti-HBc reactivity highlights the need to understand the risk of reactivation with this serological pattern.