The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #72582

Paula J Lum, MD MPH¹, Kimberly Page Shafer, PhD¹, Judith A Hahn, PhD¹, Jennifer Evans, MS², Peter J Davidson, BA¹, Ellen Stein, MPH³, and Andrew R Moss, PhD². (1) Department of Medicine, Positive Health Program, University of California, San Francisco, UCSF Box 0874, San Francisco, CA 94143, 415-476-4082 x 411, plum@php.ucsf.edu, (2) University of California, San Francisco, Epidemiology & Biostatistics, San Francisco, CA 94105, (3) Epidemiology & Biostatistics, University of California, San Francisco, 74 New Montgomery St Suite 600, San Francisco, CA 94105

Objectives: To examine risk factors for hepatitis B virus (HBV) infection among young injection drug users (IDU) in San Francisco (SF). Methods: We conducted cross-sectional interviews and HBV serologic testing among IDU under age 30 recruited by street outreach. Results: 177/831 (21%) were infected with HBV; 468 (56%) were HBV-naïve; and 185 (22%) showed vaccine-induced immunity. Among the 646 without vaccine-induced immunity, HBV infection was associated with age, incarceration, SF residence, HIV and HCV co-infections, and injecting and sexual behavior. On multivariate analysis, the odds of infection were higher for those reporting: SF residence for >1 year (AOR=2.1; 95% CI=1.38-3.05); more years injecting (AOR=1.1 per year; 95% CI=1.04-1.16), daily injection (AOR=1.7; 95% CI=1.15-2.46); syringe borrowing (AOR=1.7; 95% CI=1.11-2.67); >100 male sex partners (AOR=2.5; 95% CI=1.27-4.78); and receiving money for sex (AOR=1.7; 95% CI=1.14-2.59). Risk factors for infection varied when the model was stratified by gender and sexual behavior. Independent predictors of HBV infection were limited to duration of injecting and daily injection among heterosexual male IDU; and sex trade and SF residence among MSM-IDU. Among female IDU, predictors of HBV were duration of injecting, syringe borrowing, >100 lifetime male sex partners, and SF residence. Conclusions: Many young IDU remain at risk of HBV in the era of needle exchange and an effective vaccine. Immunization programs should target IDU early in their injecting careers and upon arrival in SF. Special focus should be paid to young MSM-IDU engaging in sex work and young female IDU with multiple male sex partners.

Learning Objectives:

At the conclusion of the session, the participant (learner) in this session will be able to:
• List six independent risk factors for HBV infection in young IDU in San Francisco.
• Articulate how these risk factors are varied when stratified by gender and sexual behavior.
• Recognize windows of opportunity for HBV prevention, including immunization, among young IDU.

Keywords: Hepatitis B, Epidemiology

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.