Association between syphilis, antibodies to herpes simplex virus type 2, and recreational drug use and hepatitis B virus infection in the Women's Interagency HIV Study

Since the advent of HAART, liver disease has become a leading cause of death in HIV-infected men and women [1, 2]. Death due to liver disease has been attributed to coinfection with hepatitis B virus (HBV), hepatitis C virus (HCV), or both HBV and HCV, as well as to other factors, including the use of alcohol and hepatotoxic medications. Even prior to the advent of HAART, coinfection with HIV and HBV (compared to infection with HIV alone) was associated with reduced survival [3]. In another study of men with chronic HBV infection [4], HIV coinfection was associated with a higher risk of HBV-related cirrhosis and decreased survival. As the clinical significance of coinfection with HIV and HBV becomes better understood, it is imperative to understand the prevalence and correlates of HBV infection in those with and at risk for HIV infection, especially because occult HBV infection (i.e., active HBV replication in the absence of HBV serological data suggestive of active disease) may be more common in this population. HBV infection is highly prevalent in certain populations in the United States; the prevalence approaches 60%–80% in immigrants from areas of endemicity [5], men who have sex with men [4], injection drug users [6], and persons with multiple sexual partners [7]. HIV infection is also highly prevalent in the latter 3 groups, because HBV and HIV infections have similar sexual and parenteral modes of transmission. Users of noninjection drugs have also been identified as a group potentially at high-risk for HBV infection. In a recent study conducted in New York City [8], nearly one-quarter of 483 noninjection heroin users were HBV infected; sexual risk factors appeared responsible for the increased risk. Epidemiologic studies of HBV infection have mainly involved men. The few studies involving women have been in predominantly HIV-uninfected women, and the prevalence of HBV infection has varied widely [7, 9, 10]. Women reporting injection drug use (IDU) and those reporting no history of IDU had prevalences of 74% and 38%, respectively, in a national multisite study conducted from 1986 through 1987 among 1368 female sex workers [7]. This study was conducted prior to the implementation of universal vaccination strategies to reduce HBV transmission and widespread strategies to reduce HIV transmission, which have likely impacted HBV transmission. Two subsequent studies [9, 10], both of which excluded women with a history of IDU, reported prevalences of HBV infection of 19% and 6%, respectively. The first study [9] was conducted from 1990 through 1991 and involved 599 inner city women in Brooklyn, New York; the other [10] was conducted from 1996 through 1998 and involved 1337 low-income young women in the San Francisco Bay area. Few if any studies have explored the prevalence and predictors of HBV infection in a cohort of predominantly HIV-infected women. We determined the prevalence of and risk factors for HBV infection among the participants of the Women’s Interagency HIV Study (WIHS). We performed a cross-sectional analysis of the predictors of HBV infection among women whom, at the time of their enrollment into the WIHS, reported either a history of IDU, a history of noninjection drug use (non-IDU) only, or no history of illicit drug use.