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Background:
People who have used or continue to use drugs are at increased risk of blood borne infections hepatitis B (HBV) and D (HDV).
Screening allows appropriate vaccination of those at risk and treatment of those who have chronic hepatitis B (CHB) and D (CHD) infection.
Worldwide, approximately 5% of those with CHB have hepatitis D (HDV) coinfection. HDV-co-infection leads to accelerated disease progression in 70-90% of cases with earlier progression to cirrhosis and increased risk of hepatocellular carcinoma.
Methods:
The Swiss Association for the Medical Management in Substance Users (SAMMSU)-cohort is a nationwide open cohort, established in 2013. By 06/01/2025, 1500 patients with current/previous opioid agonist therapy were enrolled. We determined the prevalence of HBV and HDV screening, infection and vaccination in this population.
Results:
Of the 1500 participants, 76% (1135) were male, 97% (1462) white, the median age at registration was 44 (IQR: 36-51) years, 73% (1071/1463) ever injected drugs and 90% (1301/1446) ever used intranasally.
81.3% (1219/1500) had Hepatitis B core antibody (anti-HBc) tests, 33.1% (404) were positive. 77.7% (1166/1500) had Hepatitis B surface antigen (HBsAg) tests, 1.3% (15) were positive.
72.6% (1089/1500), had a hepatitis B surface antibody (anti-HBs)-titer. 72.0% (784) were >10 U/l and 47.4% (516) >100 U/l. 26.7% (400/1500) were neither anti-HBc-positive, anti-HBs-positive nor HBV-vaccinated, and unprotected against HBV.
CHB prevalence (either ever HBsAg- or HBV-DNA-positive) was 1.7% (26 [15+11]/1500). Overall of 29 patients were anti-HDV-tested and 31% (9) positive. 46.2%(12/26) with CHB) had an anti-HDV-test, 50% (6) were positive. 2/4 participants with a HDV-RNA test were positive.
Conclusion:
20% of the SAMMSU participants had no HBV serology and a quarter are unprotected against HBV. CHB and HDV prevalence in those who are tested is high.
This demonstrates the need to increase CHB/CHD screening, vaccination and management in this high-risk population in accordance with national and international guidelines
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