Epidemiology of hepatitis B, hepatitis C and HIV infections among intravenous drug users in Jerusalem, Israel

The demography and drug use practices in Israel are changing partly due to immigration. Objectives: Study the prevalence of blood borne viruses among intravenous drug users (IDU) and non-IDU and compare to previous surveys done at the same centers. Methods: A cross-sectional survey of all 233 illicit drug users attending two drug rehabilitation centers in Jerusalem. Antibodies to HBV, HCV and HIV were measured and questionnaires related to drug use and sexual practices given. Results: 200 (85.8%) were males. Most cases (210 - 90%) were of Mediterranean origin, 23 (10%) of East European origin. 87 (37.3%) were IDU and more frequent in individual from East European origin (78.3%) than Mediterranean origin (32.9%) (p<0.0001). East European origin drug users comprised 20.6% of all injectors, but only 3.4 % of non-injectors (p<0.001). Compared to an earlier survey, the fraction of IDU almost doubled. We found an HCV prevalence of 24.5% (55.5% among IDU, 6.3% in non-IDU, p<0.001); HBV: 32.2% (38.3% among IDU, 29.1% in non-IDU - NS); HIV: 1.3% (3.4% among IDU, 0% in non-IDU). Exposure to HCV and HBV was significantly related to the intensity of drug injections (p<0.0002). Conclusion: Despite that the number of IDU almost doubled between the studies, the level of blood born viruses (HBV and HCV) stayed alsmost similar. Drug use patterns in Jerusalem in 1995-1996 suggested a shift towards IDU, mostly among individuals of East European origin. This may contribute to high rates of HCV and HBV infections in the future within this population group.