Association of Sexual Behavior with HBV Infection Among Adults: Results from the NHANES study

Wei Zhao^1†, Zhi-Qin Xie^2†, Hong Gao¹, Lin Wu¹, Liang Zhao¹, Bin Feng^2*, Yu-Qing Zhou^1*

¹Department of Hepatobiliary Surgery, Chongqing Emergency Medical Center, Chongqing, China

²Department of Hepatobiliary and Pancreatic Surgery, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou City, Hunan Province, China

†These authors have contributed equally to this work and share first authorship.

*Correspondence: Bin Feng, fengbin19720303@163.com; Yu-Qing Zhou, zhouyuqing1977@hotmail.com

Abstract

Background and Aims: Although it is known that hepatitis B virus (HBV) can be transmitted through sexual behavior, limited research has been conducted on the specific types of sexual behavior that facilitate transmission. The purpose of the research was to analyze the association of sexual behavior with HBV infection in US adults.

Method: Four cycles (2009-2016) of National Health and Nutrition Examination Surveys (NHANES) were collected, and 16569 participants were finally included. HBV infection was determined by a positive HBV core antibody and participants were categorized into two groups: “yes” and “no” group. Data pertaining to sexual behaviors were gathered. The sexual identity group comprised individuals with no sex, heterosexual, homosexual, bisexual, or unclear. The sexual type group consisted of individuals with no sex, heterosexual vaginal sex, heterosexual oral sex, heterosexual anal sex, heterosexual multiple types, bisexual sex, male homosexual sex, female homosexual sex, or unclear. Multivariable logistic regression was used to analyze the association of sexual identity/type with HBV infection by adjusting different covariates.

Results: The present study comprised a sample of 16,569 individuals between the ages of 18 and 69. Participants with HBV infection were more likely to be 40-69 years predominant, men, non-Hispanic Black. Additionally, these individuals were more likely to have co-infections with HIV or HCV, engage in drug use or current smoking, identify as homosexual or bisexual. After full adjustment, it was found that homosexual men were associated with a higher risk of HBV infection (odds ratio [OR]: 4.00, 95% confidence interval [CI]: 2.09-7.64) compared to men without sexual behavior. Bisexual men (OR: 5.65, 95% CI: 2.13-15) and men with heterosexual anal sex (OR: 4.52, 95% CI: 1.12-18.2) were associated with a higher risk of HBV infection. Notably, women engaging in any type of sexual behavior with men or women did not have a significantly higher risk of HBV infection compared to women without sexual behavior.

Conclusion: The study showed that homosexual men, bisexual men, and men with heterosexual anal sex were found to be correlated with a higher risk of HBV infection. These results may offer valuable insights for the pursuit of HBV elimination.

Key words: sexual behavior, sexual identity, sexual type, hepatitis B virus