Association of Sexual Behavior with HBV Infection Among Adults: Results
from the NHANES study
Wei
Zhao1†,
Zhi-Qin Xie2†, Hong Gao1, Lin
Wu1, Liang Zhao1, Bin
Feng2*, Yu-Qing Zhou1*
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