Seroprevalence update of Hepatitis B Virus, Hepatitis C Virus, and human immunodeficiency virus among people who inject drugs in Kuwait: a cross-sectional study at a national addiction treatment center

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Abstract Background People who inject drugs (PWID) represent a key population disproportionately affected by blood-borne viruses. Updated epidemiological data are crucial for informing public health interventions. This study provides a 2024 update on the seroprevalence and correlates of Hepatitis B (HBV), Hepatitis C (HCV), and Human Immunodeficiency Virus (HIV) among PWID at Kuwait’s national addiction treatment center, building on a previous 2017 baseline. Methods A cross-sectional study was conducted from January to December 2024, enrolling 1,287 consecutive patients. Serological screening for HBsAg, anti-HCV, and anti-HIV was performed using chemiluminescent immunoassays. Seropositive samples underwent confirmatory nucleic acid testing to detect active viremia. Multivariable logistic regression was used to identify factors associated with each infection. Results The cohort was predominantly male (86.6%) and Kuwaiti (87.3%), with a median age of 33 years. The overall seroprevalence was 0.2% for HBsAg (2/1,255), 2.1% for anti-HCV (25/1,169), and 0.93% for anti-HIV (12/1,287). A significant age-dependent increase in HCV prevalence was observed ( p < 0.001), with the highest prevalence (10.8%) in participants aged ≥ 50 years. All HIV-positive cases were male. Molecular testing revealed universal active viremia for HCV (100%, 25/25) and HBV (100%, 2/2), and detectable viremia in 66.7% (8/12) of HIV-seropositive cases. In multivariable analysis, increasing age was significantly associated with HCV infection (aOR = 1.1, 95% CI: 1.07–1.16, p < 0.001). For HIV, female sex was associated with significantly lower odds of infection (aOR = 0.14, 95% CI: 0.02–0.92, p = 0.04). Due to the extremely low number of HBV-reactive cases ( n = 2), multivariable logistic regression was not feasible for HBV, and no adjusted estimates could be derived. Conclusion Compared to 2017 data, this study reveals a concerning increase in HIV prevalence and a shift to universal active HCV viremia among PWID in Kuwait. The near-ubiquitous presence of transmissible infection upon seroconversion indicates a critical gap in the care cascade. These findings underscore an urgent need for the scale-up of targeted harm reduction, test-and-treat strategies, and integrated care services to curb transmission.