Kuwait’s national addiction treatment center is reporting a marked change in the blood-borne virus landscape among people who inject drugs, with hepatitis C virus (HCV) remaining closely linked to age and HIV appearing more prevalent than in a previous 2017 assessment. The findings come from a cross-sectional study of patients evaluated throughout 2024, offering one of the most recent national snapshots of hepatitis B virus (HBV), HCV, and human immunodeficiency virus (HIV) infection in this population. The study, published in BMC Infectious Diseases, examined both antibody or antigen evidence of infection and, where screening was positive, the presence of viral genetic material in blood. That distinction is critical: a positive serological test can indicate current infection, past exposure, or immune recognition, whereas nucleic acid testing identifies active viral replication and therefore a more immediate potential for transmission.
The investigation enrolled 1,287 consecutive patients attending Kuwait’s national addiction treatment center between January and December 2024. Most participants were men, who represented 86.6% of the cohort, and 87.3% were Kuwaiti nationals. The median age was 33 years. Researchers screened blood samples using chemiluminescent immunoassays, laboratory techniques that detect specific immune markers or viral proteins through light-producing chemical reactions. For HBV, the principal screening marker was hepatitis B surface antigen, or HBsAg, a protein found on the surface of the virus and commonly used as an indicator of ongoing infection. HCV screening searched for antibodies generated in response to the virus, while HIV testing identified serological evidence of infection. Samples that reacted in screening were then subjected to nucleic acid testing to determine whether viral RNA or DNA could be detected.
The overall HBV result was low but clinically important. HBsAg was detected in two of 1,255 tested participants, corresponding to a seroprevalence of 0.2%. Both reactive samples were confirmed by molecular testing to contain active HBV viremia. HBV is a DNA virus that infects liver cells and can establish chronic infection, particularly when the immune system fails to clear the virus after exposure. Even a small number of active infections can matter in networks where needles, syringes, or other injection equipment are shared, because HBV is efficiently transmitted through infected blood and can persist outside the body longer than several other blood-borne viruses. The number of HBV-positive cases was too small to support reliable multivariable statistical analysis, so the researchers did not calculate adjusted risk estimates for this infection.
HCV was detected in 25 of 1,169 participants, producing an overall anti-HCV prevalence of 2.1%. Unlike antibody screening alone, however, the molecular results showed that all 25 seropositive participants had detectable HCV RNA. In practical terms, every person identified through HCV serology in this cohort also had evidence of active infection at the time of testing. HCV is an RNA virus that can rapidly diversify within the body, helping it evade immune clearance and increasing the likelihood of chronic infection. Persistent HCV replication can cause progressive liver inflammation, fibrosis, cirrhosis, and liver cancer, although modern direct-acting antiviral medicines can cure most infections after a relatively short course of treatment. The finding of universal detectable viremia therefore points not only to an infectious reservoir but also to a potentially treatable gap between diagnosis and care.
Age emerged as the clearest statistical correlate of HCV infection. Prevalence increased significantly across age groups, with a reported probability value below 0.001, and reached 10.8% among participants aged 50 years or older. In the adjusted analysis, each increase in age was associated with higher odds of HCV infection, with an adjusted odds ratio of 1.1 and a 95% confidence interval from 1.07 to 1.16. An odds ratio of this magnitude represents a gradual but meaningful accumulation of risk across the lifespan rather than a sudden change at one particular age. Older participants may have experienced more years of injection exposure, repeated contact with contaminated equipment, or earlier periods when harm-reduction services and antiviral treatment were less accessible. The cross-sectional design cannot establish which mechanism was responsible, but the age gradient is consistent with infection accumulating over time in a population exposed to recurrent blood contact.
HIV was identified in 12 of the 1,287 participants, giving an overall seroprevalence of 0.93%. All HIV-positive cases were male, reflecting both the strong male predominance of the treatment-center cohort and a possible difference in exposure patterns that the study could not fully explain. Molecular testing detected HIV viremia in eight of the 12 seropositive participants, or 66.7%. A reactive HIV screening test therefore did not always correspond to detectable circulating virus in the available samples. This may reflect effective antiretroviral therapy, low-level infection below the assay’s detection threshold, or other clinical and laboratory factors; the abstract does not specify the treatment status of those participants. HIV is a retrovirus that converts its RNA genome into DNA and integrates that DNA into host cells, creating a lifelong infection that requires sustained antiretroviral therapy to suppress replication.
In the multivariable model, female sex was associated with substantially lower odds of HIV infection than male sex, with an adjusted odds ratio of 0.14, a 95% confidence interval of 0.02 to 0.92, and a reported p-value of 0.04. This estimate should be interpreted cautiously because the number of HIV-positive cases was very small and the cohort contained far more men than women. Small case counts can produce wide confidence intervals and make adjusted associations sensitive to the inclusion or exclusion of individual observations. Nevertheless, the result reinforces the need for prevention and testing strategies that account for the gendered structure of drug-use and treatment populations rather than assuming that a single intervention will reach all groups equally.
The authors describe the HIV findings as a concerning increase compared with the center’s 2017 baseline, while also reporting a shift toward universal active HCV viremia among those with positive HCV serology. Direct comparison between years requires caution because changes in recruitment, testing methods, patient composition, treatment access, and the duration of injection exposure can all influence observed prevalence. Even so, the results reveal a critical weakness in the care cascade. Testing is only the first step: patients must receive confirmatory results, clinical evaluation, antiviral treatment when indicated, adherence support, and follow-up testing. For HCV, the fact that all 25 seropositive participants were viremic suggests that antibody detection was not identifying a large pool of people who had cleared infection or already been cured. Instead, it uncovered individuals who appeared to remain untreated or otherwise connected to active transmission networks.
The study’s implications extend beyond the treatment center. The researchers call for expanded harm reduction, including reliable access to sterile injecting equipment, safer-injection education, vaccination and prevention services for HBV, and integrated screening for multiple blood-borne viruses. HCV test-and-treat programs could be particularly valuable because direct-acting antivirals can eliminate the virus, reduce the risk of liver disease, and lower the probability of onward transmission. HIV prevention must combine routine testing with rapid linkage to antiretroviral therapy, while people who test negative but remain at substantial risk may benefit from prevention counseling and, where clinically appropriate, pre-exposure prophylaxis. The molecular confirmation of active HBV and HCV infection also demonstrates why serological screening alone is insufficient for public health planning. Kuwait’s 2024 data depict a population in which infections remain concentrated but consequential, and where connecting diagnosis to treatment could transform viral surveillance into a measurable reduction in transmission and disease.
Subject of Research: Blood-borne virus infections among people who inject drugs in Kuwait
Article Title: 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
Article References: Altawalah H, Altannak F, Abounouh K, et al. BMC Infectious Diseases (2026). Published 26 August 2026.
Image Credits: AI Generated
DOI: 10.1186/s12879-026-14300-8
Keywords: People who inject drugs, hepatitis B virus, hepatitis C virus, HIV, seroprevalence, Kuwait, viremia, harm reduction
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