The novel is unusual in that it deals with the practical considerations of vampirism, such as the difficulty in obtaining victims and concealing frequent murders. The Hunger suggests a science-fiction explanation for vampirism, that vampires are a species that bears a resemblance to humans. They are not immortal but do not age after reaching physical maturity and are extremely strong and difficult to kill. Miriam discovers that some vampire traits, such as prolonged youth, can be transmitted to humans by performing a blood transfusion.
Miriam Blaylock is a vampire whose life began in ancient Egypt. She has taken human companions (male or females) to ease her loneliness. While her blood will grant them greatly expanded lifespans, they (unlike her) eventually begin to age, a process that cannot be halted. Eventually they wither to dusty shells but unfortunately for them they remain conscious. Unable to bear the thought of murdering her lovers, Miriam imprisons them in steel-encased chests to keep with her for eternity.
The novel begins when John, her most recent companion suddenly begins to age. Miriam is surprised at the brief amount of time that John lasted (only about 200 years). She has been secretly following the work of Dr. Sarah Roberts, a brilliant young physician whose research may hold the key to immortality for her lover. John becomes too uncontrollable for Miriam to deal with and she soon sets her sights on another companion, Sarah.