Blood-borne hepatitis in opiate users in iran: a poor outlook and urgent need to change nationwide screening policy

PLoS One. 2013 Dec 2;8(12):e82230. doi: 10.1371/journal.pone.0082230. eCollection 2013.

Abstract

Objective: Iran has the highest rate of opiate use worldwide. However, most opiate users are not screened for hepatitis virus infections. This study aimed to provide accurate, detailed data on the size of the opiate user population at risk of developing these infections.

Method: This seroprevalence study was conducted in the city of Shiraz, southern Iran. All participants were screened for HBV, HCV and HIV infection. The data were analyzed with SPSS.

Result: Among 569 participants, 233 (40.9%) were injection drug users (IDU), 369 (64.8%) were heterosexual, 84 (14.7%) were bisexual and 15 (2.6%) were homosexual. One hundred nine (19.1%) were HCV antibody-positive, 18 (3.1%) were HBS antigen-positive, 72 (12.6%) were HBc antibody-positive and 23 (4%) were HIV-positive. Among IDU compared to non-IDU, positivity rates for HBS antigen (5.5 vs 1.4%), HBc antibody (22.7 vs 5.6%), HCV antibody (40.3 vs 4.4%) and HIV (7.7 vs 1.4%) were higher (P < 0.05). Most patients with HBV (80.7%) and HCV infection (83.4%) were HIV-negative. In the cumulative analysis, only history of imprisonment was a statistically significant determinant of infection by HCV or HBV in opiate users.

Conclusion: The current policy of screening only HIV-positive drug users for HBV and HCV in Iran misses most cases of HBV and HCV infection. We therefore recommend urgent revision of the nationwide protocol by the Ministry of Health in Iran to implement routine screening of all opiate users and especially IDU for these viruses, regardless of their HIV status.

MeSH terms

  • Adult
  • Female
  • HIV Infections / epidemiology
  • HIV Seropositivity
  • Hepatitis / epidemiology*
  • Hepatitis / etiology
  • Hepatitis B / epidemiology
  • Hepatitis B / etiology
  • Hepatitis C / epidemiology
  • Humans
  • Iran / epidemiology
  • Male
  • Seroepidemiologic Studies
  • Substance Abuse, Intravenous / complications
  • Substance Abuse, Intravenous / epidemiology*

Grants and funding

This study was supported by the Department of Research affiliated with Fars Provincial Government and Shiraz University of Medical Sciences through shared contract No. 19260. Neither of these institutions was involved in the collection of data or other steps of this research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.