Article

Correlates of Co-infection with Human Immunodeficiency Virus and Hepatitis C Virus in Male Injection Drug Users in Iran

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Archives of Iranian medicine (Impact Factor: 1.11). 07/2010; 13(4):318-23.
Source: PubMed
ABSTRACT
Aim of the study was to evaluate the HIV and hepatitis C virus (HCV) coinfection and associated risk behaviors among Injection Drug Users in Detention, Tehran, Iran.
A cross-sectional survey included 499 male Injection Drug Users arrested by police during a predetermined police sweep in Tehran (February, 2006). At the temporary detention center, they were screened using a urine test and a physical examination for injection marks. Those who were identified as injectors were sent to the rehabilitation center for 3 months. A questionnaire was filled out for each individual by interview. Blood specimens were collected for HIV and HCV testing. The variables associated with HIV/HCV coinfection at a significance level of P<0.10 were considered in multivariate analysis.
Of the 417 participants, 100 (24.0%) had HIV/HCV coinfection (95%CI 19.9 - 28.4). Factors independently associated with HIV/HCV coinfection included history of using opioid in jail, and age (P<0.05). There were not any association between other demographic characteristics (marital status, birthplace, residence, and education), type and years of drug abuse, age of first injection, years of injection, sharing needles inside and outside of jail, injection in jail, history of tattooing, any sexual behavior, and history of sexually transmitted diseases with HIV/HCV coinfection (P>0.05).
This study supports that incarceration is contributing to the increased spread of HIV/HCV coinfection. So, there is urgent need for effective harm reduction programs, particularly among incarcerated Injection Drug Users.

Full-text

Available from: Parastoo Kheirandish
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Introduction
Hepatitis C virus (HCV) infection has emerged
as an important cofactor in the clinical and immu-
nological progression and treatment of HIV infec-
tion. Coinfected individuals may have an altered re-
sponse to antiretroviral treatment (ART) and are at
increased risk of ART-related hepatotoxicity. Like-
wise, response rates to HCV therapy in coinfected
individuals are generally 10% to 15% lower than
with HCV monoinfection, and therapy may also be
complicated by ART drug interactions and signi-
cant toxicity.
1,2
In addition, HIV infection appears to
increase the persistence of HCV, the level of HCV
RNA, the progression of HCV-related liver disease,
and end-stage liver disease.
1,3–5
In the post-ART
era, HCV is becoming a leading cause of premature
death among persons living with HIV/AIDS.
1–3,6–8
Authors’ afliations:
1
Department of Epidemiology and Biostatistics,
School of Public Health, Tehran University of Medical Sciences, Teh-
ran,
2
Iranian Research Center for HIV/AIDS (IRCHA), Tehran Univer-
sity of Medical Sciences, Tehran,
3
Research Center, Headquarters of
Police Force Medicine, Tehran,
4
Department of Medicine, Baghiyat-
Allah University, Tehran, Iran,
5
Department of Epidemiology and Bio-
statistics, University of California, San Francisco, USA.
•Corresponding author and reprints: Hamid Emadi Koochak MD,
Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of
Medical Sciences, Tehran, Iran. Telefax: +98-216-694-7984, E-mail:
ircha@tums.ac.ir
Accepted for publication: 27 January 2010
Original Article
HIV/HCV in Drug Users
Prevalence and Correlates of Co-infection with Human
Immunodeciency Virus and Hepatitis C Virus in Male
Injection Drug Users in Iran
Mostafa Hosseini PhD
1
, SeyedAhmad SeyedAlinaghi MD
2
, Parastoo Kheirandish MD
2
, GholamReza Es-
maeli Javid MD
2
, Hadi Shirzad MD
3
, Nazli Karami MD
2
, MohammadReza Jahani MD
4
, MohammadReza
Seyed Ahmadian MD
3
, Fatemeh Payvarmehr RN
2
, Minoo Mohraz MD
2
, Hamid Emadi Koochak MD
•2
,
Willi McFarland MD PhD
5
Abstract:
Objective: Aim of the study was to evaluate the HIV and hepatitis C virus (HCV) coinfection and associated risk behaviors
among Injection Drug Users in Detention, Tehran, Iran.
Methods: A cross-sectional survey included 499 male Injection Drug Users arrested by police during a predetermined
police sweep in Tehran (February, 2006). At the temporary detention center, they were screened using a urine test and a
physical examination for injection marks. Those who were identied as injectors were sent to the rehabilitation center for 3
months. A questionnaire was lled out for each individual by interview. Blood specimens were collected for HIV and HCV
testing.
The variables associated with HIV/HCV coinfection at a signicance level of P<0.10 were considered in multivariate
analysis.
Results: Of the 417 participants, 100 (24.0%) had HIV/HCV coinfection (95%CI 19.9 – 28.4). Factors independently as-
sociated with HIV/HCV coinfection included history of using opioid in jail, and age (P<0.05).
There were not any association between other demographic characteristics (marital status, birthplace, residence, and
education), type and years of drug abuse, age of rst injection, years of injection, sharing needles inside and outside of
jail, injection in jail, history of tattooing, any sexual behavior, and history of sexually transmitted diseases with HIV/HCV
coinfection (P>0.05).
Conclusions:
This study supports that incarceration is contributing to the increased spread of HIV/HCV coinfection. So,
there is urgent need for effective harm reduction programs, particularly among incarcerated Injection Drug Users.
Keywords: coinfection, HIV, HCV, injection drug users, risk factors
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Due to shared routes of transmission, HIV/HCV
coinfection is common, with highest rates of HIV/
HCV coinfection being found in regions where in-
jection drug users predominate in the HIV epidem-
ic.
3,9
Of the 33 million people living with HIV/AIDS
worldwide, four to ve million are co-infected with
HCV.
6
A relation between incarceration and trans-
mission
of HIV and HCV among IDU in prison has
been described.
10–19
Other risk factors
that identify
HIV and HCV in
prisoners are prior imprisonment,
tattooing, and sexual behaviors.
11,20, 21
To date, there are limited data on the prevalence
and correlates of HIV/HCV coinfection among
IDU in Iran. We therefore conducted a survey of
IDU upon detention in Tehran, Iran to measure the
prevalence of coinfection and characterize risk fac-
tors associated with HIV/HCV. Results will provide
public-health information necessary to address this
emerging problem and prepare for the resulting fu-
ture burden of disease.
Materials and Methods
We conducted a cross-sectional survey of male
IDU, who were approached consecutively upon de-
tention in Tehran, Iran, to estimate the prevalence
of HIV/HCV coinfection and associated risk factors
during February, 2006. Participants included men
who were arrested by police during a predetermined
police sweep in Tehran. Police check points were
geographically distributed throughout the city at
major intersections in areas of known drug dealing,
previous drug-related arrests, and petty crime. In-
dividuals were identied by police based on a drug
addiction prole, screened via questioning, and if
suspicious, were sent to a temporary detention cen-
ter. At the temporary detention center they were
screened for illegal drugs using a urine test and for
injection drug use through physical examination for
injection marks by an experienced physician. Those
who were identied as injectors were sent to a re-
habilitation center for three months for mandatory
detoxication.
Upon entry to the rehabilitation center, detain-
ees were offered the option of participating in our
study. After providing consent, a questionnaire was
completed for each individual via a face-to-face in-
terview by a physician. The questionnaire covered
demographic characteristics, imprisonment history,
injecting drug practices, and sexual behaviors.
After completion of the interview, blood speci-
mens were collected by a professional phleboto-
mist for HIV and HCV antibody testing for those
who agreed to participate in the blood test. Sero-
logical specimens were screened with an enzyme-
linked immunosorbent assay for HIV antibodies
(Biotest AG, Germany) and conrmed by Western
blot (Diagnostic, Germany). Specimens were tested
for HCV antibodies (DiaSorin, Spain). We did not
conduct HCV RNA testing due to cost constraints.
While we recognize HCV antibody seropositivity
may not denote current infection, we use the term
HIV/HCV coinfection here for simplicity.
The data were entered and analyzed using STATA
(version 8.0). Baseline point prevalence estimates
and 95% condence intervals (CI) for HIV/HCV
coinfection were calculated as the number of con-
rmed HIV/HCV coinfected individuals divided by
the number with conrmed negative or positive test
results within each group. Bivariate logistic regres-
sion analysis was used to identify potential corre-
lates of coinfection. Variables associated with coin-
fection at the P<0.10 level were included as candi-
dates in multivariate logistic regression analysis and
retained in the nal model if P<0.05.
Recognizing the special vulnerability of incarcer-
ated persons, participation was voluntary and no
incentives or special privileges were given. Infor-
mation was kept condential and separate from jail
health and criminal justice records, and referrals to
care were done through the Tehran University Medi-
cal Sciences Clinical Services. Informed consent
was obtained and the Institutional Review Board
of Tehran University of Medical Sciences reviewed
and approved the study protocol.
Results
A total of 499 male IDU were detained by the po-
lice. Of these, 417 (83.6%) agreed to participate in
the study, and completed the questionnaire and HIV/
HCV blood tests. HIV and HCV prevalence were
24.4% (95%CI 20.5 – 28.6), and 80% (95%CI 76.2
– 83.6), respectively. Of the 417 participants, 100
(24.0%, 95%CI 19.9 – 28.4) tested positive for HIV
and HCV antibodies. The gure translates to 89.3%
of HIV-positive IDU in the survey (100 out of 112
HIV-positives). Demographic characteristics and
M. Hosseini, S. A. SeyedAlinaghi, P. Kheirandish, et al.
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Variable
n
1
(%)
Coinfection
(n)
Co-infection prevalence
% (95%CI)
Total 417 (100) 100 24.0 (19.9–28.4)
Age group
2
17 – 24 yrs 58 (14.3) 5 8.6 (2.9–19.0)
25 – 34 yrs 213 (52.6) 52 24.4 (18.8–30.7)
35 – 44 yrs 93 (23.0) 25 26.9 (18.2–37.1)
45 yrs 41 (10.1) 15 36.6 (22.1–53.1)
Marital status
3
Single 154 (38.0) 28 18.2 (12.4–25.2)
Married 159 (39.3) 42 26.4 (19.7–34.0)
Divorced 89 (22.0) 27 30.3 (21.0–41.0)
Widowed 3 (0.7) 0 0.0 (0.0–70.8)
4
Education level
Illiterate 28 (7.0) 8 28.6 (13.2–48.7)
Did not complete high school 300 (74.6) 76 25.3 (20.5–30.6)
Completed high school or higher 74 (18.4) 12 16.2 (7.6–24.8)
Drugs reported having ever used (local name)
Opium (taryak) 331 (79.4) 81 24.5 (19.9–29.5)
Boiled opium resin (shireh) 92 (22.1) 24 26.1 (17.5–36.3)
Opium resin (sookhteh) 75 (18.0) 18 24.0 (14.9–35.2)
Heroin 311 (74.6) 78 25.1 (20.4–30.3)
“Crack” (purer form of heroin) 66 (15.8) 13 19.7 (10.9–31.3)
Hashish 121 (29.0) 25 20.7 (13.8–29.0)
Bupenorphine (norgeezak) 404 (96.9) 96 23.8 (19.7–28.2)
Bupenorphine + steroids (afzoor) 9 (2.2) 1 11.1 (0.3–48.2)
Methamphetamine (crystal) 17 (4.1) 3 17.6 (3.8–43.4)
Morphine 10 (2.4) 3 30.0 (6.7–65.2)
Other drug 58 (13.9) 11 19.0 (9.9–31.4)
Reported ever sharing needles 51 (12.2) 14 27.4 (15.9–41.7)
Reported ever sharing equipment 110 (26.4) 30 27.3 (19.2–36.6)
Reported ever sharing needles or equipment 113 (27.1) 30 26.5 (18.7–35.7)
History of tattooing
3
111 (26.6) 34 17.6 (3.8–43.4)
Reported past history of incarceration
5
311 (74.6) 83 26.7 (21.8–32.0)
Reported history of using an opioid in jail
2
80 (19.2) 32 40.0 (29.2–51.6)
Reported history of injection in jail 27 (6.5) 10 37.0 (19.4–57.6)
Reported past access to new syringes in jail 284 (68.1) 66 23.2 (18.4–28.6)
Reported ever having sex
3
318 (76.3) 84 26.4 (21.6–31.6)
Reported sex only with wife 305 (73.1) 77 25.2 (20.5–30.5)
Reported sex with commercial sex worker 101 (24.2) 26 25.7 (17.6–35.4)
Reported history of male-male sex 22 (5.3) 7 31.8 (13.9–54.9)
Reported history of male-male sex in jail 24 (5.8) 8 33.3 (15.6–55.3)
Reported history of sex in jail 21 (5.0) 8 38.1 (18.1–61.6)
Reported history of genital discharge 34 (8.1) 9 26.5 (12.9–44.4)
Reported history of STD 31 (7.4) 7 22.6 (9.6–41.1)
1
Subgroups do not always add up to total due to missing data.
2
P<0.01,
3
P<0.10,
4
One-sided 97.5%CI,
5
P=0.03.
Model Adjusted OR (95%CI) P-value
Reported history of using opioid in jail 2.66 (1.56–4.54) 0.001
Age group
17–24 yr referent
25–34 yr 3.60 (1.35–9.60) 0.010
35–44 yr 3.89 (1.38–10.96) 0.010
45 yr 5.94 (1.92–18.42) 0.002
Table 1. Characteristics, behaviors, and co-infection prevalence among injection drug users upon detention, Tehran, Iran, 2006
Table 2. Independent associations of prevalent coinfection among injection
drug users upon detention, Tehran, Iran, 2006
HIV/HCV in Drug Users
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risk behaviors of detained IDU are described in Ta-
ble 1 along with corresponding prevalence of HIV/
HCV co-infection. At the P<0.10 level, HIV/HCV
coinfection was associated with older age, being di-
vorced, tattoos, past incarceration, opioid use in jail,
and ever having sex. We did not detect associations
between HIV/HCV coinfection and other demo-
graphic characteristics, type of drugs used, injection
practices, history of sexually transmitted disease, or
other sexual behaviors. In multivariate logistic re-
gression analysis (Table 2), history of opioid use in
jail and age remained signicant, independent pre-
dictors of HIV/HCV coinfection.
Discussion
We document that approximately nine out of ten
HIV-positive IDU and one in four of all IDU in Teh-
ran may be coinfected with HCV. These estimates
are much higher than observed in other developing
and middle-income countries and comparable to
levels in developed nations with mature HIV epi-
demics among IDU. For example, in a study among
IDUs in Shiraz, southern Iran, 80.1%, and 1.2%
were positive for anti-HCV, and HIV, respective-
ly.
22
In another study among IDU at Loghman Ha-
kim Hospital, Tehran, 36% and 30% were positive
for anti-HCV, anti-HIV, respectively.
23
Our level
of HCV/HIV coinfection is higher than that mea-
sured in Kenya (1%),
24
Brazil (10%),
25
Argentina
(12%),
16
and Mozambique (16%),
25
while compa-
rable to those among HIV-positive IDU measured
in ten European cities (80%), Italy (90%), and India
(86%).
9,14,26
The increasing prevalence by age in our
survey also suggests that the numbers of coinfec-
tions will accumulate over time as the currently very
young population of Iran ages.
In this study, the history of opioid use while in jail
was strongly associated with co-infection. As de-
scribed in other studies, incarceration can lead to
increased sharing of injection equipment due to the
scarcity of clean needles and syringes.
27,28
Added
to this situation, the incarceration of non-injecting
opioid users can precipitate their change to injec-
tion as smoking opium in jails is difcult to conceal.
Thus, incarceration may accelerate HCV transmis-
sion among IDU and among previously non-inject-
ing drug users. The lack of nding an association
of co-infection with specic practices of sharing
equipment may be the result of under-reporting due
to social desirability response bias. Acknowledging
opioid use while in jail may be a more easily admit-
ted behavior than the sharing of equipment. While
HCV transmission through sex is possible,
29
a lack
of observed associations in our study may be due
to lower transmission efciency through sex or to
lower admission to the highly stigmatized and ille-
gal behaviors of male-male sex and sex outside of
marriage.
30
In addition to potential under-reporting of illegal
behaviors in the jail setting, we acknowledge oth-
er potential biases and limitations. Without RNA
testing for HCV, we are likely over-estimating the
prevalence of current coinfection. Other limitations
include not knowing the timing of infection in re-
lation to the reported risk behaviors and to incar-
ceration, and the representativeness of our sample
to the wider IDU population of Tehran. It may be
the case, for example, that IDU from a higher socio-
economic status are under-represented due to the
locations and nature of the police sweeps. Finally,
a major limitation is that our sample did not include
female IDU, a population very difcult to sample in
the Middle East.
Despite these potential limitations, our data con-
nect the nal points of a worrisome emerging public
health problem. Iran has the highest per capita opi-
oid use in the world, increasing numbers of injec-
tors,
28
increasing prevalence of HIV among IDU,
31
high rates of incarceration of IDU,
32
and, within our
study, incarceration associated with HIV/HCV coin-
fection, with one in four incarcerated IDU already
coinfected and increasing prevalence with age.
These ingredients predict an enormous morbidity
and mortality in the near to intermediate term unless
met with rapid scale-up of harm reduction, treat-
ment programs outside and inside detention, and,
with the consensus among Iranian health ofcials,
assent of policy makers and society, as well as less
incarceration of drug users.
Acknowledgments
This research has been supported by Tehran Uni-
versity of Medical Sciences and Health Services
grant and Dariush Research Institute [grant num-
ber 801/86/7056].
M. Hosseini, S. A. SeyedAlinaghi, P. Kheirandish, et al.
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References
1. Matthews GV, Dore GJ. HIV and hepatitis C coin-
fection. J Gastroenterol Hepatol. 2008; 23: 1000
– 1008.
2. Kumar R, Singla V, Kacharya S. Impact and man-
agement of hepatitis B and hepatitis C virus coin-
fection in HIV patients. Trop Gastroenterol. 2008;
29: 136 – 47.
3. Carmo RA, Guimarães MD, Moura AS, Neiva
AM, Versiani JB, Lima LV, et al. The inuence of
HCV coinfection on clinical, immunological, and
virological responses to HAART in HIV—patients.
Braz J Infect Dis. 2008; 12: 173 – 179.
4. Roe B, Hall WW. Cellular and molecular interac-
tions in coinfection with hepatitis C virus and hu-
man immunodeciency virus. Expert Rev Mol Med.
2008; 10: e30.
5. Monto A, Currie S, Wright TL. Liver disease in in-
jection drug users with hepatitis C, with and with-
out HIV coinfection. J Addict Dis. 2008; 27: 49 –
59.
6. Low E, Vogel M, Rockstroh J, Nelson M. Acute
hepatitis C in HIV-positive individuals. AIDS Rev.
2008; 10: 245 – 253.
7. McDonald SA, Donaghy M, Goldberg DJ, Hutchin-
son S, Robertson C, Bird S, et al. A population-
based record linkage study of mortality in hepatitis
C-diagnosed persons with or without HIV coinfec-
tion in Scotland. Stat Methods Med Res. 2009; 18:
271 – 283.
8. Lo Re V, Kostman JR, Amorosa VK. Management
complexities of HIV/hepatitis C virus coinfection
in the twenty-rst century. Clin Liver Dis. 2008;
12: 587 – 609.
9. Solomon S, Srikrishnan A, Mehta S, Vasudevan C,
Murugavel K, Thamburaj E, et al. High prevalence
of HIV, HIV/hepatitis C virus coinfection, and risk
behaviors among injection drug users in Chennai,
India: a cause for concern. JAIDS. 2008; 49: 327
– 332.
10. Catalan-Soares BC, Almeida RTP, Carneiro-Proiet-
ti ABF. Prevalence of HIV-1/2, HTLV-I/II, hepatitis
B virus (HBV), hepatitis C virus (HCV), Trepone-
ma pallidum, and Trypanosoma cruzi among prison
inmates at Manhuacu, Minas Gerais State, Brazil.
Rev Soc Bras Med Trop. 2000; 33: 27 – 30.
11. Haber PS, Parsons SJ, Harper SE, White PA, Raw-
linson WD, Lloyd AR. Transmission of hepatitis C
within Australian prisons. Med J Aust. 1999; 171:
31 – 33.
12. Mutter RC, Grimes RM, Labarthe D. Evidence of
intraprison spread of HIV infection. Arch Intern
Med.1994; 154: 793 – 795.
13. Stark K, Bienzle U, Vonk R, Guggenmoos-Holz-
mann I. History of syringe sharing in prison and
risk of hepatitis B virus, hepatitis C virus, and hu-
man immunodeciency virus infection among in-
jecting drug users in Berlin. Int J Epidemiol. 1997;
26: 1359 – 1366.
14. Pontali E, Ferrari F. Prevalence of hepatitis B virus
and/or hepatitis C virus coinfections in prisoners
infected with the human immunodeciency virus.
Int J Prison Health. 2008; 4: 77 – 82.
15. Adjei AA, Armah HB, Gbagbo F, Ampofo WK,
Quaye IKE, Hesse IFA, et al. Prevalence of human
immunodeciency virus, hepatitis B virus, hepatitis
C virus, and syphilis among prison inmates and of-
cers at Nsawam and Accra, Ghana. J Med Micro-
biol. 2006; 55: 593 – 597.
16. Re V, Gallego S, Farías A, Barbás G, Kremer L,
Díaz MP, et al. Hepatitis C and HIV coinfection in
central region of Argentina: prevalence, genotype
characterization, and risk factors. Enferm Infecc
Microbiol Clin. 2008; 26: 423 – 425.17.
17. Sabbatani S, Giuliani R, Fulgaro C, Paolillo P,
Baldi E, Chiodo F. HIVAb, HCVAb, and HBsAg
seroprevalence among inmates of the prison of Bo-
logna and the effect of counselling on the compli-
ance of proposed tests. Epidemiol Prev. 2004; 28:
163 – 168.
18. Sáiz de la Hoya P, Bedia M, Murcia J, Cebriá J,
Sánchez-Payá J, Portilla J. Predictive markers of
HIV and HCV infection and coinfection among in-
mates in a Spanish prison. Enferm Infecc Microbiol
Clin. 2005; 23: 53 – 57.
19. Khani M, Vakili MM. Prevalence and risk factors
of HIV, hepatitis B virus, and hepatitis C virus in-
fections in drug addicts among Zanjan prisoners.
Arch Iran Med. 2003; 6: 1 – 4.
20. Massad E, Rozman M, Azevedo RS. Seropreva-
lence of HIV, HCV, and syphilis in Brazilian pris-
oners: preponderance of parenteral transmission.
Eur J Epidemiol. 1999; 15: 439 – 445.
21. Skoretz S, Zaniewski G, Goedhuis NJ. Hepatitis C
virus transmission in the prison/inmate population.
Can Commun Dis Report. 2004; 30: 16 – 26.
22. Mirahmadizadeh AR, Kadivar MR, Hemmati AR,
Javadi A. Infection with HIV and hepatitis C, and
B viruses among injecting drug users in Shiraz,
Southern Iran. 15
th
International Conference on
AIDS; Bangkok, Thailand. 11 – 12 July, 2004;
23. Aminzadeh Z, Aghazadeh Sarhangi K. Seroepide-
miology of HIV, syphilis, hepatitis B, and C in in-
travenous drug users at Loghman Hakim hospital.
IJMM. 2008; 1: 53 – 56.
24. Harania RS, Karuru J, Nelson M, Stebbing J. HIV,
hepatitis B, and hepatitis C coinfection in Kenya.
HIV/HCV in Drug Users
www.SID.ir
Page 5
Archive of SID
Archives of Iranian Medicine
, Volume 13, Number 4, July 2010
323
AIDS. 2008; 22: 1221 – 1222.
25. Rodrigues MCV, Viotti JB, Braga RF, Lourenco
LFS, Antunes CMF, Lambertucci JR. HIV/HCV
coinfection in infectious disease units in Mozam-
bique and Brazil: a comparative study. Revista da
Sociedade Brasileira de Medicina Tropical. 2008;
41: 518.
26. March JC, Oviedo-Joekes E, Romero M. Fac-
tors associated with reported hepatitis C and HIV
among injecting drug users in ten European cities.
Enferm Infecc Microbiol Clin. 2007; 25: 91 – 97.
27. Zamani S, Kihara M, Gouya MM, Vazirian M,
Ono-Kihara M, Razzaghi EM, et al. Prevalence of
and factors associated with HIV-1 infection among
drug users visiting treatment centers in Tehran,
Iran. AIDS. 2005; 19: 709 – 716.
28. Razzaghi EM, Movaghar AR, Green TC, Khosh-
nood K. Proles of risk: a qualitative study of in-
jecting drug users in Tehran, Iran. Harm Reduct J.
2006; 3: 12.
29. Manavi M, Baghestanian M, Watkins-Riedel T,
Battistutti W, Pischinger K, Schatten C, et al. De-
tection of hepatitis C virus (HCV) RNA in normal
cervical smears of HCV-seropositive patients. Clin
Infect Dis. 2002; 35: 966 – 973.
30. Hajiabdolbaghi M, Razani N, Karami N, Kheiran-
dish P, Mohraz M, Rasoolinejad M, et al. Insights
from a survey of sexual behavior among a group
of at-risk women in Tehran, Iran, 2006. AIDS Educ
Prev. 2007; 19: 519 – 530.
31. UNAIDS Update 2004. Islamic Republic of Iran:
Epidemiological Fact Sheets on HIV/AIDS and
Sexually Transmitted Disease. Available from:
URL: http://data.unaids.org/Publications/Fact-
Sheets01/iran_en.pdf?preview=true (Accessed 12
May 2005 and 7 January 2007)
32. Mokri A. Brief overview of the status of drug abuse
in Iran. Arch Iran Med. 2002; 5: 184 – 190.
M. Hosseini, S. A. SeyedAlinaghi, P. Kheirandish, et al.
www.SID.ir
Page 6
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    • "Informed consent was taken from the participants by the interviewers. Blood specimens were collected for HIV/HCV testing (20, 21). "
    [Show abstract] [Hide abstract] ABSTRACT: The Ministry of Health, Treatment and Medical Education of Iran has recently announced an estimated figure of 200,000 injecting drug users (IDUs). The aim of this study was to pilot a national program using demographics, types of drug abuse and prevalence of blood-borne infections among IDUs. In order to elicit data on demographics, types of drug abuse and prevalence of blood-borne infections among IDUs, a questionnaire was designed in the Bureau of Mental-Social Health and Addiction in collaboration with Iran's Drug Control Headquarters of the Police Department. Therapeutical alliance of addiction in Shafagh Center was based on Methadone Maintenance Therapy (MMT). Among 402 reported IDUs most of them were male, single and in age range of 20 to 39 years old with 72.7% history of imprisonment. Most of them had elementary and high school education and a history of addiction treatment. The majority were current users of opioid, heroin and crack. The prevalence of blood-borne infections was 65.9% and 18.8% for HCV and HIV/AIDS infections, respectively. Prevention programs about harm reduction, treatment and counseling should include young IDUs as a core focus of their intervention structure.
    Full-text · Article · Jun 2013 · Iranian Journal of Public Health
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    • "Human immunodeficiency virus (HIV) and Treponema pallidum-the causative agent of syphilis-can coinfect the same host, because their risk factors are the same and they are transmitted sexually [1] . By the end 2007, 33 million people were infected by HIV and meanwhile, syphilis is still one of the major causes of death in some developing countries where HIV infection is also prevalent [1] [2] . "
    [Show abstract] [Hide abstract] ABSTRACT: To identify the frequency of syphilis among Iranian HIV-positive patients. A cross-sectional study on the prevalence of syphilis and HIV co-infection among 450 patients diagnosed with HIV infection was conducted between 2004 and 2008 at Imam Khomeini hospital, Tehran, Iran. The lab tests including CD4 cell count, cerebrospinal fluid, veneral disease research laboratory (VDRL), fluorescent treponema antibody-absorption (FTA-Abs) and viral load were performed for all the patients. Data regarding medical history and their demographics were also collected. Of all 450 HIV-positive patients, 24 (5.3%) had a positive VDRL test and only two men had a FTA-Abs positive test which means 0.45% of them had a definite co-infection of syphilis. 65.3% of the HIV-positive patients were injection drug users that the co-infection prevalence of them was 0.7%. We did not find any patient with neurosyphilis. Considering the increasing prevalence of HIV and also extensive use of highly active antiretroviral therapy in developing nations, the diagnosis of syphilis should be timely established using screening tests among such patients.
    Full-text · Article · Apr 2013 · Asian Pacific Journal of Tropical Biomedicine
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    • "Only two studies—one in Vancouver [15] and another in southern China [16]—distinguished between HCV mono-infection and HCV infection among IDUs. Studies that attempted to identify risk factors of HCV/HIV co-infection among IDUs were either limited to male IDUs [17] or young IDUs (≤29 years of age) [15] or underestimated the effects of co-infection because, instead of seronegative cases, they enrolled mono-infected cases [16], or both mono-infected and seronegative cases, as the reference group [15,17]. Moreover, findings on the association between syringe sharing and HCV/HIV co-infection were not consistent [15-17]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Injecting drug users (IDUs) in Taiwan contributed significantly to an HIV/AIDS epidemic in 2005. In addition, studies that identified risk factors of HCV/HIV co-infection among IDUs were sparse. This study aimed to identify risk factors of HCV/HIV co-infection and HCV mono-infection, as compared with seronegativity, among injecting drug users (IDUs) at a large methadone maintenance treatment program (MMTP) in Taipei, Taiwan. Methods Data from enrollment interviews and HCV and HIV testing completed by IDUs upon admission to the Taipei City Hospital MMTP from 2006–2010 were included in this cross-sectional analysis. HCV and HIV testing was repeated among re-enrollees whose HCV or HIV test results were negative at the preceding enrollment. Backward stepwise multinomial logistic regression was used to identify risk factors associated with HCV/HIV co-infection and HCV mono-infection. Results Of the 1,447 IDUs enrolled, the prevalences of HCV/HIV co-infection, HCV mono-infection, and HIV mono-infection were 13.1%, 78.0%, and 0.4%, respectively. In backward stepwise multinomial regression analysis, after controlling for potential confounders, syringe sharing in the 6 months before MMTP enrollment was significantly positively associated with HCV/HIV co-infection (adjusted odds ratio [AOR]=27.72, 95% confidence interval [CI] 13.30–57.76). Incarceration was also significantly positively associated with HCV/HIV co-infection (AOR=2.01, 95% CI 1.71–2.37) and HCV mono-infection (AOR=1.77, 95% CI 1.52–2.06), whereas smoking amphetamine in the 6 months before MMTP enrollment was significantly inversely associated with HCV/HIV co-infection (AOR=0.44, 95% CI 0.25–0.76) and HCV mono-infection (AOR=0.49, 95% CI 0.32–0.75). HCV seroincidence was 45.25/100 person-years at risk (PYAR; 95% CI 24.74–75.92/100 PYAR) and HIV seroincidence was 0.53/100 PYAR (95% CI 0.06–1.91/100 PYAR) among re-enrolled IDUs who were HCV- or HIV-negative at the preceding enrollment. Conclusions IDUs enrolled in Taipei MMTPs had very high prevalences of HCV/HIV co-infection and HCV mono-infection. Interventions such as expansion of syringe exchange programs and education regarding HCV/HIV prevention should be implemented for this high-risk group of drug users.
    Full-text · Article · Dec 2012 · BMC Public Health
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