HCV in Intravenous Drug Users

Hepatitis C (HCV) is increasing worldwide including Iran. HCV is more prevalent among intravenous drug abusers (IDU), especially if imprisoned, mostly due to needle sharing. We determined the rate of HCV seropositivity among IDU prisoners and compared it with those of non prisoners. A cross-sectional survey was done on consenting IDU inhabiting two prisons and attending three rehabilitation centers in Tehran, Iran. A questionnaire was completed for each subject and 5mL blood drawn. The samples were kept at 2-8°C until the sera were separated and stored at -70°C. HCV Ab (ELISA 1, third generation, DIA. PRO, Italy) with a sensitivity and specificity of 98% was checked by a single technician. Chi-square, Fisher's exact test and multivariable analysis were used where appropriate. Four-hundred and sixty seven subjects [346 (74.1%) prisoners; 425 (91%) male] were enrolled. Overall 66% tested positive for HCV Ab [287 male (67.5%), 21 female (50%), p‹0.02]. HCV seropositivity was higher among prisoners (78.3% vs. 30.6%, p‹0.001) and older IDU (76.9% vs. 62.9%, p=0.002). Multivariable analysis showed association between HCV seropositivity and imprisonment (OR= 9.32, 95%CI: 5.60-15.51), sharing syringes (OR=2.00, 95%CI: 1.27-3.17), duration of intravenous drug use annually (OR=1.16, 95%CI: 1.08-1.24) and male sex (OR=4.18, 95%CI: 2.02- 8.67). HCV is rather common among IDU prisoners. Imprisonment is an independent risk factor. The infected IDU going back to the community may be an important source of HCV. Taking effective strategies (high risk group education, provision of sterile syringes, identification and treatment of infected IDU) to reduce the risk of this public health problem is needed urgently.