Iran, a country in the Middle East and North Africa (MENA) region, has been actively involved in the fight against HIV/AIDS over the past three decades. The unique features of the HIV epidemic in Iran are reflected by the modes of transmission and its recent changes to improve management and prevention programs. In this review, we recount the initial onset and subsequent spread of HIV infection in Iran, beginning with the first case diagnosed to the ongoing responses and most recent achievements in controlling this epidemic. Although in the MENA region Iran is one of the pioneers in implementing pertinent policies including harm reduction services to decrease HIV incidence, drug injection still continues to be the major risk of infection. In line with other nations, the programs in Iran aim at the UNAIDS 90-90-90 targets 1 and to eliminate mother-to-child HIV transmission. In this article, we discuss the strengths and shortcomings of the current HIV programs and offer suggestions to provide a better perspective to track and respond to the HIV epidemic. More generally, our account of the national religious and cultural circumstances as well as obstacles to the approaches chosen can provide insights for decision-makers in other countries and institutions with comparable settings and infrastructures. KeywordsHIV; Iran; Review 1 UNAIDS 90-90-90 global targets to end the AIDS epidemic by 2020: by 2020, 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have viral suppression.

The prevalence of HIV is substantially higher among prisoners than the general population, while the incidence varies considerably in different regions around the world. If we consider Sub-Saharan Africa as one region with the highest prevalence of HIV, data on African prisoners would be limited. Despite the low prevalence of HIV in the Middle East and North Africa, its incidence is rising in these regions with a few exceptions; there are insufficient data on HIV prevalence in prisons. A similar situation is present in both Pacific and Central Asia as well as in Eastern Europe. A high rate of infection is mainly observed among prisoners in Western and Central parts of Europe, since the data from these are more available than other parts. Nowadays, the sexual transmission mode and tattooing are important ways in HIV risks among prisoners after injecting drug use as the most common route of HIV transmission in all regions. However, it is difficult to compare and analyze the prevalence of HIV among prisoners in different regions regarding the limited data and different methods which they used in collecting data. Eventually, it can certainly be said that prisons are one of the high-risk places for HIV transmission; on the other hand, can be a suitable place for implementing HIV case-finding, linkage to treatment and harm reduction programs.

We examined the effects of an 8 w circuit resistance training (RES) program using elastic bands and body weight on TCD4+ cell counts and anthropometry in HIV patients. Patients (N=21) receiving antiretroviral therapy were randomly assigned to resistance training (RES; n=14) or control group (CON; n=7) groups. RES (3/w) consisted of training with elastic bands and bodyweight training focusing on major muscle groups. CON received standard care. Statistical analyses were performed using general linear models adjusted for age, gender, length of infection and respective baseline measures. The primary outcome was TDC4+ and secondary outcomes were anthropometry indices. Tertiary assessments explored Pearson correlations surrounding the relationship between changes in anthropometry and TDC4+. We observed significant increases in TCD4+ count accompanying RES training (105.50 cells/mm3, 95% CI, 47.42, 163.59), while CON significantly decreased (-41.01 cells/mm3, 95% CI, -126.78, 44.76). Significant between group differences were noted (P<0.02; n=0.42). We also observed significant reductions in fat mass for RES (1.18 kg, 95% CI, =1.80, -0.56) vs. increased fat mass for CON (1.21 kg, 95% CI, 0.31, 2.11). Significant between group differences were noted (P=0.001, n=0.64). Similar effects were noted for lean body mass. No significant changes were observed for body weight. Significant correlations were observed for fat mass (r = -0.699, P=0.001) and lean mass (r = 0.553, P=0.017), but not body weight (r =-0.390, P=0.109) vs. changes in TDC4+. Our results suggest the RES program used in this study is effective for improving TDC4+ status and body composition in HIV patients.