Injecting drug users (IDUs) are the main at-risk population for hepatitis C virus (HCV) transmission. We studied HCV infection, risk factors, and genotype distribution in relation to the year of first injection among Iranian IDUs. Of a total of 126 specimens positive for HCV antibody, 93 (74 %) had detectible HCV RNA, and the NS5B gene was sequenced for 83, with genotype 3a (n = 48, 58 %) being predominant, followed by 1a (n = 35, 42 %). Tattooing was an independent predictor for HCV infection. No significant difference was found between HCV genotypes and IDU characteristics. Although there was no change in the distribution of prevalent genotypes before and after 1997, a slight variation in the prevalence was observed (p = 0.71). The difference in the prevalence of subtypes 1a and 3a (9.1 % in the period 1984-1996 and 18.2 % in the period 1997-2009) during 25 years was 9.1 %. These findings indicate a high prevalence of HCV infection among Iranian IDUs and highlights HCV-3a as the most prevalent subtype for the past 25 years. Harm-reduction strategies appear to be the most important measures to reduce the transmission of HCV in Iran.

Background:Hypervariability of HCV proteins is an important obstacle to design an efficient vaccine for HCV infection. Multi-epitope vaccines containing conserved epitopes of the virus could be a promising approach for protection against HCV.Objectives:Cellular and humoral immune responses against multi-epitope DNA and peptide vaccines were evaluated in BALB/c mice.Materials and Methods:In this experimental study, multi-epitope DNA- and peptide-based vaccines for HCV infection harboring immunodominant CD8+ T cell epitopes (HLA-A2 and H2-Dd) from Core (132-142), NS3 (1073-1081) and NS5B (2727-2735), a Th CD4+ epitope from NS3 (1248-1262) and a B-cell epitope from E2 (412-426) were designed. Multi-epitope DNA and peptide vaccines were tested in two regimens as heterologous DNA/peptide (group 1) and homologous peptide/peptide (group 2) prime/boost vaccine in BALB/c mice model. Electroporation was used for delivery of the DNA vaccine. Peptide vaccine was formulated with Montanide ISA 720 (M720) as adjuvant. Cytokine assay and antibody detection were performed to analyze the immune responses.Results:Mice immunized with multi-epitope peptide formulated with M720 developed higher HCV-specific levels of total IgG, IgG1 and IgG2a than those immunized with multi-epitope DNA vaccine. IFN-γ levels in group 2 were significantly higher than group 1 (i.e. 3 weeks after the last immunization; 37.61 ± 2.39 vs. 14.43 ± 0.43, P < 0.05). Moreover, group 2 had a higher IFN-γ/IL-4 ratio compared to group 1, suggesting a shift toward Th1 response. In addition, in the present study, induced immune responses were long lasting and stable after 9 weeks of the last immunization.Conclusions:Evaluation of multi-epitope DNA and peptide-vaccines confirmed their specific immunogenicity in BALB/c mice. However, lower Th1 immune responses in mice immunized with DNA vaccine suggests further investigations to improve the immunogenicity of the multi-epitope DNA vaccine through immune enhancers.

There is no published data on association of HLA class II alleles with clearance or persistence after acute hepatitis C virus (HCV) infection in patients from Iran. HLA DRB1, DQA1, and DQB1 alleles were determined using polymerase chain reaction amplification with sequence specific primers (PCR-SSP) on a total of 117 thalassemia patients (63 with chronic infection, and 54 with viral clearance) and 120 healthy controls. HLA-DRB1*0301 and DQA1*0501 alleles were found significantly present in patients with HCV clearance compared to those with chronic infection (P = 0.03 and P = 0.0007, respectively). By contrast, DRB1*0701, DQA1*0201, and DQB1*0602 alleles occurred significantly in those with chronic infection compared to those with viral clearance (P = 0.004, P = 0.007, and P = 0.02, respectively). As compared to the controls, DRB1*0301, DRB1*11, DQA1*0501, and DQB1*0301 alleles showed a significant decrease in chronic patients (P = 0.002, P = 0.001, P = 0.0001, and P = 0.0004, respectively). Furthermore, the haplotype frequencies of DRB1*0301, DQA1*0501, DQB1*0201, and DRB1*1101, DQA1*0501, DQB1*0301 were found significantly higher (P = 0.004 and P = 0.04, respectively) in patients with HCV clearance than those with chronic infection. By contrast, the haplotype DRB1*0701, DQA1*0201, DQB1*0201 occurred more frequently (P = 0.02) in those with chronic infection compared with those with viral clearance. These findings suggest that particular HLA alleles and related haplotypes may have an influence on the outcome of HCV infection among the Iranian patients. Some of the HLA alleles found in the Iranian patients are different from those reported elsewhere, suggesting that the immunogenetic makeup for HCV clearance or persistence may vary based on the ethnicity.

The high rate of hepatitis C virus (HCV) infection among transfusion related risk groups such as patients with inherited bleeding disorders highlighting the investigation on prevalent subtypes and their epidemic history among this group. In this study, 166 new HCV NS5B sequences isolated from patients with inherited bleeding disorders together with 29 sequences related to hemophiliacs obtained from a previous study on diversity of HCV in Iran were analyzed. The most prevalent subtype was 1a (65%), followed by 3a (18.7%),1b (14.5%),4(1.2%) and 2k (0.6%). Subtypes 1a and 3a showed exponential expansion during the 20th century. Whereas expansion of 3a started around 20 years earlier than 1a among the study patients, the epidemic growth of 1a revealed a delay of about 10 years compared with that found for this subtype in developed countries. Our results supported the view that the spread of 3a reached the plateau 10 years prior to the screening of blood donors for HCV. Rather, 1a reached the plateau when screening program was implemented. The differences observed in the epidemic behavior of HCV-1a and 3a may be associated with different transmission routes of two subtypes. Indeed, expansion of 1a was more commonly linked to blood transfusion, while 3a was more strongly associated to drug use and specially IDU after 1960. Our findings also showed HCV transmission through blood products has effectively been controlled from late 1990s. In conclusion, the implementation of strategies such as standard surveillance programs and subsiding antiviral treatments seems to be essential to both prevent new HCV infections and to decline the current and future HCV disease among Iranian patients with inherited bleeding disorders.

Background: Health policymakers need to use prioritization for resource allocation in the health system because of limitations to financial resources. Objectives: This study aimed to explore the criteria affecting the appropriate allocation of health system resources to different diseases. Methods: A qualitative study was carried out in 2017 using semi-structured interviews. Participants were chosen using purposeful and snowball sampling methods. Totally, 25 experts in the health care system were interviewed. The present study employed conventional content analysis and data were analyzed using MAXQDA10 software. Results: The findings were categorized into four main categories and 21 sub-categories. The main categories included criteria related to "type of disease", "patients' characteristics", "type of treatment", and "ethical and responsiveness issues". Furthermore, the most effective factors on resource allocation included the emergency or non-emergency aspects of the disease, disease severity, disease onset, treatment effectiveness, and disease prevention. Conclusions: Health policymakers should direct resources toward emergency and severe diseases that significantly affect people's quality of life. According to the findings of the present study, the "type of disease" was one of the most important criteria in health resources allocation. Therefore, similar to DRG, we can categorize diseases and health system problems based on their priority and use such grouping for health resources allocation.