Hepatitis B virus infection among people who use drugs in Iran: a systematic review, meta-analysis, and trend analysis

Abstract

Background People who use drugs (PWUD) are considered as one of the main at-risk populations for Hepatitis B virus (HBV) infection. We conducted a systematic review on the prevalence of HBV infection among PWUD in Iran. Methods Consistent with PRISMA guideline, international (Medline, Web of Science, Scopus, and Embase) and national (Scientific Information Database) databases were searched using a comprehensive search strategy up to September 2019. The retrieved records were reviewed, and experts were contacted for unpublished studies. Studies on Iranian PWUD reporting HBV surface Antigen (HBsAg) prevalence among people who inject drugs (PWID) and non-injecting PWUD were included. HBsAg prevalence was pooled for PWID and non-injecting PWUD and for other subgroups using random-effects model meta-analysis. The trend of HBV prevalence over time was investigated using meta-regression analysis. Results Overall, 35 studies reported data on HBV infection among PWID (33 studies) and non-injecting PWUD (11 studies). The pooled prevalence of HBsAg among PWID was 4.8% (95% CI 3.7–6.2). The only risk factor significantly associated with the odds of positive HBsAg in PWID was the previous history of imprisonment (OR 1.72, 95% CI 1.29–2.30, p value = 0.000). The pooled estimate of HBsAg among non-injecting PWUD was 2.9% (95% CI 2.5–3.2). Time trend analyses showed significant decrease in HBV prevalence among PWID reaching from 8.2% (95% CI 3.9–16.5) in 2004–2006 to 3.1% (95% CI 2.3–4.1) in 2016 and later (b = -0.07; p value = 0.05). No significant trend was detected for non-injecting PWUD. Conclusion The prevalence of HBV infection among non-injecting PWUD and even PWID was not considerably higher than the Iranian general population. This might be the result of extensive harm reduction interventions in Iran. However, it seems that there are subgroups of PWID, who do not adequately benefit from existing harm reduction interventions. Future programs should more specifically target these high-risk groups.

Prevalence of Hepatitis B and Hepatitis C Infections among Incarcerated Individuals in Iran: A Cross-Sectional National Bio-behavioral Study in 2019

“…The highest prevalence of HBsAg (60.8%) and HBcAb (85.1%) in Iran was observed in Afghan refugees in a camp in the south of Iran [33]. On the other hand, a meta-analysis has shown that the prevalence of HBsAg among non-injecting people who use drugs and PWID in Iran is 2.9% and 4.8%, respectively [34]. The present study showed that the prevalence of HBsAg in incarcerated individuals with a history of drug injection was 3.01%.…”

HIV prevalence among non‐injecting people who use drugs and related factors in Iran: A systematic review and meta‐analysis

“…Similarly, according to another study, there has been no significant trend of hepatitis B virus (HBV) infection among this group in 1990–2017 timespan in the country [50]. On the other hand, there has been a significant decline in the prevalence of both HIV and hepatitis B virus infection among PWID in a similar period in Iran [6,50]. The latter decline has been mostly attributed to the extensive harm reduction measures initiated in 2002 and expanded since 2005, including needle syringe and opioid substitution treatment programs [51,52].…”

“…However, we found no significant difference between the HIV prevalence among non‐injecting PWUD before 2007 and afterward. Similarly, according to another study, there has been no significant trend of hepatitis B virus (HBV) infection among this group in 1990–2017 timespan in the country [50]. On the other hand, there has been a significant decline in the prevalence of both HIV and hepatitis B virus infection among PWID in a similar period in Iran [6,50].…”

“…Although the harm reduction measures did not target the non-injecting PWUD specifically, they could have also contributed to controlling blood-borne infections among non-injecting PWUD due to their shared network with PWID. Nonetheless, given a rate of 1.9% of HIV infection (years 2007-2017), 8.0% of hepatitis C virus infection (years 2001-2012) and 2.9% of hepatitis B virus infection (years 2003-2016) among non-injecting PWID in Iran [36,50], preventive measures specifically targeted for non-injecting PWUD for the reduction of high-risk behaviours seems necessary.…”

Precore/core mutations of hepatitis B virus genotype D arising in different states of infection

“…A meta-analysis study in 2017 estimated that the prevalence rates of HBsAg and anti-HBcAb in Iran’s general population were 1.79% (1.67% to 2.32%) and 13.59% (12.92% to14.29%), respectively [ 2 ]. Moreover, the pooled pre-valence of HBsAg among people who use drugs through injecting and otherwise was 4.8% and 2.9%, respectively [ 3 ]. Additionally, the pooled prevalence of HBsAg among Iranian hemodialysis patients was 4% [ 4 ].…”