Epidemiologic Situation of
Human Immunodeficiency Virus (HIV/AIDS Patients) in a Private Clinic in Tehran,
Amitis Ramezani MD•*,
Minoo Mohraz MD**, Latif Gachkar MD***
Research Center, Pasteur Institute, **Imam Khomeini Hospital,
Tehran University of Medical Sciences, ***Infectious Diseases
and Tropical Medicine Research Center, Shaheed Beheshti
University of Medical Sciences, Tehran, Iran .
•Corresponding author and
Ramezani MD, Clinical Research Center, Pasteur
Institute, Pasteur Square, Tehran, Iran. Tel: +98-21-6696-8852,
Accepted for publication: 25
Injection drug use has been the major route of HIV transmission
over the past several years in some countries. The aim of this
study was to describe epidemiologic and demographic factors, as
well as the risk behavior data in HIV-positive patients referred
to a private clinic in Tehran.
retrospective study was conducted in 2005 based on documents of
150 HIV-infected patients referred to a private clinic from 1992
through 2004 in Tehran.
150 HIV-positive patients (124 males and 26 females) were
analyzed. Injection drug use with one other risk factor, namely
shared needle (n = 46), injection drug use without any other
known risk factor (n = 37), and sexual activity (n = 25) were
the major possible routes of transmission of HIV infection. The
major possible route of transmission in female patients was
sexual activity (n = 17), mostly from infected husbands (13/17).
no patient with a history of drug abuse from 1992 to 1997. The
frequency of HIV-positive injection drug users was 1 in 1997 –
1998, 6 in 1999, 3 in 2000, 24 in 2001, 32 in 2002, 37 in 2003,
and 11 in 2004.
Eighty-three (55%) of 150 and 64 (74%) of 86 patients had a
history of drug abuse and incarceration, respectively.
high rates of hepatitis C and B virus coinfection in our
HIV-positive patients. Injection drug use is the main risk
factor associated with HIV infection in Iran.
of Iranian Medicine, Volume 9, Number 4, 2006: 315 – 318.
injection drug user
t the beginning of 1980’s,
acquired immune deficiency syndrome (AIDS) and its etiological
agent were for the first time described to be associated with
sexual contact, especially sex with other men as the main risk
factor of human immunodeficiency virus (HIV) transmission.
Nowadays, in many countries including Iran, however, drug abuse
has been the major route of HIV transmission over the past
several years. Among males with AIDS in Argentina, 45% were
injection drug users (IDUs). It was estimated that 50% of women
had acquired infection through heterosexual contact and 12%
through sex with IDU male partners; 31% of
women were themselves IDUs; 7% showed
blood transfusion as the possible route of transmission. Among
children who developed AIDS, it was estimated
that 3% acquired the infection through
blood transfusions and 95% were children whose
mothers were infected with HIV.1
According to the United States
(US) Center for Disease Control and Prevention (CDC), drug abuse
remains the second most common cause of exposure to HIV among
cases in the United States.2, 3
Considering the above points and
regarding the increasing rate of drug abusing in Iran, this
study was aimed to investigate this problem. Although, HIV and
drug abuse are associated with numerous medical and health
consequences, we focused on the prevalence of drug abuse and co
occurrence of blood-borne infections and demographic features of
our HIV-positive patients referred to a private clinic from 1992
This retrospective study was
carried out in 2005, using the existing data of 150 HIV-positive
patients who were referred from other clinics to a private
clinic in Tehran from 1992 through 2004. We studied some
demographic characteristics including age, sex, history of
injection drug using, possibility of other routes of
transmission, having a risky behavior, history of incarceration,
etc. We also examined some laboratory tests including
anti-hepatitis C virus (HCV) antibody (Ab) and hepatitis B virus
surface antigen (HBsAg) using ELISA, in their documents. All
these patients were enrolled into our study (inclusion
criteria). Data obtained from these 150 documents were extracted
and statistical analyses were performed using SPSS (version
Anti-HCV Ab and HBsAg were
detected in only 95 patients and referral date were not recorded
in seven of 150 patients. History of incarceration was not
reported in 64 documents.
In this study, documents of 150
referral HIV-positive patients were retrospectively analyzed.
There were 124 (83%) male and 26 (17%) female patients. The mean
± SD age of patients was 33.8 ± 9.5 (range: 2 – 57) years
Distribution of HIV-positive patients in different
Injection drug use with one
other risk factor, namely shared needle (n = 46), Injection drug
use without any other known risk factor (n = 37), sexual
activity (n = 25), blood disorders (e.g., hemophilia and
thalassemia major) (n = 12), and surgery (n = 7) were the major
possible modes of transmission. In 16 patients, the possible
acquisition routes included perinatal transmission (n = 3), oral
addiction (n = 2), needle stick (n = 2), dental manipulation (n
= 2), shared blade (n = 2), bleeding (n = 1) tattooing (n = 2),
Ghamehzani [self-injury with poniard in ritual
(n = 1), and self-injury with an infected needle for suicide (n
= 1). In seven (5%) patients, we could not detect any probable
route of HIV transmission. From 143 patients with detectable
route of HIV transmission, 49 (34%) had more than one risk
Out of 150 HIV-positive
patients, 88 (55%) were IDUs. Sixty-three (74%) of 86 patients
had a history of incarceration (data were not available for the
remaining 64 patients).
In female patients, sexual
transmission was the major possible route of transmission (17 of
26 cases). In 13 female patients, the possible source of sexual
acquisition was their husbands.
Only 95 patients were checked
for HCV Ab and HBsAg. The seroprevalence of anti-HCV Ab and
HBsAg were 68% (n = 65; 63 males and 2 females) and 9.4% (n = 9;
all males), respectively.
From the year 1992 through the
end of 2003, 132 patients were included in our study. Of these
HIV-positive patients, 37 (28%) were diagnosed in 2003, 32 (24%)
in 2002, and 24 (18%) in 2001 (Figure 2). In 2004, we diagnosed
11 patients (date not available in seven patients).Trend of HIV
positive patients with drug abuse from 1992 through 2004 is
shown in Table 1.
Trend of HIV-positive patients from the years 1992
Trend HIV-positive patients with drug abuse from
1992 through 2004 in Iran.
patients with history of drug abuse
We showed an increasing trend
from 1992 through 2003 in HIV-positive patients with injection
drug use. Although this study was restricted to a private
clinic, considering the number of cases and many referral
patients from other clinics or organizations, relatively high
prevalence of drug abuse and incarceration in HIV-positive
patients could be noted. But in 2004, because of the
establishment of counseling centers for behavioral diseases and
the AIDS Research Centerin Tehran, Iran,
we observed a reduction in HIV-positive IDUs referred to our
private clinic. In fact, the most HIV-positive IDUs were
referred to other centers for receiving methadone.
The major findings of this study
were the high frequency of injection drug use (55%) and high
coinfection rate (68%) of HIV and HCV in our patients. Syringe
sharing was the major risk factor for the spread of HIV and HCV
Numerous seroprevalence studies
have shown a high rate of coinfection with hepatitis C among HIV1-infected
patients, ranging from 98% in hemophiliacs and 80% among IDUs,
to 3% – 15% in homosexual/bisexual men. Data have shown that HIV
increases the rate of HCV progression; there is also some
evidence suggesting that HCV worsens HIV progression, although
this is controversial. There is growing recognition of the
significant impact of co-infection on the management of HIV
disease. Hepatitis morbidity and mortality among co-infected
patients have increased five-fold in the recent years.4
Most HIV-infected IDUs were 20
to 35 years old. An estimated 1.8 million adults and children
are currently living with HIV in Latin America and the
Caribbean, and injection drug abuse remains a major factor in
initial exposures to HIV in these parts of the world.5
In Spain, 75% of the 61,000 cases of AIDS have been related to
injection drug use 5 In comparison to low frequency
of HBV coinfection in our patients (9.4%), in Spain, this number
was very high (73%).
In Argentina, among the 12,252
HIV-infected individuals, the frequency of injection drug use
was 47%, HCV infection 92%, and HBV infection 73%.5
Among 285 addicts, including 242
IDUs and 43 oral drug users living in three cities of China, HIV
and HCV were presented as detected by ELISA and/or PCR. The
overall prevalence of HIV infection was 71.9%. The rate of HCV
coinfection among 138 HIV-infected IDUs was 99.3%.In this
study, most HIV-infected patients with injection drug use were
aged between 20 to 35 years (similar to our study). The
prevalence of HIV in female IDUs (81.2%) was significantly
higher than male IDUs (68.2%) (in contrast to our study).6
In another study performed by
Islam et al in Bangladesh, 505 male drug addicts, including 250
IDUs and 255 non-IDUs were investigated for presence of anti-HIV1
by ELISA. Amongst the IDUs (n = 250), the seroprevalence rate
was 5.6% (n = 14) and in non-IDUs (n = 255) it was 1.96% (n =
Another study carried out by
Nguyen et al in Vietnam on IDU patients, the nationwide
prevalence of HIV increased from 10.1% in 1996 to 32% in 2002.8
They reported that an HIV epidemic is predominant among IDUs.8
Our study also showed a rising trend in HIV-positive patients
with injection drug use.
In a study on HIV-seropositive
IDUs in Manipur, India, the rate of HCV infection reached 92%.9
The trends in HIV prevalence
among IDUs in Rotterdam (1994 – 2002) was studied by de Boer and
coworkers.10 The prevalence of HIV did not change
over time, being 11.4% in 1994, 9.4% in 1997, and 10.2% in 2002.
In Iran, we had a rising trend in HIV-positive IDUs.
In the present study, injection
drug use and sexual behavior were the major possible mode of
transmission of HIV infection. Injection drug use had an
increasing trend from 1992 through 2003. Based on this report,
evaluation of several strategies for HIV infection/AIDS harm
reduction such as AIDS education, access to condoms, as well as
exchange and provision of means for disinfecting injectable
devices are recommended.
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