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1.  The assessment of hepatitis B seroprevalence in persons with intravenous drug use history in the Isfahan province: Community-based study 
Background:
Hepatitis B with its complications has become one of the universal problems. Injection drug use is one of the most important risk factors in the transmission of hepatitis B. Therefore, we assessed hepatitis B virus prevalence among cases with a history of intravenous drug use (IVDU) as the first announcement-based study in this regard.
Materials and Methods:
The announcement-based detection of hepatitis B seroprevalence in volunteers with a history of intravenous drug use was conducted in the Isfahan province. A comprehensive community announcement was made in all the public places and to all physicians, in all the regions. One thousand five hundred and eighty-eight volunteers were invited to the Isfahan reference laboratories and serum samples were tested for HBs-Ag, HBc Ab, and HBs-Ab, using the enzyme-linked immunosorbent assay (ELISA) method.
Results:
In this study, 1588 individuals volunteered, who were estimated to be 50% of all the expected intravenous drug users in the community. HBs Ag was detected in 4.2% of them. HBc Ab and HBs Ab were detected in order in 11.4 and 17.3%, respectively.
Conclusion:
We estimated that the seroprevalence of hepatitis B positivity in intravenous drug users was moderate to high. Therefore, it was suggested that this group be encouraged to prevent acquiring infection by vaccination, education, counseling for risk reduction, and treatment of substance abuse, and finally hepatitis B virus (HBV) screening.
PMCID: PMC3963325  PMID: 24672567
Hepatitis B; history of IVDU; Iran
2.  Seroprevalence of hepatitis B virus and human immunodeficiency virus among young prisoners 
Background:
Juveniles in custody are affected by sexually transmitted infections due to risky behaviors. Therefore, they have a disproportionate burden of hepatitis B virus (HBV) and human immunodeficiency virus (HIV). In this study, the prevalence and associated characteristics of hepatitis B and HIV infections were assessed in young prisoners.
Materials and Methods:
In this cross-sectional study, prevalence of HBV and HIV infections was assessed among young prisoners during 2008-2009. A checklist consisting of demographic, social, and risk factors was filled out and blood was drawn for their tests. Sera were analyzed for hepatitis B surface antigen (HBs Ag), hepatitis B surface antibody (HBs Ab), hepatitis B core antibody (HBc Ab) and HIV Ab, and Western blot test was performed on antibody-positive HIV.
Results:
A total number of 160 young prisoners (147 boys and 13 girls) were evaluated. The mean age of the subjects was 16.59 ± 1.24 year. HBs Ag, HBc Ab, HBs Ab, and HIV Ab were detected in 1 (0.63%), 1 (0.63%), 52 (32.5%), and 1 (0.63%), respectively.
Conclusion:
With respect to national vaccination program against HBV infection, the juvenile prisoners had low prevalence of HBs Ab.
PMCID: PMC3719232  PMID: 23900503
Hepatitis B virus; human immunodeficiency virus; young prisoners
3.  Prevalence and Risk Factors of HIV, Syphilis, Hepatitis B and C Among Female Prisoners in Isfahan, Iran 
Hepatitis Monthly  2012;12(7):442-447.
Background
Female prisoners are at risk of acquiring sexually transmitted infections (STIs). There has been no previous study regarding the epidemiological status of STIs among female prisoners in Isfahan, central Iran.
Objectives
The aim of this study was to investigate the prevalence and risk factors of the aforementioned infections among women incarcerated in the central prison, Isfahan, to determine appropriate prevention measures.
Patients and Methods
In a cross-sectional study, all of the 163 women incarcerated in the central prison, Isfahan in 2009, were voluntarily enrolled by the census method. After completing a checklist consisting of demographic, social, and risk factors, a 5ml blood sample was taken from each individual. The sera were analyzed for markers of the hepatitis B virus (HBV; HBsAg, HBsAb, HBcAb), hepatitis C virus (HCV; HCV antibodies), human immunodeficiency virus (HIV; HIV antibodies), and syphilis (RPR). Confirmatory tests were performed on HCV antibody-positive cases.
Results
The mean age of the participants in the study was 34.54 ± 11.2 years old, 94.3% of these women were Iranian, and many of them had only a primary level of education. The prevalence of HBsAg, HBcAb, HBsAb, and HCV antibodies were; 1.2%, 7.4%, 12.9% and 7.4% respectively. No positive RPR or HIV antibodies were detected.
Conclusions
A significant relationship was seen between the HCV antibody, drug injection and illegal sex in the women, and also between HBc-Ab and drug injection. Regular screening, educational programs, and facilitation of access to suitable treatment care should be widely implemented in the prison population. Testing for immunity against HBV should be considered on admission, and afterwards vaccination of all prisoners and an appropriate preventative approach should be applied.
doi:10.5812/hepatmon.6144
PMCID: PMC3437455  PMID: 23008724
HIV; Hepatitis B Virus; Hepatitis C; Syphilis; Prevalence; Risk Factors
4.  Identification of Patients with Hepatitis C Virus Infection in Persons with Background of Intravenous Drug Use: The First Community Announcement-based Study From Iran 
Objectives:
Injection drug use plays the most important role in transmission of hepatitis C. In Iran, surveys have been conducted on various high risk groups but this is the first announcement based study for hepatitis C virus HCV prevalence among cases with history of intravenous drug using (IVDU) in the country.
Methods:
The announcement-based detection and follow-up of patients with anti-HCV positive project in volunteers with history of intravenous drug using was conducted in Isfahan province. At the first step, six focus groups were conducted and 2 pilot studies were carried out in two cities to design the main study. Comprehensive community announcement was done in all of public places and for physicians. The volunteers were invited to Isfahan reference laboratories and the serum samples were sent to Infectious Diseases Research Center Laboratory in standard conditions and HCV-Ab was tested by ELISA method.
Results:
In this study, 1,747 individuals that are estimated 50% of all expected intravenous drug users in the community were presented themselves. The most important reasons of success in recruiting volunteers in this study were the perfect propaganda, appropriate cooperation of lab staffs, continuous evaluation and good cooperation in Isfahan province administrations. HCV-Ab was detected in 34% of them and the HCV-Ab positives were sent for further follow-up procedures including confirmatory test, education, and treatment.
Conclusions:
In spite of some limitations to select real cases, this study was considered as a successful experience. Compared to the surveys in Iran on HCV prevalence in intravenous drug users, the results of this study, which was based on volunteers by announcement seems to be noteworthy.
PMCID: PMC3399287  PMID: 22826761
Announcement; Community; Hepatitis C; Intravenous drug using
5.  Hepatitis C among Intravenous Drug Users in Isfahan, Iran: a Study of Seroprevalence and Risk Factors 
Objectives:
Hepatitis C virus (HCV) is one of the major public health problems worldwide which is transmitted through contact with infected blood or blood products. One of the most prevalent modes of HCV transmission is injecting drug with unclean needles or syringes. Therefore intravenous drug users (IVDUs) are the most important group who should be considered. The aim of this study was to evaluate seroprevalence and risk factors of hepatitis C virus in IVDUs population.
Methods:
The cross-sectional study was carried out on intravenous drug users who attended health and social care Drop-in centers during November 2008 to February 2009 in Isfahan province, Iran. Data was gathered using interviewer-administered questionnaire including demographic characteristics and main risk factors for HCV infection. 5ml venous blood sample was obtained from each subject. The HCV-Ab test was performed on all blood samples by ELISA. The data was analyzed using descriptive statistical methods and multiple logistic regressions by SPSS software, version 15.
Results:
The mean age of participants was 31.77 ± 8.51. 503 (94.7%) were men and 28 (5.3%) were women. HCV seroprevalence was 47.1% (95% CI: 42.9, 51.3). The multiple logistic regressions demonstrated that history of tattooing (OR 1.72, 95% CI 1.02-2.90), history of imprisonment (OR 2.49, 95% CI 1.40-4.42) and sharing needles/syringes (OR 2.76, 95% CI 1.54-4.95) are significant predictors of risk of HCV in IVDU population.
Conclusions:
In conclusion, according to the high prevalence of HCV infection among IVDUs and high adds of HCV infection from tattooing, sharing of needles/syringes and imprisonment, effective harm reduction programs should be expanded among IVDUs to prevent new HCV infections.
PMCID: PMC3399288  PMID: 22826755
Hepatitis C virus; High-risky behaviors; Intravenous drug users; Risk factors
6.  Prevalence of Anti HCV Infection in Patients with Beta-Thalassemia in Isfahan-Iran 
Objectives:
Hepatitis C virus (HCV) is the major cause of post-transfusion hepatitis infection (PTH). Patients with thalassemia major are at high risk of hepatitis C due to the blood transfusion from donors infected by HCV. The aim of this study was to detect the prevalence of anti-HCV antibodies and risk factors in multitransfused thalassemic patients in Isfahan-Iran to establish more preventive strategies.
Methods:
This study was conducted to assess the patients with beta-thalassemia in Isfahan hospitals during 1996-2011 for HCV infection. A structured interview questionnaire was developed by the trained researcher to collect the demographic and risk factors. Statistical analysis was done by Chi-square test, Mann-Withney and multiple logistic regressions using SPSS software, version 15.
Results:
466 patients with major thalassemia participated in this study. The mean age of patients was 17.46 ± 8.3. Two hundred and seventy (58.3%) and 193 (41.7%) of participants were male and female, respectively. The prevalence of HCV was estimated 8% among thalassemia patients. History of surgery, history of dental procedure, number of units transfused per month, number of transfusion per month and duration of transfusion had significant association with HCV seropositivity in univariate analysis. There were no statistical significant risk factors for HCV seropositivity in multiple logistic regression models.
Conclusions:
Our findings revealed that blood transfusion was the main risk factors for HCV infection among beta-thalassemic patients. Therefore, more blood donor screening programs and effective screening techniques are needed to prevent transmission of HCV infection among beta-thalassemic patients.
PMCID: PMC3399295  PMID: 22826753
Beta-thalassemia; HCV infection; Iran
7.  Hepatitis C virus infection in patients with hemophilia in Isfahan, Iran 
Objectives:
Patients with hereditary bleeding disorders are at risk of viral infection such as hepatitis C due to frequent transfusion of blood and blood products. This study aimed to determine the prevalence of hepatitis C and associated risk factors in hemophilic patients in Isfahan, the second big province in Iran.
Methods:
In a descriptive study, patients with hemophilia in Isfahan province were enrolled. A questionnaire, including demographic and risk factors of hepatitis C was completed through a structured interview with closed questions by a trained interviewer for each patient and HCV-Ab test results were extracted from patient records.
Results:
In this study, 232 of 350 patients with hemophilia A and B (66%) were positive for hepatitis C. Based on Multivariate Logistic Regression model, no independent risk factor was found.
Conclusions:
Prevalence of hepatitis C in patients with haemophilia A and B in Isfahan is high. Since no independent risk factor for hepatitis C disease was found in this high risk group, it can be concluded that multitransfusion is the only predictor for hepatitis C.
PMCID: PMC3399298  PMID: 22826775
Hemophilia; Hepatitis C; risk factors
8.  Hepatitis C Virus and Associated Risk Factors among Prison Inmates with History of Drug Injection in Isfahan, Iran 
Objectives:
Hepatitis C virus (HCV) infection is a major public health problem worldwide with serious complications. According to the importance of intravenous drug use (IDU) as the main risk factor for HCV infection and transmission and prison as the main source of risky behaviors, this study conducted to define HCV infection and related risk factors in prison inmates with history of IDU in Isfahan province, Iran.
Methods:
This is a cross –sectional study which the prison inmates with IDU history in voluntary basis were enrolled. A validated questionnaire was asked and blood sample was obtained from each subject for the presence of HCV antibody. Odds ratio and logistic regression were used for data analysis and P-value < 0.05 considered significant.
Results:
I943 inmates with history of IDU participated in the study. The overall prevalence of HCV antibody was 41.6%. The main independent risk factors were number of injection in the month [OR: 1.006 (1.002- 1.011)], Length of drug addiction [OR: 1.05 (1.004-1.098)], multiple incarceration [OR: 1.15 (1.05-1.23)] and use of needle/syringe share inside prison [OR: 4.19 (2.22-7.9)]. In our study, marriage was a protective factor for HCV infection [OR: 0.34 (0.18-0.64)] as well.
Conclusions:
According to relatively high prevalence of HCV infection and associated risk factors which observed in this study it is important to primary prevention in prisons through syringe/needle exchange and counsel with imprisoned IDUs.
PMCID: PMC3399300  PMID: 22826759
HCV; IDU; Prison
9.  Seroprevalence of Hepatitis A in Patients with Chronic Hepatitis C in Isfahan Province 
Objectives:
Patients with Hepatitis C Virus infection are at high risk of getting hepatitis A virus. Hepatitis A virus is an important widespread virus that usually causes more severe medical consequences in patients with chronic liver disease. The purpose of this study was to evaluate prevalence of Hepatitis A Virus antibody in patients with chronic HCV in Isfahan province, Iran.
Methods:
A cross-sectional study was carried out on 117 patients with chronic hepatitis C virus from spring 2010 to spring 2011. Subject's characteristics such as age, gender, education, genotype of HCV infection and history of intravenous drug use were collected by questionnaire and studied. Statistical analysis was done by SPSS software (version 19.0. 2010, SPSS) using Chi-square test, Fisher Exact tests and Cochran-Armitage trend test.
Results:
The mean age of the subjects was 33.18 ± 10.97 years. The seroprevalence of HAV was 94.9% in patients with chronic HCV. The prevalence of anti-HAV increased nearly as age increased. But, there was no statistically significant difference in HAV positive rate according to the age groups (P = 0.242) and other patient's characteristics.
Conclusions:
According to the high HAV immunity in our study and less severe form of HAV infection, vaccination was not required in these patients. However, hepatitis A vaccination program should be performed in HAV seronegative patients with HCV to produce an adequate immune response.
PMCID: PMC3399306  PMID: 22826750
Chronic liver diseases; Hepatitis A virus; Hepatitis C virus
10.  Seroprevalence and Risk Factors of Hepatitis C Virus among Juveniles in Correctional Center in Isfahan, Iran 
Objectives:
Juveniles in custody are affected by blood borne viruses due to high rates of risk behaviors. Therefore, they have a disproportionate burden of infectious diseases, such as hepatitis C virus (HCV) infection. The purpose of the present study was to determine prevalence and associated characteristics of hepatitis C infection in inmates of a correctional center in Isfahan, Iran.
Methods:
We conducted a cross-sectional study of HCV infection in 160 youths, who were admitted to correctional center in Isfahan during 2008-2009. Subjects were asked questions regarding behaviors that might put them at high risk for acquiring HCV and blood was drawn for this test. Sera were analyzed for HCV Ab and RIBA test was performed on antibody-positive HCV. We used Chi-square test and logistic regression model to analyze data and P < 0.05 was considered statistically significant.
Results:
A total of 160 young prisoners (147 boys and 13 girls) were studied. The mean age of the inmates was 16.59 ± 1.24 year. A history of intravenous drug addiction was reported in 3.8% of them. HCV infection was detected in 7 (4.4%) subjects. This study revealed that history of IDU was the main risk factor for HCV (OR, 134.44; 95% confidence interval [CI], 7.29-2481.03).
Conclusions:
To prevent HCV transmission, proper drug prevention educations should be performed in young age prisoners.
PMCID: PMC3399313  PMID: 22826752
Correctional center; HCV; Isfahan
11.  Hepatitis D virus infection in Isfahan, central Iran: Prevalence and risk factors among chronic HBV infection cases 
Hepatitis Monthly  2011;11(4):269-272.
Background
Hepatitis D virus (HDV) is dependent on hepatitis B virus (HBV) infection. Acute infection with HDV can occur simultaneously with acute HBV infection or be superimposed onto a chronic HBV infection.
Objectives
This study aimed to identify cases of HDV and determine its prevalence in patients with chronic HBV infection for the first time study in Isfahan, central Iran.
Patients and Methods
In a cross-sectional study in 2009, 346 who had been diagnosed for at least 6 months with chronic HBV were enrolled consecutively. Anti-HDV was measured by ELISA in the serum of these patients.
Results
The study included 245 males (70.8%) and 101 (29.2%) females with a mean age of 39 ± 12.4 years. Anti-HDV was present in 8 (3.5%) HBe antibody-positive patients (p = 0.36) and in 2 (2.3%) HBe antigen-positive cases (p = 0.68). No association was found between hepatitis D and probable risk factors.
Conclusions
This study demonstrates that the prevalence of HDV infection is higher in patients who are positive for HBeAb compared those who are HBeAg-positive. Therefore, most HDV antibody-positive cases in Isfahan are HBV/HDV superinfections but not coinfections.
PMCID: PMC3206699  PMID: 22706272
Hepatitis B infection; Hepatitis D infection; Prevalence; Iran

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