High hepatitis C virus prevalence among drug users in Iran: systematic review and meta-analysis of epidemiological evidence (2001–2012)

•The search yielded 24 original studies on HCV prevalence in drug users in Iran.•Injection drug users had a higher HCV prevalence than non-injection drug users.•The pooled HCV prevalences in recent and ever injectors were 53% and 40%, respectively.•Approximately 11% of injection drug users with HCV had an HBV or HIV co-infection.

SummaryObjectiveDrug users, particularly drug injectors, are at elevated risk of blood-borne diseases. This study systematically reviewed the prevalence of hepatitis C virus (HCV) mono-infection and its co-infections with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) in drug users in Iran.MethodsSearches were conducted in international, regional, and Iranian databases. Documents were screened, data extracted, and pooled point prevalence and 95% confidence intervals (CI) were calculated.ResultsOverall, 13 821 subjects (87.4% male) with an average age of 32.4 years (95% CI 31–33 years) from 24 original studies were included in the analysis. The pooled HCV prevalence (95% CI) among drug users with and without an injection history was 45% (37–54%) and 8% (4–13%), respectively. The pooled HCV prevalences (95% CI) among individuals with vs. without a history of imprisonment and needle sharing were 58% (39–77%) vs. 44% (20–68%) and 56% (41–71%) vs. 49% (26–71%), respectively. The prevalence of HCV/HIV co-infection among injectors was 11% (95% CI 5–16%).ConclusionsHCV prevalence is high in drug users in Iran, especially among those with a history of injection drug use, needle sharing, and imprisonment. Drug user-focused HCV prevention and treatment programs are urgently needed.