Posted on February 03, 2020

Researchers at Weill Cornell Medicine-Qatar (WCM-Q) have found that half of people who inject drugs in the Middle East and North Africa (MENA) region are infected with hepatitis C virus (HCV), and that the majority of those have an active infection and are in need of treatment.

The research, published in the prestigious journal Addiction, estimated that over 220,000 persons who currently inject drugs have active HCV infection. The largest numbers were found in Iran at 68,000, followed by Pakistan at 46,000, and Egypt at 33,000. The study further showed that there was no decline in infection levels in recent years. This persistence of HCV infection levels suggests that interventions targeting this population are either nonexistent or have insufficient coverage levels to achieve a meaningful impact.

HCV is a blood-borne pathogen and one of the leading causes of liver diseases and liver cancer. The virus is mostly transmitted through sharing of unsterile needles and syringes, such as among people who inject drugs, use of contaminated medical equipment, and transfusion of infected blood. Until recently, a person with HCV infection was destined to develop liver complications such as liver fibrosis, cirrhosis, and cancer. However, only in the last few years, novel treatment regimens with newly-developed direct-acting antiviral (DAA) drugs have cured this infection and eliminated the virus from treated persons.

Sarwat Mahmud, WCM-Q Epidemiologist and first author of the study said: “With these study results, we are now able to provide guidance on strategies to maximize the benefits of the advent of the new HCV drugs that are now available. This can prevent or minimize the costly HCV complications among drug users in the MENA region, a region where many countries are struggling with limited resources. It should also be noted that the scale of this public health challenge may be even greater than this study suggests, as the estimates in the study include only those who are currently injecting drugs. The number of persons who injected drugs in the past and acquired the infection through injection but are no longer using drugs, remains unknown, but is possibly twice the number of current users.”

Hiam Chemaitelly, co-author of the study and Senior Epidemiologist at WCM-Q said: “HCV public health efforts in the region need to prioritize populations most affected by HCV. We cannot escape the need for harm reduction programs and for testing and treatment services among people who inject drugs, which are common practice in other parts of the world and have contributed significantly to reducing HCV and HIV infection levels in these populations.” Dr. Laith Abu-Raddad, principal investigator of the study and Professor of Healthcare Policy and Research at WCM-Q said: “Without an appropriate public health response, the healthcare system in the region will continue to endure serious and costly health complications of HCV infection in terms of liver diseases and cancer, and the region will not be able to achieve the World Health Organization’s goal of eliminating this infection by 2030.”

The study, ‘The status of hepatitis C virus infection among people who inject drugs in the Middle East and North Africa’, was conducted at WCM-Q with funding from the Qatar National Research Fund, a Qatar Foundation member, through the National Priorities Research Program (NPRP 9-040-3-008 and more recently NPRP 12S-0216-190094). Infrastructure funding was also provided by the WCM-Q Biomedical Research Program (BMRP).

The study can be read in full here: https://doi.org/10.1111/add.14944

Key scientific findings of the study

  • Half of people who inject drugs in the Middle East and North Africa region are infected with hepatitis C virus, with the majority having active infections and being in need of treatment.
  • There has been no decline in HCV infection levels among people who inject drugs in recent years, indicating that interventions targeting this population are either nonexistent or have insufficient coverage levels to achieve a meaningful impact.
  • In addition to there being more than 220,000 chronically infected persons who currently inject drugs, there are an unknown number of HCV infected persons who acquired the infection through drug use in the past but are no longer injecting drugs.

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