We read an interesting article by Abousaidi et al. recently published in Thrita Journal in which they found 1.7% hepatitis C virus (HCV) infected patients among their study participants (1).
The world health organization (WHO) planned to eliminate HCV by 2030 (2, 3). Reaching this important goal needs finding and curing HCV infected patients (2). The HCV prevalence is less than 0.5% in the general population of Iran, and mass-screening of the general population does not seem cost-effective (4). Mass-screening would be more effective if we start screening and finding the patients among people with higher probability of being HCV infected. Intravenous drug users (IDUs) are one of the most important primary sources of HCV infection in Iran (5). Also, HCV prevalence in Iranian drug users has been estimated to be 45% in IDUs and 8% in drug users without history of injection (6). Despite underestimating the prevalence of HCV infection by evaluating the documents of private clients, Abousaidi et al. found 1.7% HCV prevalence, which is at least 3 times higher than the general population of Iran. Hence, methadone maintenance therapy (MMT) clients seem to be good cases for finding HCV infected patients.
Another issue is HCV treatment, which should be more accessible for the patients in MMT clients. Low cost generic direct acting antiviral (DAA) drugs are generally available in Iran (7). However, this is not enough; some of these patients are unable to cover the treatment costs due to their low socioeconomic status. Free of charge treatment should be provided for patients with low socioeconomic status.
A simple Iranian guideline for HCV treatment by generic DAAs is available in Iran (8). The treatment process will be more accessible if done by the physicians of MMT clients. On the other hand, a close observation is needed for drug delivery among these patients. Also, adherence may be lower if they refer to another place for treatment.
In conclusion, MMT clients should be more noticed as they are a good source for finding and treating HCV infected patients and reaching the goal of HCV elimination.
Abousaidi H, Rezahosseini O, Bidaki R, Fathollahi MS, Nejad HRG, Shahi GHH, et al. Viral and Psychiatric Disorders in Methadone Maintenance Therapy (MMT) Clients. Thrita. 2016;5(4).
Hesamizadeh K, Sharafi H, Rezaee-Zavareh MS, Behnava B, Alavian SM. Next Steps Toward Eradication of Hepatitis C in the Era of Direct Acting Antivirals. Hepat Mon. 2016;16(4). e37089. doi: 10.5812/hepatmon.37089. [PubMed: 27275164].
Lancet T. Towards elimination of viral hepatitis by 2030. Elsevier; 2016.
Polaris Observatory H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol. 2017;2(3):161-76. doi: 10.1016/S2468-1253(16)30181-9. [PubMed: 28404132].
Mirminachi B, Mohammadi Z, Merat S, Neishabouri A, Sharifi AH, Alavian SH, et al. Update on the Prevalence of Hepatitis C Virus Infection Among Iranian General Population: A Systematic Review and Meta-Analysis. Hepat Mon. 2017;17(2). doi: 10.5812/hepatmon.42291.
Malekinejad M, Navadeh S, Lotfizadeh A, Rahimi-Movaghar A, Amin-Esmaeili M, Noroozi A. High hepatitis C virus prevalence among drug users in Iran: systematic review and meta-analysis of epidemiological evidence (2001-2012). Int J Infect Dis. 2015;40:116-30. doi: 10.1016/j.ijid.2015.09.022. [PubMed: 26460088].
Hajarizadeh B. Generic Direct Acting Antiviral Treatment: The First Step Towards Elimination of Hepatitis C in Iran. Hepat Mon. 2017;17(1). doi: 10.5812/hepatmon.45788.
Alavian SM, Hajarizadeh B, Bagheri Lankarani K, Sharafi H, Ebrahimi Daryani N, Merat S, et al. Recommendations for the Clinical Management of Hepatitis C in Iran: A Consensus-Based National Guideline. Hepat Mon. 2016;16(8). doi: 10.5812/hepatmon.guideline.