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.

Dr Laith Abu Raddad and Hiam Chemaitelly

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 that with these study results, they are now able to provide guidance on strategies to maximise the benefits of the advent of the new HCV drugs that are available now.

This can prevent or minimise 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 the study suggests, as the estimates 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.

Dr Laith Abu Raddad, principal investigator of the study and Professor of Healthcare Policy and Research at WCM-Q said that 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. Infrastructure funding was also provided by the WCM-Q Biomedical Research Program.