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The “hidden” epidemic: a snapshot of Moroccan intravenous drug users

Roxana-Delia Trimbitas1, Fatima Zahra Serghini2, Fatiha Lazaar1, Warda Baha1, Abderrahim Foullous1, Mohammed Essalhi2, Abdelouahed El Malki1, Abdelkrim Meziane Bellefquih3 and Abdelouaheb Bennani14*

Author Affiliations

1 Pasteur Institute of Morocco, Place Louis Pasteur, 20360 Casablanca, Morocco

2 Hasnouna Center of Addictology, 15 Moulay Driss St., Tangier, Morocco

3 Delegation of Public Health (Tangier/Tetouan region), Ministry of Health, Tetouan Public Hospital, Av. Abdelkhalek Torres, Tetouan, Morocco

4 Department of Medical Biology, Molecular Biology Laboratory, Pasteur Institute of Morocco, Place Louis Pasteur, Casablanca, Morocco

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Virology Journal 2014, 11:43  doi:10.1186/1743-422X-11-43

Published: 6 March 2014

Abstract

Background

Hepatitis C virus is a persistent epidemiological problem, with an estimated 170 million individuals infected worldwide, and the leading cause of asymptomatic chronic infection, liver cirrhosis and hepatocellular carcinoma. Injection drug users (IDUs) have the highest seroprevalence as compared to chronic hemodialysis and transfusion patients, and this cohort remains the most under-studied high-risk group in North Africa to date. This study first sought to characterize the demographic, epidemiological, and genotypic profile of a total sample size of 211 chronically-infected IDUs living in the Tangier region of Northern Morocco, and secondly to contrast this to other chronically-infected patients, in order to uncover possible discrepancies.

Results

The general ‘profile’ of local IDUs marks a stark contrast to chronically-infected HCV Moroccan patients, other African countries, and neighboring European countries. The majority of Moroccan drug users were found to be middle-aged and celibate. A relatively high seroprevalence was found among drug users (60%), and this increased with age. The majority of drug users shared their needles and this hold implications for transmission, as seropositive status was significantly different between those users that shared vs. those that did not share their needles. In addition, IDUs exhibited genotypes 1a and 3a predominantly, as compared to the predominant 1b and 2a/2c genotypes found in chronically HCV-infected patients. The IDU genotypic profile closely matches the one in other European countries (Portugal, Spain, France, and Italy), which are invariably speculated as the potential source of currently-circulating genotypes in Moroccan IDUs.

Conclusion

These findings have implications for disease prevention, transmission and treatment, as this distinct IDU subgroup cannot be collectively pooled along with other HCV-positive high-risk groups. Local government, practitioners, and health institutions should take this into account when treating, prescribing antiviral therapy, and designing preventative public health campaigns.

Keywords:
Hepatitis C; IDUs; Prevalence; Genotype; Risk factors; Public health; Morocco