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

Abstract

BackgroundHepatitis 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.ResultsThe 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.ConclusionThese 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.

Hepatitis C Virus in North Africa: An Emerging Threat

“…Drug addiction is a serious problem in Morocco and has been considered to be a “male-associated habit” because the overwhelming majority of drug addicts are young males who are either single or divorced. HCV seroprevalence is high among this group, reaching up to 60% [ 35 ].…”

“…Morocco is the only country in the region that has reliable surveillance programs for HIV. Prevalence of HIV/HCV coinfections in Morocco was reported to be about 20% among injecting drug users and sex workers, but it was 10.6% among patients of different socioeconomic backgrounds [ 35 ].…”

Molecular characterization of hepatitis C virus core region in moroccan intravenous drug users

“…The average viral load for our sample was high (6log), this was expected as the majority of samples had a high viral titer upon inspection. The average viral load was not significantly higher for one genotype versus another; however, a previous study did report a significantly higher viral load for genotype 1a, and the finding might have been confirmed had the sample size been larger [Trimbitas et al, ]. Only one patient was infected with genotype 4a, while the majority of IDUs exhibit genotypes 1a and 3a.…”

“…Despite these finding, the IDU group remains one of the most poorly‐studied groups in the MENA region, with few countries having published prevalence and/or genotype data in this part of the world (Cyprus, Egypt, Iran, Israel, Lebanon, Saudi Arabia, Syria, and Morocco, respectively) [Ramia et al, ]. A recent study indicated that Moroccan drug users have a high anti‐HCV seropositivity (60%), engage heavily in needle‐sharing behaviour, and collectively exhibit genotypes 1a and 3a which differ from those found in the general population [Trimbitas et al, ]. HCV is known for its high mutations rate and confers it high genetic variability and countless subtypes [Abe et al, ; Simmonds, ].…”

Molecular characterization of HCV in a Swedish county over 8 years (2002–2009) reveals distinct transmission patterns

“…HCV exhibits a high degree of genetic diversity ( 7 ) and is characterized by regional variations in genotype prevalence ( 8 , 9 ). It has been classified into seven genetically different genotypes, 1–7, 67 confirmed subtypes, and an additional 21 unassigned subtypes ( 10 , 11 ).…”