ORIGINAL REPORT

Incidence of Hepatitis B and HIV Virus at Cadaver of

IV Drug Abusers in Tehran
Hassan Tofigi1, Mazaher Ghorbani1, Mitra Akhlaghi1, Asadollah Yaghmaei2,
Babak Mostafazadeh3, Esmaeel Farzaneh2, and Ali Reza Mohaghegh2
1

Department of Legal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
2
3

Legal Medicine Organization, Tehran, Iran

Department of Legal Medicine, Loghman Hospital, Shahid Beheshti of Medical Sciences, Tehran, Iran
Received: 17 Sep. 2009; Received in revised form: 22 Dec. 2009; Accepted: 12 Mar. 2010

Abstract- Injection drug use has been the most growing rout of drug abuse in Iran in the past decade and it

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has been responsible for the transmission of HIV virus in more than two third of cases. The aim of the present
study was to determine the prevalence of HIV and hepatitis B in a group of IDU cadavers and to compare the
results to a group of cadavers of the normal population. In a case-control study the blood samples of the
cadavers of 400 randomly chosen IDUS and 400 other cadavers as control group were checked for HBS
antigen and Anti HIV antibody in the forensic medicine center of Tehran. The prevalence of HIV and HBV
infection was compared in two groups according to their demographic characteristics. The number of HIV
and HBV positive cadavers was significantly higher in the IDU group than the controls (6.25% vs 0.5%,
P<0.001, 27.5% vs 3%, P<0.001). The risk of getting infected by HIV virus was 13.27 times greater in the
IDU group and the risk of HBV infection was 12.26 times greater in this group as compared to the control
group. The age distribution of IDU cadavers indicated that the percentage of IDU cadavers in the
reproductive (21-40 years old) age was 80%. The greater prevalence of the HIV and HBV infection especially
in the reproductive age of IDUS indicates a greater concern to the authorities for more attention to prevention
and harm reduction programs.
2011 Tehran University of Medical Sciences. All rights reserved.
Acta Medica Iranica, 2011; 49(1): 59-63.

Introduction

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Keywords: Drug user; Cadaver; Hepatitis B; HIV infections

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As a whole, Iran enjoys the highest per capita of using

Opium and Heroin in the world: from every 17 Iranian,
one uses narcotics regularly, and 20 percent of the
Iranian population of 15-60 year-old are involved in
using narcotics (1, 2). Historically, in previous decades,
the prohibition of production and distribution of
narcotics in the Country gradually caused to develop
traffic of Heroin in Afghanistan (3). The lower price and
high presentation of Heroin, caused to increase of the
number of its takers and finally eruptive growth of the
number of the addicts of drugs injection in the Country,
in a way that, in the previous decades, the injection of
narcotics had been the developing way of using drugs in
Iran, and up to 2004, more than 300000 addicts of drug
injection appeared in the country which included 67
percent of reported new HIV cases since this year (4-6).

According to the annual report of World Health

Organization (WHO), up to 2005, 38.6 million people
were infected by HIV that among this number 4.1
million people were infected in this year and 2.8 million
one have died of HIV (7). The recent statistics indicate
that HIV is developing in Iran, Algeria, Morocco, and
Libya with more speed (8). The number of infected
peoples is estimated for more than 30000 (9). It is
noticeable that unlike most of the regions of the world
which intravenous injection of drugs enjoys third grade
in incidence of this disease after sexual infection and
infection from mother to fetus, in Iran there is a close
relationship between injection of drugs and HIV
infection, in a way that based on the report of World
Health Organization, 67.3 percent of these HIV infected
patients and 85 percent of HIV affected patients, have
the prehistory of drugs injection in their pathological
history (10).

Corresponding Author: Mazaher Ghorbani,

Department of Legal Medicine,School of Medicine,Tehran University of Medical Sciences,Tehran,Iran
Tel: +98 21 66405588, Fax: +98 21 66405588, E-mail: mghorbani@sina.tums.ac.ir

www.SID.ir

Incidence of hepatitis B and HIV virus at cadaver of IV drug abusers

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they had minimum of 7 intravenous drugs injections,

were studied as drugs injection addicts. On the contrary,
criteria for selecting control group such as lack of
physical marks of intravenous drugs abuse and findings
in favor of intravenous drugs addiction were found in
their pathological history. As a whole, this group
included bodies of persons who had died of car
accidents, sudden death and.
After selecting bodies, their characteristics were
collected from police or their families and the
information were added to the special questionnaires.
Then, in completely sterilized environment two blood
samples each for 10 cc, were provided from peripheral
veins of each body, and in sampling day they were sent
from Anatomy Hall to the Laboratories on the sampling
day, in two separate test tubes and in standard testing
conditions, in cool box and on temperature of 2-5 C, to
the laboratories of contract parties. Ethical
considerations were observed for execution of this plan,
and besides considering cultural values and respect to
the rights of under studying persons, all of the
interferences were planned and executed in a way that
no physical injury and diagnostic interference was made
on the bodies.
After centrifugation, the samples which were sent to
the laboratory were tested for infection with AIDS (Anti
HIV Ab) and Hepatitis B (HBS Ag) viruses, through
Eliza Method.
Results achieved from laboratorial findings, and the
mentioned information in questionnaires was statically
analyzed.
The Chi2 Test was used for analysis. P<0.05
assumed meaningful and in necessary occasions risk
chances was estimated by calculation of odds ratio for
the under-study population.

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Detriments of intravenous injection on personal and

social health are explicit to everyone. On the other hand,
hazardous behaviors of this kind of addicts such as using
joint syringe, using the same syringe again or several
times, or using infected syringes, are from the main
factors for infection of AIDS, Hepatitis B and C and
various lung and cerebral abscesses (11-12), and that
sexual hazardous behaviors of this infected group will
cause the infection of these types of diseases in the level
of families and society. As a whole, various kinds of
studies in farthest reaches of the and C have a high level
of infection in addicts of drug injection and their level of
infection is indicated up to 78 percent for Hepatitis C, 32
to 70 percent for Hepatitis B and 12 to 30 percent for
HIV. Some of these studies show that up to 90 percent
of these people suffer from one of viral diseases and
there is a direct relationship between the level of cases
infected by these viruses and duration of drugs
intravenous injection (13-22).
Totally Iran was endemic for Hepatitis B and more
than 35 percent of the population is exposed to this
disease. 3 percent of the population of Iran was
indicated as chronic transmitters of this disease in 2000
(23). The way of transmission of this virus which exists
in all of the secretions of the body, is mainly through
sexual relationships, but according to the studies its
transmission develops all over the world through drugs
injection by polluted syringe (21). Another important
issue is the high possibility of being affected
simultaneously by these viruses, which causes
considerable increase of death rate, for example in a
study, the simultaneous affection of HIV and Hepatitis B
caused to increase of death rate of HIV infected patients
in a determined period of time, from 6 to 15 (22-24).
The current study aimed in estimating the rate of
infection of HIV and Hepatitis B in the bodies of drugs
injection addicts and determining their sexual and age
distribution and sexual and age hazardous groups from
the point of view of infection by these viruses, has been
planed and performed.

Patients and Methods

In this Case-control study which was performed in
Forensic Medicine Centre, Tehran, bodies of 400 drugs
injection addicts and 400 person as control group, were
studied from point of view of infection with AIDS virus
and Hepatitis B. The persons who had external
symptoms in favor of drugs injection and their
pathological history showed that they had intravenous
drug injection for minimum 1 month, and in this period

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Results
The results of this study, indicates that the incidence
of HBS positive cases in drugs injection addicts (27.5
percent) is considerably more than its incidence in
control group (3%) (P = 0.0001) and the risk(odds ratio)
for being infected with Hepatitis B, for drugs injection
addicts is 12.26 times higher than control group (safe
distance of 95%: 6.631-22.684).
HIV incidence in the bodies of drugs injection
addicts (6.25%) is considerably higher than its incidence
in control group (0.5%) (P<0.0001) and the risk for
infection with this virus in drugs injection addicts group
is 13.27 times higher than control group (safe distance
of 95%: 3.121-56.397).

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H. Tofighi, et al.

Table 2. Sex distribution and percentage of infected cases in

two groups.
Sex
HIV+
HBS+

IV Drug
abuser

Control

P value

Male
Female
Male

6%
9.4%
27.4%

0.7%
0.0%
3.4%

<0.0001
<0.001
<0.0001

Female

28.1%

1.9%

<0.0001

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In this case, Jaundice prehistory in drugs injection

addicts (34.75%) is more than the control group (3.25%)
(P<0.0001).There is not a statically considerable
difference between drugs injection addicts and control
group, from the point of view of transmission blood
prehistory (P = 0.182).
It is noteworthy that the rate of tattoo cases in drugs
injection addicts (59.75%) is much more than witness
group (7.75%) (P<0.0001).

Discussion

The results of this study indicate the higher incidence of

Hepatitis B and infection with AIDS virus in drugs
injection addicts and a much higher risk of infection in
compare with control group. These results are totally
parallel to the previous studies and national reports in
this field (10, 18-22).
Lesser incidence of infection with AIDS virus in our
study in compare with most of the foreign studies may
be different, because of that this virus is new in Irans
society, and that the cases were selected from a special
geographical district, not from all regions of the country,
and the laboratorial measuring method. Anyhow,
regarding to that the policies for decreasing detriments
in Iran was set into program of policy makers too late in
compare with other pioneer points of the world (3, 10),
the possibility for change of infection rate in our
country, comparing with the other countries in future,
does not seem unlikely. But fewer infected cases
promises that in case of performing on-time detriment
prevention and decreasing measures will cause future
satisfying results in this case.
Difference of age distribution of drugs injection
addicts with control group is so noteworthy, but it is
warning. As it was mentioned before, about 80 percent
of drugs injection addicts are in the ages of 20 to 40
years old or better to say, in fertility ages. It means that
developing process of drugs injection addiction and
death rate is highly increasing in the mature group of
drugs injection addicts society. With regard to the

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Age distribution of the bodies of drugs injection

addicts shows a considerable statistical difference
comparing with the control group (P ,0.0001), in a way
that the highest frequency of drugs injection addiction in
the age group of 20-30 year-old was (46%) and the
highest frequency of control group in the age group of
more than 50 years old was (25.25%) (Figure 1). As a
whole, the age of 20-40 years old, includes 80% of
drugs injection addicts, whereas this rate is 41.75% in
control group. However, statistical comparison of the
number of HIV positives in both age groups was
impossible because of the insufficient number of these
cases in control group (2 cases), but comparison of
infection with Hepatitis B virus shows a considerable
difference in all of the age groups (Table 1).
Sex distribution of drugs injection addiction shows a
considerable difference in both groups (P = 0.0001), and
the percentage of men in drugs injection addicts group
(92%) is more than the percentage in control group
(73.25%) (X2 = 48.177).
However, the rate of infected cases for both men and
women in drugs injection addicts is more than witness
group (Table 2).

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Figure 1. Frequency distribution of age in drugs injection

addicts and control groups.
Table 1. Comparsion of the number of HIV and HBV
positive in both age groups.
Age(Year)
HIV+

<20

IV Drug
abuse
5.1%

control

P value

0%

NS

HBS+

21-30
31-40
>40
<20

6.5%
5.9%
7.3%
23.1%

1.4%
1.1%
0%
1.9%

NS
NS
NS
0.001

21-30
31-40
>40

26.6%
31.6%
22%

4.1%
4.3%
2.2%

<0.0001
<0.0001
<0.0001

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Incidence of hepatitis B and HIV virus at cadaver of IV drug abusers

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