Hepatitis C Rapid Point-of-Care Testing and Laboratory-based Non-invasive Assessment of Liver Fibrosis among Drug Abusers: An Experience from Iran

Background: People who use drugs, particularly injection drug users (IDUs) are known as the major source of hepatitis C virus (HCV) infection. This study was performed to determine the prevalence of HCV infection using rapid point-of-care testing and to assess liver fibrosis by non-invasive lab tests among addict populations of Mashhad, Iran. Methods: In this cross-sectional study, drug users who referred to drug treatment and harm reduction centers of Mashhad were enrolled during March and December 2019. A rapid test kit was used to assess the presence of anti-HCV antibodies and a real-time PCR was performed to confirm the infection. The AST-platelet ratio index (APRI) and fibrosis-4 (FIB-4) score were used to investigate liver fibrosis in patients with positive HCV RNA. A P value <0.05 was considered as significant. Results: A total of 390 drug users aged 15-74 years were assessed. Sixty-four individuals showed positive results for anti-HCV (16.4%), of whom 58 blood samples were available for PCR test. The viremic rate among the latter group was calculated at 84.5% (49/58); the total viremia prevalence was 12.8% (49/384). Multivariate analysis revealed that being single (P = 0.040) or divorced/widow (P = 0.011) and history of drug injection (P < 0.001) and tattoos (P = 0.021) were significantly associated with current HCV infection. Using APRI and FIB-4 indices, significant liver fibrosis was identified in 14.3% and 18.4% of cases, respectively. Conclusion: HCV infection screening using rapid tests and examining liver fibrosis by non-invasive lab tests appear to be practicable and useful among poor populations in settings such as drug treatment centers.