Epidemiology of HIV/AIDS in the East Azerbaijan Province, Northwest of Iran
Identifieur interne : 000127 ( Pmc/Corpus ); précédent : 000126; suivant : 000128Epidemiology of HIV/AIDS in the East Azerbaijan Province, Northwest of Iran
Auteurs : Seyyed Mortaza Haghgoo ; Hadi Joula ; Ramin Mohammadzadeh ; Siamak Sabour ; Reza Yousefi ; Gholamreza Ghahramani ; Ali A. R. RahimiSource :
- Jundishapur Journal of Microbiology [ 2008-3645 ] ; 2015.
Abstract
This study was performed in response to the rapid propagation of HIV/AIDS across Iran and its status in this region. Accordingly, an evidence-based program is required to combat this disease.
The present study estimated the prevalence of HIV/AIDS in East Azerbaijan (population: 3,724,000).
We created a database of all positive cases from 1987 to 2012. We also analyzed and described the epidemiological status of HIV/AIDS during a 25-year period by using SPSS.
In East Azerbaijan, 371 HIV/AIDS cases have been reported, i.e. 1 case per 10,000 population. The vast majority of reported cases (91%, n =338) were men, whereas only 9% (
The results indicate a rapid increase in the number of HIV/AIDS cases in East Azerbaijan, necessitating immediate attention and strategies to combat the rapid spread of the disease. Development of provincial and national HIV/AIDS strategies demands more accurate and comprehensive HIV/AIDS surveillance.
Url:
DOI: 10.5812/jjm.19766v2
PubMed: 26468361
PubMed Central: 4601292
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PMC:4601292Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Epidemiology of HIV/AIDS in the East Azerbaijan Province, Northwest of Iran</title><author><name sortKey="Haghgoo, Seyyed Mortaza" sort="Haghgoo, Seyyed Mortaza" uniqKey="Haghgoo S" first="Seyyed Mortaza" last="Haghgoo">Seyyed Mortaza Haghgoo</name><affiliation><nlm:aff id="aff62803">Student Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Joula, Hadi" sort="Joula, Hadi" uniqKey="Joula H" first="Hadi" last="Joula">Hadi Joula</name><affiliation><nlm:aff id="aff62803">Student Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Mohammadzadeh, Ramin" sort="Mohammadzadeh, Ramin" uniqKey="Mohammadzadeh R" first="Ramin" last="Mohammadzadeh">Ramin Mohammadzadeh</name><affiliation><nlm:aff id="aff62803">Student Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Sabour, Siamak" sort="Sabour, Siamak" uniqKey="Sabour S" first="Siamak" last="Sabour">Siamak Sabour</name><affiliation><nlm:aff id="aff62804">Department of Clinical Epidemiology (COH), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Yousefi, Reza" sort="Yousefi, Reza" uniqKey="Yousefi R" first="Reza" last="Yousefi">Reza Yousefi</name><affiliation><nlm:aff id="aff62805">Health Center of East Azerbaijan Province, Tabriz University of Medical Sciences, Tabriz, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Ghahramani, Gholamreza" sort="Ghahramani, Gholamreza" uniqKey="Ghahramani G" first="Gholamreza" last="Ghahramani">Gholamreza Ghahramani</name><affiliation><nlm:aff id="aff62805">Health Center of East Azerbaijan Province, Tabriz University of Medical Sciences, Tabriz, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Rahimi, Ali A R" sort="Rahimi, Ali A R" uniqKey="Rahimi A" first="Ali A. R." last="Rahimi">Ali A. R. Rahimi</name><affiliation><nlm:aff id="aff62806">Department of Medical Microbiology, Tabriz University of Medical Sciences, Tabriz, IR Iran</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26468361</idno><idno type="pmc">4601292</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4601292</idno><idno type="RBID">PMC:4601292</idno><idno type="doi">10.5812/jjm.19766v2</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000127</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000127</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Epidemiology of HIV/AIDS in the East Azerbaijan Province, Northwest of Iran</title><author><name sortKey="Haghgoo, Seyyed Mortaza" sort="Haghgoo, Seyyed Mortaza" uniqKey="Haghgoo S" first="Seyyed Mortaza" last="Haghgoo">Seyyed Mortaza Haghgoo</name><affiliation><nlm:aff id="aff62803">Student Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Joula, Hadi" sort="Joula, Hadi" uniqKey="Joula H" first="Hadi" last="Joula">Hadi Joula</name><affiliation><nlm:aff id="aff62803">Student Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Mohammadzadeh, Ramin" sort="Mohammadzadeh, Ramin" uniqKey="Mohammadzadeh R" first="Ramin" last="Mohammadzadeh">Ramin Mohammadzadeh</name><affiliation><nlm:aff id="aff62803">Student Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Sabour, Siamak" sort="Sabour, Siamak" uniqKey="Sabour S" first="Siamak" last="Sabour">Siamak Sabour</name><affiliation><nlm:aff id="aff62804">Department of Clinical Epidemiology (COH), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Yousefi, Reza" sort="Yousefi, Reza" uniqKey="Yousefi R" first="Reza" last="Yousefi">Reza Yousefi</name><affiliation><nlm:aff id="aff62805">Health Center of East Azerbaijan Province, Tabriz University of Medical Sciences, Tabriz, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Ghahramani, Gholamreza" sort="Ghahramani, Gholamreza" uniqKey="Ghahramani G" first="Gholamreza" last="Ghahramani">Gholamreza Ghahramani</name><affiliation><nlm:aff id="aff62805">Health Center of East Azerbaijan Province, Tabriz University of Medical Sciences, Tabriz, IR Iran</nlm:aff></affiliation></author><author><name sortKey="Rahimi, Ali A R" sort="Rahimi, Ali A R" uniqKey="Rahimi A" first="Ali A. R." last="Rahimi">Ali A. R. Rahimi</name><affiliation><nlm:aff id="aff62806">Department of Medical Microbiology, Tabriz University of Medical Sciences, Tabriz, IR Iran</nlm:aff></affiliation></author></analytic><series><title level="j">Jundishapur Journal of Microbiology</title><idno type="ISSN">2008-3645</idno><idno type="eISSN">2008-4161</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background:</title><p>This study was performed in response to the rapid propagation of HIV/AIDS across Iran and its status in this region. Accordingly, an evidence-based program is required to combat this disease.</p></sec><sec><title>Objectives:</title><p>The present study estimated the prevalence of HIV/AIDS in East Azerbaijan (population: 3,724,000).</p></sec><sec><title>Materials and Methods:</title><p>We created a database of all positive cases from 1987 to 2012. We also analyzed and described the epidemiological status of HIV/AIDS during a 25-year period by using SPSS.</p></sec><sec><title>Results:</title><p>In East Azerbaijan, 371 HIV/AIDS cases have been reported, i.e. 1 case per 10,000 population. The vast majority of reported cases (91%, n =338) were men, whereas only 9% (<italic>n = </italic>33) were women. The mean age of patients was 30.8 ± 12.3 years. Unsafe drug injection (59%, n = 219) and sexual interaction (13%, n = 48) were the two major modes of HIV transmission. In addition, 7% (n = 25) of patients have been diagnosed with HIV, hepatitis B Virus, and hepatitis C virus simultaneously. Moreover, 60% (n = 205) of men were infected via drug injection, while 82% (n = 27) of women were infected via unprotected sexual interaction (P < 0.001).</p></sec><sec><title>Conclusions:</title><p>The results indicate a rapid increase in the number of HIV/AIDS cases in East Azerbaijan, necessitating immediate attention and strategies to combat the rapid spread of the disease. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Jundishapur J Microbiol</journal-id><journal-id journal-id-type="iso-abbrev">Jundishapur J Microbiol</journal-id><journal-id journal-id-type="doi">10.5812/jjm</journal-id><journal-id journal-id-type="publisher-id">Kowsar</journal-id><journal-title-group><journal-title>Jundishapur Journal of Microbiology</journal-title></journal-title-group><issn pub-type="ppub">2008-3645</issn><issn pub-type="epub">2008-4161</issn><publisher><publisher-name>Kowsar</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26468361</article-id><article-id pub-id-type="pmc">4601292</article-id><article-id pub-id-type="doi">10.5812/jjm.19766v2</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Epidemiology of HIV/AIDS in the East Azerbaijan Province, Northwest of Iran</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Haghgoo</surname><given-names>Seyyed Mortaza</given-names></name><xref ref-type="aff" rid="aff62803">1</xref></contrib><contrib contrib-type="author"><name><surname>Joula</surname><given-names>Hadi</given-names></name><xref ref-type="aff" rid="aff62803">1</xref></contrib><contrib contrib-type="author"><name><surname>Mohammadzadeh</surname><given-names>Ramin</given-names></name><xref ref-type="aff" rid="aff62803">1</xref></contrib><contrib contrib-type="author"><name><surname>Sabour</surname><given-names>Siamak</given-names></name><xref ref-type="aff" rid="aff62804">2</xref></contrib><contrib contrib-type="author"><name><surname>Yousefi</surname><given-names>Reza</given-names></name><xref ref-type="aff" rid="aff62805">3</xref></contrib><contrib contrib-type="author"><name><surname>Ghahramani</surname><given-names>Gholamreza</given-names></name><xref ref-type="aff" rid="aff62805">3</xref></contrib><contrib contrib-type="author"><name><surname>Rahimi</surname><given-names>Ali A. R.</given-names></name><xref ref-type="aff" rid="aff62806">4</xref><xref ref-type="corresp" rid="cor62807">*</xref></contrib></contrib-group><aff id="aff62803"><label>1</label>Student Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran</aff><aff id="aff62804"><label>2</label>Department of Clinical Epidemiology (COH), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran</aff><aff id="aff62805"><label>3</label>Health Center of East Azerbaijan Province, Tabriz University of Medical Sciences, Tabriz, IR Iran</aff><aff id="aff62806"><label>4</label>Department of Medical Microbiology, Tabriz University of Medical Sciences, Tabriz, IR Iran</aff><author-notes><corresp id="cor62807"><label>*</label>Corresponding author: Ali Rahimi, Department of Medical Microbiology, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-9127624297, Fax: +98-4113360510, E-mail: <email>ali.rahimi@alumni.uottawa.ca</email></corresp></author-notes><pub-date pub-type="epub"><day>01</day><month>8</month><year>2015</year></pub-date><pub-date pub-type="collection"><month>8</month><year>2015</year></pub-date><volume>8</volume><issue>8</issue><elocation-id>e19766</elocation-id><history><date date-type="received"><day>28</day><month>4</month><year>2014</year></date><date date-type="rev-recd"><day>13</day><month>7</month><year>2014</year></date><date date-type="accepted"><day>25</day><month>7</month><year>2014</year></date></history><permissions><copyright-statement>Copyright © 2015, Ahvaz Jundishapur University of Medical Sciences.</copyright-statement><copyright-year>2015</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/"><license-p><pmc-comment>CREATIVE COMMONS</pmc-comment>This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/">http://creativecommons.org/licenses/by-nc/4.0/</ext-link>) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.</license-p></license></permissions><abstract><sec><title>Background:</title><p>This study was performed in response to the rapid propagation of HIV/AIDS across Iran and its status in this region. Accordingly, an evidence-based program is required to combat this disease.</p></sec><sec><title>Objectives:</title><p>The present study estimated the prevalence of HIV/AIDS in East Azerbaijan (population: 3,724,000).</p></sec><sec><title>Materials and Methods:</title><p>We created a database of all positive cases from 1987 to 2012. We also analyzed and described the epidemiological status of HIV/AIDS during a 25-year period by using SPSS.</p></sec><sec><title>Results:</title><p>In East Azerbaijan, 371 HIV/AIDS cases have been reported, i.e. 1 case per 10,000 population. The vast majority of reported cases (91%, n =338) were men, whereas only 9% (<italic>n = </italic>33) were women. The mean age of patients was 30.8 ± 12.3 years. Unsafe drug injection (59%, n = 219) and sexual interaction (13%, n = 48) were the two major modes of HIV transmission. In addition, 7% (n = 25) of patients have been diagnosed with HIV, hepatitis B Virus, and hepatitis C virus simultaneously. Moreover, 60% (n = 205) of men were infected via drug injection, while 82% (n = 27) of women were infected via unprotected sexual interaction (P < 0.001).</p></sec><sec><title>Conclusions:</title><p>The results indicate a rapid increase in the number of HIV/AIDS cases in East Azerbaijan, necessitating immediate attention and strategies to combat the rapid spread of the disease. Development of provincial and national HIV/AIDS strategies demands more accurate and comprehensive HIV/AIDS surveillance.</p></sec></abstract><kwd-group kwd-group-type="author"><kwd>HIV</kwd><kwd>Acquired Immunodeficiency Syndrome</kwd><kwd>Epidemiology</kwd></kwd-group></article-meta></front><body><sec id="sec107859"><title>1. Background</title><p>When the HIV epidemic peaked in 1993, AIDS was the leading cause of death among 25 - 44-year-old men and women and the eighth most common cause of death worldwide (<xref rid="A19766R1" ref-type="bibr">1</xref>). Injection drug use (IDU) and unprotected sex are considered as major risk factors for the acquisition of retroviral infection (<xref rid="A19766R2" ref-type="bibr">2</xref>-<xref rid="A19766R4" ref-type="bibr">4</xref>), and more than half of people living with HIV are women and girls (<xref rid="A19766R2" ref-type="bibr">2</xref>, <xref rid="A19766R5" ref-type="bibr">5</xref>-<xref rid="A19766R7" ref-type="bibr">7</xref>). Because of social, economic, and political differences among regions, the epidemic has not been uniform (<xref rid="A19766R8" ref-type="bibr">8</xref>, <xref rid="A19766R9" ref-type="bibr">9</xref>). The most common route of HIV transmission in high-income countries such as the United States and the United Kingdom is homosexuality. People who engage in high-risk sexual behaviors in Sub-Saharan Africa and IDUs in Eastern Europe and Southeast Asia are the major at-risk groups (<xref rid="A19766R10" ref-type="bibr">10</xref>-<xref rid="A19766R14" ref-type="bibr">14</xref>). In 2011, adolescents, women, homosexuals, and serodiscordant couples (i.e. one partner is HIV positive, and the other is HIV negative) were reported to be the populations with the highest risk of infection (<xref rid="A19766R10" ref-type="bibr">10</xref>). </p><p>Although the AIDS epidemic is relatively mild in Asia, factors such as low condom use, unsafe injections among injection drug users, immigration, lack of education, and misconceptions about HIV/AIDS could affect the HIV/AIDS epidemic in all countries that currently have low prevalence (<xref rid="A19766R15" ref-type="bibr">15</xref>-<xref rid="A19766R17" ref-type="bibr">17</xref>). According to estimates by the Ministry of Health and Medical Education, as of September 21, 2011, approximately 23,500 people were living with HIV in Iran. More than 91% of these patients were men, and approximately 4,400 had died (<xref rid="A19766R18" ref-type="bibr">18</xref>). Needle sharing in IDUs is the most common route of HIV transmission in men in Iran, accounting for approximately 70% of established transmissions. However, studies show an increased rate of high-risk behaviors for HIV infection, particularly unprotected sex (<xref rid="A19766R18" ref-type="bibr">18</xref>-<xref rid="A19766R22" ref-type="bibr">22</xref>). In addition, it is important to consider the HIV infection prevalence in specific populations in Iran, such as patients with tuberculosis (<xref rid="A19766R23" ref-type="bibr">23</xref>). </p><p>Rapid changes in the epidemiological characteristics of infectious diseases necessitate health practitioners being aware of the current status of these diseases, especially in cases of pandemic diseases such as AIDS, whose control requires global efforts (<xref rid="A19766R24" ref-type="bibr">24</xref>-<xref rid="A19766R26" ref-type="bibr">26</xref>). In this regard, research should serve as a tool to improve the effectiveness of healthcare systems. Successful AIDS prevention and treatment depend on the complete and accurate identification of at-risk populations as well as regular and standardized data collection, analysis, and interpretation (<xref rid="A19766R1" ref-type="bibr">1</xref>, <xref rid="A19766R27" ref-type="bibr">27</xref>). One of the best opportunities to combat AIDS in Iran is the use of the healthcare system. However, behavioral research in the general population and high-risk groups is not systematic, integrated, or consistent (<xref rid="A19766R24" ref-type="bibr">24</xref>, <xref rid="A19766R28" ref-type="bibr">28</xref>).</p></sec><sec id="sec107860"><title>2. Objectives</title><p>The present study investigated the epidemiology of HIV/AIDS in East Azerbaijan, Iran.</p></sec><sec id="sec107861"><title>3. Patients and Methods</title><p>This retrospective study was conducted during 1987 - 2012 in East Azerbaijan, Iran. The target population was all patients with HIV/AIDS in East Azerbaijan province, including patients who acquired HIV infection through IDU, sexual transmission, mother-to-child transmission (i.e. vertical transmission), and contaminated blood products. The Vice Chancellor of Research and Technology of Tabriz University of Medical Sciences ethical committee approval was obtained for the study (decision number: 5.4.328).First, necessary supplies including computers, telephone lines, etc. were prepared for project implementation. Data including age, sex, transmission route, etc. (<xref ref-type="table" rid="tbl27686">Table 1</xref>) were extracted and entered into Microsoft Excel software for classification and sorting. Next, data were analyzed, and diagrams and tables were created using Microsoft Excel and SPSS. Quantitative variables are presented as mean ± standard deviation (SD). The <italic>χ</italic><sup>2</sup> test was used to analyze qualitative variables. Meanwhile, regression analysis was used to evaluate the roles of confounding factors. The level of significance was set at P < 0.05.</p><table-wrap id="tbl27686" orientation="portrait" position="float"><label>Table 1.</label><caption><title> Demographic Characteristics of Patients With HIV/AIDS in East Azerbaijan, Iran From 1987 to 2012 <sup><xref ref-type="table-fn" rid="fn26846">a</xref>,<xref ref-type="table-fn" rid="fn26847">b</xref></sup></title></caption><table frame="hsides" rules="groups"><thead><tr><th style="text-align: left;" rowspan="1" colspan="1">Characteristics</th><th rowspan="1" colspan="1">Values</th></tr></thead><tbody><tr><td style="text-align: left;" rowspan="1" colspan="1"><bold>Sex</bold></td><td rowspan="1" colspan="1"></td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Male</td><td style="text-align: center;" rowspan="1" colspan="1">338 (91)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Female</td><td style="text-align: center;" rowspan="1" colspan="1">33 (9)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Total</td><td style="text-align: center;" rowspan="1" colspan="1">371 (100)</td></tr><tr><td rowspan="1" colspan="1"><bold>Age ,y</bold></td><td style="text-align: center;" rowspan="1" colspan="1"></td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">0 – 20</td><td style="text-align: center;" rowspan="1" colspan="1">42 (11)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">20 - 40</td><td style="text-align: center;" rowspan="1" colspan="1">264 (71)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">≥ 40</td><td style="text-align: center;" rowspan="1" colspan="1">65 (18)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Total</td><td style="text-align: center;" rowspan="1" colspan="1">371 (100)</td></tr><tr><td rowspan="1" colspan="1"><bold>Education level</bold></td><td style="text-align: center;" rowspan="1" colspan="1"></td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Illiterate</td><td style="text-align: center;" rowspan="1" colspan="1">37 (10)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Primary and secondary school</td><td style="text-align: center;" rowspan="1" colspan="1">214 (58)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">University</td><td style="text-align: center;" rowspan="1" colspan="1">7 (2)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Unknown</td><td style="text-align: center;" rowspan="1" colspan="1">113 (30)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Total</td><td style="text-align: center;" rowspan="1" colspan="1">371 (100)</td></tr><tr><td rowspan="1" colspan="1"><bold>Marital status</bold></td><td style="text-align: center;" rowspan="1" colspan="1"></td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Single</td><td style="text-align: center;" rowspan="1" colspan="1">200 (54)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Married</td><td style="text-align: center;" rowspan="1" colspan="1">122 (33)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Unknown</td><td style="text-align: center;" rowspan="1" colspan="1">49 (13)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Total</td><td style="text-align: center;" rowspan="1" colspan="1">371 (100)</td></tr><tr><td rowspan="1" colspan="1"><bold>Hometown</bold></td><td style="text-align: center;" rowspan="1" colspan="1"></td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Tabriz</td><td style="text-align: center;" rowspan="1" colspan="1">228 (61)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Maragheh</td><td style="text-align: center;" rowspan="1" colspan="1">44 (12)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Myaneh</td><td style="text-align: center;" rowspan="1" colspan="1">26 (7)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Other</td><td style="text-align: center;" rowspan="1" colspan="1">57 (15)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Unknown</td><td style="text-align: center;" rowspan="1" colspan="1">16 (5)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Total</td><td style="text-align: center;" rowspan="1" colspan="1">371 (100)</td></tr><tr><td rowspan="1" colspan="1"><bold>Transmission route</bold></td><td style="text-align: center;" rowspan="1" colspan="1"></td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">IDU</td><td style="text-align: center;" rowspan="1" colspan="1">219 (59)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">IDU and unprotected sex</td><td style="text-align: center;" rowspan="1" colspan="1">51 (14)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Unprotected sex</td><td style="text-align: center;" rowspan="1" colspan="1">42 (11)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Blood transfusion</td><td style="text-align: center;" rowspan="1" colspan="1">10 (2.5)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Vertical transmission</td><td style="text-align: center;" rowspan="1" colspan="1">3 (0.8)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Unprotected sex and tattooing</td><td style="text-align: center;" rowspan="1" colspan="1">3 (0.8)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">IDU and blood transfusion</td><td style="text-align: center;" rowspan="1" colspan="1">1 (0.3)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Tattooing</td><td style="text-align: center;" rowspan="1" colspan="1">1 (0.3)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Needling</td><td style="text-align: center;" rowspan="1" colspan="1">1 (0.3)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Unknown</td><td style="text-align: center;" rowspan="1" colspan="1">40 (11)</td></tr><tr><td style="padding-left: 20pt;" rowspan="1" colspan="1">Total</td><td style="text-align: center;" rowspan="1" colspan="1">371 (100)</td></tr></tbody></table><table-wrap-foot><fn id="fn26846"><p><sup>a</sup> Data are presented as No. (%).</p></fn><fn id="fn26847"><p><sup>b</sup> IDU: injection drug use.</p></fn></table-wrap-foot></table-wrap></sec><sec id="sec107862"><title>4. Results</title><p>Among the 371 patients who were identified by healthcare centers in East Azerbaijan from 1987 to 2012 (<xref ref-type="fig" rid="fig20582">Figure 1</xref>), 91% (n = 338) were men and 9% (n = 33 cases) were women. The prevalence of HIV/AIDS increased along with the population growth from 1987 to 2012 (data not shown), the current prevalence of HIV/AIDS in East Azerbaijan is 1/10,000. The mean ages of the total, male, and female patients were 30.8 ± 12.3, 31.3 ± 12.1, and 28 ± 10.3 years, respectively. Moreover, 48% of the patients were 25 - 34 years old.</p><fig id="fig20582" orientation="portrait" position="float"><label>Figure 1.</label><caption><title>Percentage of frequency in Patients With HIV/AIDS in East Azerbaijan, Iran From 1987 to 2012</title></caption><graphic xlink:href="jjm-08-08-19766-i001"></graphic></fig><p>Most identified patients were from Tabriz (n = 228). Approximately 54% (n = 200) of patients were single (<xref ref-type="table" rid="tbl27686">Table 1</xref>). More than one-third (n = 131) of patients had died, and 27% (n = 99) were actively undergoing regular consultation (<xref ref-type="fig" rid="fig20583">Figure 2</xref>). The most common transmission route was related to IDU (59%, n = 219) (<xref ref-type="table" rid="tbl27686">Table 1</xref>). The educational status of about 30% of patients (n = 112) was unknown. Among patients with known educational status, approximately 80% (n = 208) of them had high school or lower (<xref ref-type="table" rid="tbl27686">Table 1</xref>). The occupational status of 36% (n = 102) and 17% (n = 48) of patients was recorded as “self-employed” and “unemployed,” respectively (<xref ref-type="table" rid="tbl27686">Table 1</xref>). The rest of the patients were employed in various jobs (data not shown).</p><fig id="fig20583" orientation="portrait" position="float"><label>Figure 2.</label><caption><title>Current Status of Patients With HIV/AIDS Who Have Registered by Council Centers in East Azerbaijan</title><p>Available: patients who actively undergoing regular consultation; Unavailable: Patients who haven’t referred to Council Centers since they have diagnosed as HIV positive.</p></caption><graphic xlink:href="jjm-08-08-19766-i002"></graphic></fig><p>The frequencies of coinfection with hepatitis C virus (HCV), hepatitis B virus (HBV), syphilis, and toxoplasmosis with respect to sex are shown in <xref ref-type="table" rid="tbl27687">Table 2</xref>. Thirty-one of 207 patients (15%) were diagnosed with HBV, and 25 of 371 patients were diagnosed with HIV/HBV/HCV co-infection.</p><table-wrap id="tbl27687" orientation="portrait" position="float"><label>Table 2.</label><caption><title> Frequencies of Coinfections in Patients with HIV/AIDS in East Azerbaijan, Iran From 1987 to 2012 <sup><xref ref-type="table-fn" rid="fn26848">a</xref>,<xref ref-type="table-fn" rid="fn26849">b</xref></sup></title></caption><table frame="hsides" rules="groups"><thead><tr><th style="text-align: left;" rowspan="1" colspan="1">Coinfection</th><th rowspan="1" colspan="1">Hepatitis B</th><th rowspan="1" colspan="1">Hepatitis C</th><th rowspan="1" colspan="1">Syphilis</th><th rowspan="1" colspan="1">Toxoplasmosis</th></tr></thead><tbody><tr><td rowspan="1" colspan="1"><bold>Test result</bold></td><td style="text-align: center;" rowspan="1" colspan="1">P: 31 (8)</td><td style="text-align: center;" rowspan="1" colspan="1">P: 168 (45)</td><td style="text-align: center;" rowspan="1" colspan="1">P: 3 (1)</td><td style="text-align: center;" rowspan="1" colspan="1">P: 94 (25)</td></tr><tr><td rowspan="1" colspan="1"><bold>Test result</bold></td><td style="text-align: center;" rowspan="1" colspan="1">N: 176 (48)</td><td style="text-align: center;" rowspan="1" colspan="1">N: 42 (12)</td><td style="text-align: center;" rowspan="1" colspan="1">N: 107 (29)</td><td style="text-align: center;" rowspan="1" colspan="1">N: 63 (17)</td></tr><tr><td rowspan="1" colspan="1"><bold>Test result</bold></td><td style="text-align: center;" rowspan="1" colspan="1">UD: 164 (44)</td><td style="text-align: center;" rowspan="1" colspan="1">UD: 161 (43)</td><td style="text-align: center;" rowspan="1" colspan="1">UD: 261 (70)</td><td style="text-align: center;" rowspan="1" colspan="1">UD: 214 (58)</td></tr><tr><td rowspan="1" colspan="1"><bold>Total</bold></td><td style="text-align: center;" rowspan="1" colspan="1">371 (100)</td><td style="text-align: center;" rowspan="1" colspan="1">371 (100)</td><td style="text-align: center;" rowspan="1" colspan="1">371 (100)</td><td style="text-align: center;" rowspan="1" colspan="1">371 (100)</td></tr></tbody></table><table-wrap-foot><fn id="fn26848"><p><sup>a</sup> Data are presented as No.(%).</p></fn><fn id="fn26849"><p><sup>b</sup> P: positive, N: negative, UD: undetermined.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tbl27688" orientation="portrait" position="float"><label>Table 3.</label><caption><title> HIV/AIDS Transmission Routes by Age Group in East Azerbaijan, Iran From 1987 to 2012 <sup><xref ref-type="table-fn" rid="fn26850">a</xref>,<xref ref-type="table-fn" rid="fn26851">b</xref></sup></title></caption><table frame="hsides" rules="groups"><thead><tr><th style="text-align: left;vertical-align: top;" rowspan="2" colspan="1">Transmission route</th><th style="border-bottom: solid thin;" colspan="3" rowspan="1">Age group (y)</th><th style="vertical-align: top;" rowspan="2" colspan="1">Total</th></tr><tr><th rowspan="1" colspan="1">0 - 19</th><th rowspan="1" colspan="1">20 - 39</th><th rowspan="1" colspan="1">≥ 40</th></tr></thead><tbody><tr><td rowspan="1" colspan="1"><bold>IDU</bold></td><td style="text-align: center;" rowspan="1" colspan="1">11 (3)</td><td style="text-align: center;" rowspan="1" colspan="1">166 (44.9)</td><td style="text-align: center;" rowspan="1" colspan="1">42 (11.4)</td><td style="text-align: center;" rowspan="1" colspan="1">219 (59.3)</td></tr><tr><td rowspan="1" colspan="1"><bold>IDU and unprotected sex</bold></td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">42 (11.4)</td><td style="text-align: center;" rowspan="1" colspan="1">9 (2.4)</td><td style="text-align: center;" rowspan="1" colspan="1">51 (13.8)</td></tr><tr><td rowspan="1" colspan="1"><bold>Unprotected sex</bold></td><td style="text-align: center;" rowspan="1" colspan="1">3 (0.8)</td><td style="text-align: center;" rowspan="1" colspan="1">33 (8.9)</td><td style="text-align: center;" rowspan="1" colspan="1">6 (1.6)</td><td style="text-align: center;" rowspan="1" colspan="1">42 (11.4)</td></tr><tr><td rowspan="1" colspan="1"><bold>IDU and blood transfusion</bold></td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">1 (0.3)</td><td style="text-align: center;" rowspan="1" colspan="1">0</td><td style="text-align: center;" rowspan="1" colspan="1">1 (0.3)</td></tr><tr><td rowspan="1" colspan="1"><bold>Other</bold></td><td style="text-align: center;" rowspan="1" colspan="1">28 (7.6)</td><td style="text-align: center;" rowspan="1" colspan="1">22 (5.9)</td><td style="text-align: center;" rowspan="1" colspan="1">8 (1.8)</td><td style="text-align: center;" rowspan="1" colspan="1">58 (15.3)</td></tr><tr><td rowspan="1" colspan="1"><bold>Total</bold></td><td style="text-align: center;" rowspan="1" colspan="1">42 (11.4)</td><td style="text-align: center;" rowspan="1" colspan="1">264 (71.4)</td><td style="text-align: center;" rowspan="1" colspan="1">65 (17.2)</td><td style="text-align: center;" rowspan="1" colspan="1">371 (100)</td></tr></tbody></table><table-wrap-foot><fn id="fn26850"><p><sup>a</sup> Data are presented as No. (%).</p></fn><fn id="fn26851"><p><sup>b</sup> IDU: injection drug use.</p></fn></table-wrap-foot></table-wrap></sec><sec id="sec107863"><title>5. Discussion</title><p>The HIV epidemic has entered the concentrated phase in Iran. The prevalence of HIV infection among injection drug users is reported to be 15.07% (<xref rid="A19766R18" ref-type="bibr">18</xref>). The results of the present study show that IDU is the most common HIV transmission route in East Azerbaijan province, which is similar to national reports on HIV/AIDS (<xref rid="A19766R18" ref-type="bibr">18</xref>). In a study conducted in Tehran and Kermanshah provinces, unsafe needle sharing was the reported cause of 83% of HIV infections (<xref rid="A19766R29" ref-type="bibr">29</xref>). Another study performed in 2007 in Imam Khomeini Hospital in Tehran reports IDU as the most common HIV transmission route (31%) (<xref rid="A19766R30" ref-type="bibr">30</xref>). Furthermore, a study conducted by researchers at Shiraz University of Medical Sciences reports 76% of patients had a history of IDU. However, in the present study, IDU was not the only route of HIV acquisition (<xref rid="A19766R31" ref-type="bibr">31</xref>), 15% of patients simultaneously had a history of IDU and other high-risk behaviors. </p><p>A study conducted in China in 2008 found that the most common HIV transmission route is IDU (> 43% of transmissions) (<xref rid="A19766R32" ref-type="bibr">32</xref>). Meanwhile, a study in the US reports the most common HIV transmission route is homosexual contact in men, whereas IDU is ranked third (<xref rid="A19766R1" ref-type="bibr">1</xref>). Thus, it seems that educating prisoners and injection drug users, reducing jail time, focusing on public education, making more efforts to provide methadone for people unable to quit their drug addiction, and doing research counseling methods and behavioral disorders at healthcare centers and prisons may improve the current status of the HIV epidemic (<xref rid="A19766R24" ref-type="bibr">24</xref>, <xref rid="A19766R33" ref-type="bibr">33</xref>-<xref rid="A19766R36" ref-type="bibr">36</xref>). Many studies conducted in Iran report the prevalence of HIV/AIDS is higher in men than in women (approximately 85 - 95% higher) (<xref rid="A19766R29" ref-type="bibr">29</xref>, <xref rid="A19766R31" ref-type="bibr">31</xref>, <xref rid="A19766R37" ref-type="bibr">37</xref>, <xref rid="A19766R38" ref-type="bibr">38</xref>). However, the 2010 Joint United Nations Programme on HIV/AIDS Global Report states that more than 50% of people living with HIV worldwide are women and girls (<xref rid="A19766R39" ref-type="bibr">39</xref>). The higher prevalence of HIV infection among men in Iran and East Azerbaijan could be due to a lack of precise data on the number of sex workers, which may partly explain the low rate of HIV/AIDS in women. </p><p>HBV and HCV coinfection among patients infected with HIV is common; and severe complications can occur in these patients (<xref rid="A19766R40" ref-type="bibr">40</xref>). Severe complications can occur in patients with coinfection via the same transmission route of HIV (<xref rid="A19766R40" ref-type="bibr">40</xref>-<xref rid="A19766R44" ref-type="bibr">44</xref>). The present results show that 53% of patients with HIV/AIDS were coinfected with HCV, HBV, or both. In a study conducted in southwestern Iran, HCV or HBV coinfection was detected in 80% of patients infected with HIV (<xref rid="A19766R45" ref-type="bibr">45</xref>). However, the prevalence of coinfection with hepatitis viruses in patients with HIV/AIDS varies among studies as well as populations with respect to exposure to different risk factors, geographic region, and ethnicity (<xref rid="A19766R41" ref-type="bibr">41</xref>, <xref rid="A19766R46" ref-type="bibr">46</xref>).</p><p>One limitation of the present study is that the sample may not be representative of the total population in East Azerbaijan province. Furthermore, the paper-based records of some patients were incomplete, preventing us from analyzing some variables (associated to the clinical features) (e.g. some laboratory parameters). However, the present study is one of the few studies on this topic that have been conducted in Iran; there are no reports from many other provinces. The findings of this study highlight the information gap in this area and help fill in a small part of it. It is noteworthy that some countries have had success in controlling and preventing contagious diseases such as HIV through healthcare systems set up for the general population; thus, the development of effective methods on the basis of evidence and data is clearly possible (<xref rid="A19766R22" ref-type="bibr">22</xref>, <xref rid="A19766R24" ref-type="bibr">24</xref>, <xref rid="A19766R28" ref-type="bibr">28</xref>, <xref rid="A19766R47" ref-type="bibr">47</xref>-<xref rid="A19766R50" ref-type="bibr">50</xref>).</p></sec></body><back><ack><p>The authors would like to thank the Vice Chancellors of Research and Technology and Health of the Tabriz University of Medical Sciences, Health Center of East Azerbaijan as well as Dr. Ahmad Kousha, the head of the Health Center, for his contributions to the project.</p></ack><fn-group><fn id="afn39973" fn-type="other"><p><bold>Authors’ Contributions:</bold>Study concept and design: Ali Rahimi; Acquisition of data: Seyyed Mortaza Haghgoo, Hadi Joula, Ramin Mohammadzadeh, Reza Yousefi, Gholamreza Ghahramani, Ali Rahimi; Data analysis and interpretation: Siamak Sabour, Seyyed Mortaza Haghgoo; Drafting of the manuscript: Seyyed Mortaza Haghgoo, Ali Rahimi; Critical revision of the manuscript for important intellectual content: Seyyed Mortaza Haghgoo, Siamak Sabour, Ali Rahimi; Statistical analysis: Siamak Sabour; Administrative, technical, and material support: Reza Yousefi, Gholamreza Ghahramani; Study supervision: Ali Rahimi.</p></fn><fn id="afn39975" fn-type="supported-by"><p><bold>Funding/Support:</bold>This research was supported by a grant (5/46/116) from the Vice Chancellor of Research of Tabriz University of Medical Sciences and the Student Research Center.</p></fn></fn-group><ref-list><title>References</title><ref id="A19766R1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hariri</surname><given-names>S</given-names></name><name><surname>McKenna</surname><given-names>MT</given-names></name></person-group><article-title>Epidemiology of human immunodeficiency virus in the United States.</article-title><source>Clin Microbiol Rev.</source><year>2007</year><volume>20</volume><issue>3</issue><fpage>478</fpage><lpage>88</lpage><pub-id pub-id-type="doi">10.1128/CMR.00006-07</pub-id><comment>table of contents</comment><pub-id pub-id-type="pmid">17630336</pub-id></element-citation></ref><ref id="A19766R2"><label>2</label><element-citation publication-type="report"><person-group person-group-type="author"><name><surname>Joint United Nations Programme on HIV/AIDS (UNAIDS).</surname></name></person-group><source>UNAIDS report on the global AIDS epidemic 2013</source><year>2013</year></element-citation></ref><ref id="A19766R3"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Jenness</surname><given-names>SM</given-names></name><name><surname>Neaigus</surname><given-names>A</given-names></name><name><surname>Hagan</surname><given-names>H</given-names></name><name><surname>Murrill</surname><given-names>CS</given-names></name><name><surname>Wendel</surname><given-names>T</given-names></name></person-group><article-title>Heterosexual HIV and sexual partnerships between injection drug users and noninjection drug users.</article-title><source>AIDS Patient Care STDS.</source><year>2010</year><volume>24</volume><issue>3</issue><fpage>175</fpage><lpage>81</lpage><pub-id pub-id-type="doi">10.1089/apc.2009.0227</pub-id><pub-id pub-id-type="pmid">20214485</pub-id></element-citation></ref><ref id="A19766R4"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Centers for Disease Control Prevention.</surname></name></person-group><article-title>HIV prevalence estimates--United States, 2006.</article-title><source>MMWR. 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