AIMS In Iran, injecting drug use has been the major route of human immunodeficiency virus (HIV) transmission. In order to control the HIV epidemic, a harm reduction program was initiated and expanded in recent years. The aim of this study was to provide an updated estimate of HIV prevalence among people who inject drugs (PWID) in Iran, investigate prevalence differences over time, and assess prevalence correlates. DESIGN A comprehensive systematic review was undertaken in the international, regional, and national bibliographic databases in November 2018 and extensive contacts with authors were made. For studies conducted before 2005, we used data from a previous published systematic review. SETTING All studies conducted in Iran were included. Recruitment settings included anywhere except studies conducted in infectious diseases wards or HIV counselling centers. PARTICIPANTS PWID with any definition utilized in the studies. Thirty-six studies were included, which were conducted in 24 out of 31 provinces with a sample size of 22,160 PWID. MEASUREMENTS We included studies that had done HIV testing and had confirmed diagnosis of HIV through repeating the enzyme-linked immunosorbent assay (ELISA) or western immunoblot assay (WB). Pooled prevalence of HIV was calculated for the total sample and for different subgroups, by available sociodemographic and behavioral factors. For assessing the trend of HIV prevalence over time, a linear meta-regression model was fitted separately for before 2007, and 2007 and afterwards. FINDINGS The pooled prevalences of HIV before 2007 and in 2007 and afterwards were 14.3% (95% CI: 9.8-18.9) and 9.7% (95% CI: 7.6-11.9), respectively. HIV prevalence increased until 2005-2006 and then slowly declined until 2009-2010, which was not significant. Prevalence of HIV was significantly higher in PWID above age 25, and in those with history of imprisonment and history of needle/syringe sharing. HIV prevalence was higher in men than in women, but the difference was insignificant. CONCLUSION The prevalence of HIV among people who inject drugs in Iran decreased after 2006, which could be, at least in part, attributed to the development of extensive harm reduction programs in the country.

中文翻译：

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伊朗注射毒品者 (PWID) 和相关因素中的 HIV 流行率：系统评价、荟萃分析和趋势分析

目的 在伊朗，注射吸毒一直是人类免疫缺陷病毒 (HIV) 传播的主要途径。为了控制艾滋病毒的流行，近年来启动并扩大了一项减少危害计划。本研究的目的是提供对伊朗注射吸毒者 (PWID) 中 HIV 流行率的最新估计，调查随时间推移的流行率差异，并评估流行率的相关性。设计 2018 年 11 月在国际、区域和国家书目数据库中进行了全面的系统评价，并与作者进行了广泛的接触。对于 2005 年之前进行的研究，我们使用了之前发表的系统评价中的数据。设置 在伊朗进行的所有研究都包括在内。招募环境包括在传染病病房或 HIV 咨询中心进行的研究以外的任何地方。参与者具有研究中使用的任何定义的 PWID。纳入了 36 项研究，这些研究在 31 个省中的 24 个省进行，样本量为 22,160 名 PWID。测量 我们纳入了进行 HIV 检测并通过重复酶联免疫吸附试验 (ELISA) 或蛋白质免疫印迹试验 (WB) 确诊 HIV 的研究。根据可用的社会人口统计学和行为因素，计算了总样本和不同亚组的合并 HIV 流行率。为了评估 HIV 流行率随时间的变化趋势，分别拟合了 2007 年之前和 2007 年及之后的线性元回归模型。结果 2007 年之前和 2007 年及之后的合并 HIV 流行率分别为 14.3%（95% CI：9.8-18.9）和 9.7%（95% CI：7.6-11.9）。艾滋病毒流行率一直上升到 2005-2006 年，然后缓慢下降，直到 2009-2010 年，这并不显着。在 25 岁以上的注射吸毒者以及有监禁史和共用针头/注射器史的人中，艾滋病毒流行率显着更高。男性的 HIV 感染率高于女性，但差异并不显着。结论 2006 年之后，伊朗注射吸毒者中的艾滋病毒流行率有所下降，这至少部分归因于该国开展了广泛的减低危害计划。艾滋病毒流行率一直上升到 2005-2006 年，然后缓慢下降，直到 2009-2010 年，这并不显着。在 25 岁以上的注射吸毒者以及有监禁史和共用针头/注射器史的人中，艾滋病毒流行率显着更高。男性的艾滋病毒感染率高于女性，但差异并不显着。结论 2006 年之后，伊朗注射吸毒者中的艾滋病毒流行率有所下降，这至少部分归因于该国开展了广泛的减低危害计划。艾滋病毒流行率一直上升到 2005-2006 年，然后缓慢下降，直到 2009-2010 年，这并不显着。在 25 岁以上的注射吸毒者以及有监禁史和共用针头/注射器史的人中，艾滋病毒流行率显着更高。男性的 HIV 感染率高于女性，但差异并不显着。结论 2006 年之后，伊朗注射吸毒者中的艾滋病毒流行率有所下降，这至少部分归因于该国开展了广泛的减低危害计划。