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hepatitis b virus ( hbv ) and hepatitis c virus ( hcv ) infections are still among the important health issues , in turkey .
however , human immunodeficiency virus ( hiv ) infections are less frequently observed , in the country .
although the modes of transmission are through parenteral , horizontal and vertical routes , while its incidence may vary between different countries and regions . the individuals who had blood transfusions , patients undergoing hemodialysis , intravenous drug addicted individuals , people who had tattoos / piercings , communal living environments , contamination of a family member and prisoners are the main risk groups ( 1 )
it is known that 400 million people worldwide are infected with hbv and approximately 175 million people are infected with hcv .
these infections become chronic and cause hepatic failure , cirrhosis and hepatocellular cancer ( 1 , 2 ) . according to a 2014 report of the world health organization ( who ) , 35 million people in the world are infected with hiv and approximately 39 million people have died because of this disease since it was defined in 1981 . according to the data stated in june 2014 by turkish ministry of health ,
it is thought that this number does not reflect the reality since there is insufficient admissions to health institutions of sexually transmitted infections and inaccurate recording ( 3 ) .
determination of hepatitis infections and implementing preventive measures in communal living environments , such as prisons , is of high importance .
furthermore , the high rates of drug addiction among prison inmates make this issue more challenging .
although there are several worldwide studies dealing with this risky group , few studies are conducted in turkey .
the current study aimed to discuss the prevalence and genotypes of hepatitis , and prevalence of hiv among the prison inmates regarding the literature .
the study was approved in the ethics committee of kahramanmaras sutcu imam university medical faculty , kahramanmaras , turkey ( date : 02.06.2014 , number : 07 ) and conducted with the permission of the public prosecutor of kahramanmaras ( date : 29.08.2014 , no .
two - hundred and sixty - six cases sentenced in kahramanmaras prison due to certain crimes such as robbery , sexual assault , assault , substance abuse or selling were recruited for the study .
these cases were evaluated in polyclinics of necip fazil city hospital from may 2014 to may 2015 .
the age , gender and risk factors were considered , and hbsag , anti - hbs , hbeag , anti - hbe , anti - hbcigg , anti - hcv and anti - hiv levels were examined .
medical record files issued by infectious diseases department of necip fazil hospital , a clinic providing healthcare service for prisoners , for the individuals were investigated .
the relationship between diagnosis and individuals characteristics was evaluated using pearson s chi - square test with yates continuity correction and fisher s exact test .
data were expressed as the mean  sd and the distribution of frequencies as percentage .
out of 266 subjects participated in the study , 89.5% ( n = 238 ) were male and 10.5% ( n = 28 ) were female with a mean age of 31.21  8.99 years ( min = 18 , max = 63 ) . regarding the examined risk factors , 72.6% ( n = 193 ) of the subjects were free from risk factors ; while , 27.4% ( n = 73 ) showed risk factors .
out of 73 subjects with the risk factors , 20.3% had intravenous substance use , 3.8% had a history of operation / transfusion and 1.9% had a history of indentation ; while , 1.5% of subjects had previous unprotected sexual contact . when the subjects were examined according to the presence of hepatitis b , hbsag positivity was detected in 2.6% ( n = 7 ) and hbv dna level in only two subjects was above 2,000 iu / ml . no subject had received chronic hepatitis b treatment .
the ratio of anti - hbs positive subjects was 35.0% ( n = 93 ) and 43% ( n = 40 ) of them had been immunized by vaccination ( 57% were anti - hbs and anti - hbc igg positive ) , isolated anti - hbc igg positivity was detected in only one subject .
anti - hcv was positive in 17.7% ( n = 47 ) of the kahramanmaras prison inmates and genotypes 3 and 1 were 68.1% ( n = 32 ) and 2.1% ( n = 1 ) , respectively .
the ratio of anti - hcv positive and hcv rna negative individuals who had not received treatment was 29.8% ( n = 14 ) .
it is not clear whether these 14 subjects demonstrated the presence of infection or it was false anti - hcv positivity .
while there was a history of intravenous substance use in eight subjects and a history of dental treatment in one , however , no risks were found in five subjects .
the ratio of anti - hcv positive and hcv rna negative individuals who had received treatment constituted 3.8% ( n = 10 ) of the study population .
when the prisons were examined in general ; the prison inmates had risky behavioral patterns , violent tendencies , deviant sexual behavior and substance abuse ; and it was found that the cleaning and hygiene procedures were not properly followed in the environments where such crowded groups live together with continued risky behaviors in prisons ( 4 )
. continued substance abuse in prisons by most of the drug addicts , common use of injection materials , tattoos and other circumstances that result in blood contact increase the risk of infections ( 2 ) .
it is reported that 60% - 80% of the individuals in prisons previously had an hbv infection and only 5% - 10% of them carry the disease ; however , the relation of hbv infections to substance use could not be fully demonstrated ( 5 - 7 ) .
it is stated that hcv transmission is observed among intravenous drug addicts , especially in industrially developed countries ( 8 - 11 ) .
hcv seroprevalence is 30% among the prison inmates and in a meta - analysis including 30 studies , a relation was found between hcv infection and intravenous substance use ( 8 , 12 , 13 ) .
the subjects included in the current study were primarily young ( mean age 31 years ) and male . the higher ratio of males when compared to females was due to the fact that the number of female prisoners was less than the male ones .
when the risk factors were examined , there was a history of intravenous substance use in 20.3% of the prisoners included in the study . in the previously conducted studies
, it was reported that hcv transmission was a result of intravenous substance use ( 8 , 12 , 13 ) . in the studies on prisoners with a history of intravenous substance use ,
the ratio of hbsag positivity in the current study was 2.6% , which was lower compared to the related literature .
a study from iran reported that 12.37% of the individuals in the specific groups were immunized ( isolated hbsab positive ) by vaccination ( 15 ) .
therefore , it is demonstrated that the rate of immunization among the individuals who demonstrate risky behaviors is low and vaccination is necessary to protect public health . according to a report of who in 2013
the reported stated that this ratio was 3.6% ( 3.2% - 4.1% ) in north africa / middle east region , in which turkey is located ( 18 ) . in a study , dealing with general european population , by esteban et al .
the prevalence of hcv was reported 0.5% in western europe , 2.5% in southern europe and 6% in eastern europe ( 19 ) . in a meta - analysis conducted by vescio
the prevalence of hcv was 30% - 40% ( 2% - 58% ) among the prisoners ( 8) . according to the literature , the rate of hcv infection among prisoners was higher compared to the general population . in turkey ,
the rate of anti - hcv positivity among the general population varies from 0.1% to 0.9% ( 20 , 21 ) .
it is thought that the data do not reflect the worldwide populations as the studies are conducted in relatively limited regions .
thus , authors believe that the current study could represent the statistics of turkey . worldwide examination of the patients with hcv based on genotype revealed that the most common subtypes were genotypes 1 and 3 ; however , it was found that genotype 3 was particularly higher among prisoners ( 22 - 27 ) .
anti - hcv was positive in 17.7% of kahramanmaras prison inmates and positivity rates of genotypes 3 and 1 were 68.1% and 2.1% , respectively .
the ratio of anti - hcv positive , hcv rna negative subjects , who had never received treatment , was 29.8% .
the study by roman et al . which included patients and prisoners who had been hospitalized for treatment ( 28.4% ) , found that 53.4% of hcv positive cases among the general population were genotype 1 and in prisoners , 46.5% of the hcv positive cases were genotype 3 ( 28 ) .
when the studies on prisoners were examined , an hcv genotype 3 coupling was 13.4% in germany ( 29 ) ; 22% - 63% in france ( 30 , 31 ) and 29.3% in the netherlands ( 32 ) .
many studies have revealed that the most important risk factor among the individuals with hcv genotype 3 was intravenous substance use ( 33 - 35 ) . in the studies previously carried out in various states of usa ,
hiv positivity was 0.7% - 7.0% among the prisoners and this ratio was 0.4% in australia ( 2 , 36 ) . in the current study , hiv positivity was not detected . in general
, the disease has an asymptomatic duration of approximately 8 - 10 years if the virus is transmitted through unprotected sexual contact or substance use .
a failed registry system that does not work properly and the patients do not apply to a health center because of fear of being stigmatized make the diagnosis , treatment and follow up of the disease more difficult . in conclusion
, the current study provides an approximate hcv prevalence and genotypic distribution among the prisoners in turkey .
similar to european countries , intravenous drug use is a significant risk factor in hcv transmission .
it is important to prevent intravenous drug user ( ivdu ) or develop preventive measures for hcv transmission among the individuals in prisons .
it is essential to consider this situation both to develop preventive public health policies for human health and effective use of economic resources and also plan the diagnosis and early treatment .
it is necessary to conduct large scaled studies to determine hcv prevalence and substance abuse in turkey .
in conclusion , the current study provides an approximate hcv prevalence and genotypic distribution among the prisoners in turkey . similar to european countries ,
it is important to prevent intravenous drug user ( ivdu ) or develop preventive measures for hcv transmission among the individuals in prisons .
it is essential to consider this situation both to develop preventive public health policies for human health and effective use of economic resources and also plan the diagnosis and early treatment .
it is necessary to conduct large scaled studies to determine hcv prevalence and substance abuse in turkey .
backgroundhepatitis b virus ( hbv ) and hepatitis c virus ( hcv ) infections are among the most important health issues in turkey . human immunodeficiency virus ( hiv ) 
 infections are less frequently observed in the country . 
 the individuals who had blood transfusions , patients undergoing hemodialysis , and intravenous drug addicted individuals , people who had tattoos / piercings , communal living environments , contamination of a family member , and prisoners are the main risk groups.objectivesthe current study aimed to discuss the prevalence and the genotypes of hepatitis and hiv infections among a specific group , namely individuals incarcerated in prisons.patients and methodstwo - hundred and sixty - six prisoners sentenced for crimes such as robbery , sexual assault , assault substance abuse or selling drugs in the kahramanmaras closed prison were recruited for the study . demographic data and the presence of hepatitis b , hepatitis c and hiv were investigated in the study subjects.resultsout of the 266 cases included in the study , 89.5% were male , 10.5% were female and the mean age was 31.21  8.99 years . 
 risk factors were detected in 27.4% of the subjects . 
 out of the 73 subjects , among whom the risk factors were detected , 20.3% had intravenous substance use , 3.8% had a history of operation / transfusion , 1.9% had a history of indentation and 1.5% had unprotected sexual contact . 
 the rate of hepatitis b surface antigen ( hbsag ) positivity was 2.6% , the ratio of anti - hbs positive subjects was 35.0% and immunity was achieved with vaccination in 43% of the subjects . 
 anti - hcv was positive in 17.7% of the prisoners and the genotype 3 and genotype 1 were 68.1% ( n = 32 ) and 2.1% ( n = 1 ) , respectively.conclusionscontinued substance abuse among most of the drug addicted individuals in prisons , common use of injection materials , tattoos and other circumstances that cause blood contact increase the risk of blood - borne infections .