Abstract
BackgroundAlthough the co-burden of injection drug use and HIV is increasing in Africa, little is known about the laboratory markers of injection drug use and anti-retroviral treatment (ART) in Kenyan injection drug users. This study, therefore, aimed at determining the clinical chemistry profiles and identifying the key laboratory markers of HIV infection during ART in injection heroin users (IHUs).MethodsClinical chemistry measurements were performed on serum samples collected from HIV-1 infected ART-experienced (n = 22), naive (n = 16) and HIV-1 negative (n = 23) IHUs, and healthy controls (n = 15) from Mombasa, coastal Kenya.ResultsHIV uninfected IHUs had lower alanine aminotransferase (ALT) levels (P = 0.023) as ART-exposed IHUs exhibited lower albumin (P = 0.014) and higher AST to platelet index (APRI) (P < 0.0001). All IHUs presented with lower aspartate aminotransferase to ALT values (P = 0.001) and higher C-reactive protein (CRP) levels (P = 0.002). ART-naive IHUs had higher globulin levels (P = 0.013) while ART-experienced and naive IHUs had higher albumin to total protein (P < 0.0001) and albumin to globulin (P < 0.0001) values. In addition, CD4+ T cells correlated with ALT (ρ = −0.522, P = 0.011) and CRP (rho, ρ = 0.529, P = 0.011) in HIV negative and ART-experienced IHUs, respectively. HIV-1 viral load correlated with albumin to globulin index in ART-experienced (ρ = −0.468, P = 0.037) and naive (ρ = −0.554, P = 0.040) IHUs; and with albumin to total protein index (ρ = −0.554, P = 0.040) and globulin (ρ = 0.570, P = 0.033) in ART-naive IHUs.ConclusionAbsolute ALT, albumin, globulin, and CRP measurements in combination with APRI, AST to ALT, albumin to total protein and albumin to globulin indices may be useful laboratory markers for screening IHUs for initiating and monitoring treatment.
Highlights
The co-burden of injection drug use and HIV is increasing in Africa, little is known about the laboratory markers of injection drug use and anti-retroviral treatment (ART) in Kenyan injection drug users
Demographic and laboratory characteristics of the study participants The study population comprised both male (n = 39) and female (n = 37) adult participants. These comprised of HIV-1 infected ART-experienced (n = 22), naive (n = 16) and HIV-1 non-infected (n = 23) injection heroin users, and healthy controls (HC, n = 15)
Absolute albumin levels and albumin to total protein ratio reductions observed in the HIV-1 infected injection drug users are indications of derangements in protein metabolism
Summary
The co-burden of injection drug use and HIV is increasing in Africa, little is known about the laboratory markers of injection drug use and anti-retroviral treatment (ART) in Kenyan injection drug users. The rates of HIV transmission in injection drug users in the country are higher relative to the spread in the general population [4], CD4+ T cell measurements are commonly used in initiating and monitoring disease progression and treatment in HIV-1 infected individuals [5], other biomarkers may not be specific to HIV infection due to concomitant illicit drug and poly-substance use among injection drug users Since, addictive drugs such as opioids largely cause persistent immune stimulation inducing chronic inflammation [6], while anti-retroviral therapy cumulatively cause hepatotoxic injury [7], it is likely that HIV-1 infected injection drug users progressively develop intense inflammation and hepatotoxicity that can be indirectly assessed through determining hepatic functionality. These studies suggest increased inflammatory-mediated hepatic derangements in both HIV infected and uninfected injection drug users
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