Abstract
BackgroundInjection drug use is steadily rising in Kenya. We assessed the prevalence of both human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) infections among injecting heroin users (IHUs) at the Kenyan Coast.MethodsA total of 186 IHUs (mean age, 33 years) from the Omari rehabilitation center program in Malindi were consented and screened for HIV-1 and HCV by serology and PCR and their CD4 T-cells enumerated by FACS.ResultsPrevalence of HIV-1 was 87.5%, that of HCV was 16.4%, co-infection was 17.9% and 18/152 (11.8%) were uninfected. Only 5.26% of the HIV-1 negative injectors were HCV positive. Co-infection was higher among injectors aged 30 to 40 years (20.7%) and among males (22.1%) than comparable groups. About 35% of the injectors were receiving antiretroviral treatment (ART). Co-infection was highest among injectors receiving D4T (75%) compared to those receiving AZT (21.6%) or TDF (10.5%) or those not on ART (10.5%). Mean CD4 T-cells were 404 (95% CI, 365 - 443) cells/mm3 overall, significantly lower for co-infected (mean, 146; 95% CI 114 – 179 cells/mm3) than HIV mono infected (mean, 437, 95% CI 386 – 487 cells/mm3, p<0.001) or uninfected (mean, 618, 95% CI 549 – 687 cells/mm3, p<0.001) injectors and lower for HIV mono-infected than uninfected injectors (p=0.002). By treatment arm, CD4 T-cells were lower for injectors receiving D4T (mean, 78; 95% CI, 0.4 – 156 cells/mm3) than TDF (mean 607, 95% CI, 196 – 1018 cells/mm3, p=0.005) or AZT (mean 474, 95% CI -377 – 571 cells/mm3, p=0.004).ConclusionMono and dual infections with HIV-1 and HCV is high among IHUs in Malindi, but ART coverage is low. The co-infected IHUs have elevated risk of immunodeficiency due to significantly depressed CD4 T-cell numbers. Coinfection screening, treatment-as-prevention for both HIV and HCV and harm reduction should be scaled up to alleviate infection burden.
Highlights
The risks and incidents of HIV infection remain high among certain demographics globally, including injection drug users (IDUs), commercial sex workers (CSW) and men who have sex with other men (MSM) [1,2,3,4]
About 35% of the injecting heroin users (IHUs) were actively enrolled in antiretroviral treatment (ART) program
IHUs receiving cotrimoxazole had been diagnosed with Pneumocystis jirovecii, known as Pneumocystis carinii (PCP) and were not on ART at the time of the report
Summary
The risks and incidents of HIV infection remain high among certain demographics globally, including injection drug users (IDUs), commercial sex workers (CSW) and men who have sex with other men (MSM) [1,2,3,4]. 4 years into those projections, the National AIDS and STIs Control Program showed HIV prevalence among IDUs in Nairobi and Mombasa to remain alarmingly high at 18%, which represented a 300% rise in prevalence from the earlier estimates and standing at about 3-times the national HIV prevalence [20]. Another independent review of literature showed that up to 36% of all IDUs in Kenya were positive [21]. We assessed the prevalence of both human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) infections among injecting heroin users (IHUs) at the Kenyan Coast.
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