Abstract
BackgroundDrug users act as reservoirs and transmission channels for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections to the general population worldwide. Periodic epidemiological studies to monitor the prevalence and genetic diversity of these infections to inform on interventions are limited.Objective of the studyThe objective of this study was to determine the predictors of HIV infection and genetic diversity of HBV and HCV among drug users in Kenya.Materials and methodsA cross-sectional study on previous drug use history among drug users was conducted in three Kenyan cities using a respondent-driven sampling method between January 2011 and September 2012. Blood samples were collected and analysed for the presence of HBV, HCV and HIV serological markers and to determine the genotypes of HBV and HCV.ResultsThe overall prevalence of HBV, HCV and HIV among drug users was 4.3%, 6.5% and 11.1%, respectively, with evidence of HBV/HIV, HCV/HIV and HBV/HCV/HIV co-infections. The HBV circulating genotypes were A1 (69%) and D6 (19%), whereas HCV genotypes were 1a (72%) and 4a (22%). Injection drug use was a significant predictor of HIV/HCV infections. Younger age (30 years; aOR (adjusted odds ratio) = 0.50, 95% CI (confidence interval): 0.33–0.76; p < 0.001) and early sexual debut (aOR = 0.54, 95% CI: 0.40–0.82; p < 0.05) were negatively associated with detection of any of the three infections. Injecting drug use was positively associated with HCV infection (aOR = 5.37, 95% CI: 2.61–11.06; p < 0.001).ConclusionThis high level of genetic diversity exhibited by HBV and HCV isolates requires urgent implementation of harm reduction strategies and continuous monitoring for effective management of the patients.
Highlights
Substance abuse is a growing phenomenon and infection with blood-borne pathogens among drug users is a great problem around the world
The prevalence was 11.1% for Human immunodeficiency virus (HIV), 4.3% for hepatitis B virus (HBV) and 6.5% for hepatitis C virus (HCV)
The prevalence of HIV, HBV and HCV in men was 10.5%, 4.5% and 6.6%, respectively, whereas for women it was 19.1%, 2.1% and 6.4%, respectively (Table 1)
Summary
Substance abuse is a growing phenomenon and infection with blood-borne pathogens among drug users is a great problem around the world. Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) are common infections among drug users – both injecting drug users (IDUs) and non-injecting drug users (NIDUs).[1,2] Being blood-borne, HBV, HCV and HIV infections are commonly transmitted through unsafe drug injection practices and sexual contact.[3] Both HBV and HCV have been implicated in acute and chronic liver disease, with a rapid progression to liver cirrhosis and hepatocellular carcinoma.[4,5] Currently, over 2 billion people worldwide are infected with HBV and about 240 million are chronic carriers.[6] Approximately 780 000 deaths occur annually as a result of HBV infection, with an estimated 4.5 million new HBV infections occurring each year.[7] An estimated 170 million people are infected with HCV worldwide with more than 350 000 deaths annually.[8] Approximately, 26 million of the 37 million HIV-positive individuals in the world reside in Sub-Saharan Africa,[9] highlighting the disproportionate impact this pathogen is having on this region of the world, which includes Kenya. Periodic epidemiological studies to monitor the prevalence and genetic diversity of these infections to inform on interventions are limited
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