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Co-Infection Burden of Hepatitis C Virus and Human Immunodeficiency Virus among Injecting Heroin Users at the Kenyan Coast.

Mwatelah RS, Lwembe RM, Osman S, Ogutu BR, Aman R, Kitawi RC, Wangai LN, Oloo FA, Kokwaro GO, Ochieng W - PLoS ONE (2015)

Bottom Line: 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).

View Article: PubMed Central - PubMed

Affiliation: Centre for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya; Institute of Tropical Medicine and Infectious Diseases, Nairobi, Kenya; Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.

ABSTRACT

Background: Injection 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.

Methods: A 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.

Results: Prevalence 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).

Conclusion: Mono 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.

No MeSH data available.


Related in: MedlinePlus

CD4 Counts across various categories of heroin injectors.CD4 T-cells are compared between treatment arms of injectors (A). ¶ Counts are significantly lower for the D4T- arm than for the AZT arm (p = 0.004), TDF (p = 0.005) or the ART- (p<0.001) arm and lower for the sub-optimal ART than ART- (p = 0.023) arm. All subjects in the ‘ART-’ arm were not infected (NI) by either virus. Mean CD4 counts are compared between infection statuses (B). These are significantly lower for co-infected than HIV-1 mono infected injectors as shown. §Shows significantly lower CD4 counts for HIV mono-infected than NI injectors (p = 0.002). CD4 data is compared between age groups of the different infection statuses (C). No significant (NS) difference was observed. *Co-infected injectors had much lower CD4 levels compared to other infection categories in any age group. Only one injector was HCV mono-infected (horizontal bar in the >30–40 years category). CD4 Counts were not significantly different between genders of injectors (D). ART, antiretroviral treatment; CTX, cotrimoxazole (septrin); ART-, No ART; Uk, unknown ART status; Sub, sub optimal ART.
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pone.0132287.g001: CD4 Counts across various categories of heroin injectors.CD4 T-cells are compared between treatment arms of injectors (A). ¶ Counts are significantly lower for the D4T- arm than for the AZT arm (p = 0.004), TDF (p = 0.005) or the ART- (p<0.001) arm and lower for the sub-optimal ART than ART- (p = 0.023) arm. All subjects in the ‘ART-’ arm were not infected (NI) by either virus. Mean CD4 counts are compared between infection statuses (B). These are significantly lower for co-infected than HIV-1 mono infected injectors as shown. §Shows significantly lower CD4 counts for HIV mono-infected than NI injectors (p = 0.002). CD4 data is compared between age groups of the different infection statuses (C). No significant (NS) difference was observed. *Co-infected injectors had much lower CD4 levels compared to other infection categories in any age group. Only one injector was HCV mono-infected (horizontal bar in the >30–40 years category). CD4 Counts were not significantly different between genders of injectors (D). ART, antiretroviral treatment; CTX, cotrimoxazole (septrin); ART-, No ART; Uk, unknown ART status; Sub, sub optimal ART.

Mentions: By an analysis of variance (ANOVA) method, CD4 T-cells differed significantly between the ART regimen arms (p = 0.006) and infection statuses (p<0.001) but not between age groups or gender. Specific comparisons were done using post-hoc test within a Univariate ANOVA model to compare differences between multiple levels of the independent variables. By this approach, IHUs receiving D4T as part of 3-drug ART regimen had significantly depressed CD4 T-cell levels than IHUs in the other treatment arms (Fig 1A). Injectors who were dual infected with both viruses had significantly less CD4 T-cell counts (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, Table 3) injectors. The difference was also significant comparing CD4 T-cells of HIV mono-infected and uninfected injectors (p = 0.002) (Fig 1B). There were no significant differences among age groups (Fig 1C) or genders (Fig 1D), although dual-infected injectors still maintained significantly low CD4 counts in any category.


Co-Infection Burden of Hepatitis C Virus and Human Immunodeficiency Virus among Injecting Heroin Users at the Kenyan Coast.

Mwatelah RS, Lwembe RM, Osman S, Ogutu BR, Aman R, Kitawi RC, Wangai LN, Oloo FA, Kokwaro GO, Ochieng W - PLoS ONE (2015)

CD4 Counts across various categories of heroin injectors.CD4 T-cells are compared between treatment arms of injectors (A). ¶ Counts are significantly lower for the D4T- arm than for the AZT arm (p = 0.004), TDF (p = 0.005) or the ART- (p<0.001) arm and lower for the sub-optimal ART than ART- (p = 0.023) arm. All subjects in the ‘ART-’ arm were not infected (NI) by either virus. Mean CD4 counts are compared between infection statuses (B). These are significantly lower for co-infected than HIV-1 mono infected injectors as shown. §Shows significantly lower CD4 counts for HIV mono-infected than NI injectors (p = 0.002). CD4 data is compared between age groups of the different infection statuses (C). No significant (NS) difference was observed. *Co-infected injectors had much lower CD4 levels compared to other infection categories in any age group. Only one injector was HCV mono-infected (horizontal bar in the >30–40 years category). CD4 Counts were not significantly different between genders of injectors (D). ART, antiretroviral treatment; CTX, cotrimoxazole (septrin); ART-, No ART; Uk, unknown ART status; Sub, sub optimal ART.
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pone.0132287.g001: CD4 Counts across various categories of heroin injectors.CD4 T-cells are compared between treatment arms of injectors (A). ¶ Counts are significantly lower for the D4T- arm than for the AZT arm (p = 0.004), TDF (p = 0.005) or the ART- (p<0.001) arm and lower for the sub-optimal ART than ART- (p = 0.023) arm. All subjects in the ‘ART-’ arm were not infected (NI) by either virus. Mean CD4 counts are compared between infection statuses (B). These are significantly lower for co-infected than HIV-1 mono infected injectors as shown. §Shows significantly lower CD4 counts for HIV mono-infected than NI injectors (p = 0.002). CD4 data is compared between age groups of the different infection statuses (C). No significant (NS) difference was observed. *Co-infected injectors had much lower CD4 levels compared to other infection categories in any age group. Only one injector was HCV mono-infected (horizontal bar in the >30–40 years category). CD4 Counts were not significantly different between genders of injectors (D). ART, antiretroviral treatment; CTX, cotrimoxazole (septrin); ART-, No ART; Uk, unknown ART status; Sub, sub optimal ART.
Mentions: By an analysis of variance (ANOVA) method, CD4 T-cells differed significantly between the ART regimen arms (p = 0.006) and infection statuses (p<0.001) but not between age groups or gender. Specific comparisons were done using post-hoc test within a Univariate ANOVA model to compare differences between multiple levels of the independent variables. By this approach, IHUs receiving D4T as part of 3-drug ART regimen had significantly depressed CD4 T-cell levels than IHUs in the other treatment arms (Fig 1A). Injectors who were dual infected with both viruses had significantly less CD4 T-cell counts (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, Table 3) injectors. The difference was also significant comparing CD4 T-cells of HIV mono-infected and uninfected injectors (p = 0.002) (Fig 1B). There were no significant differences among age groups (Fig 1C) or genders (Fig 1D), although dual-infected injectors still maintained significantly low CD4 counts in any category.

Bottom Line: 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).

View Article: PubMed Central - PubMed

Affiliation: Centre for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya; Institute of Tropical Medicine and Infectious Diseases, Nairobi, Kenya; Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.

ABSTRACT

Background: Injection 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.

Methods: A 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.

Results: Prevalence 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).

Conclusion: Mono 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.

No MeSH data available.


Related in: MedlinePlus