title: Clinical chemistry profiles in injection heroin users from Coastal Region, Kenya.
abstract: BACKGROUND
  Although 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).
  
  
  METHODS
  Clinical 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.
  
  
  RESULTS
  HIV 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.
  
  
  CONCLUSIONS
  Absolute 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.
authors: Department of Clinical Medicine, University of Kabianga, P. O. Box 2030-20200, Kericho, Kenya.
authors: Tom
authors: T
authors: Were
authors: Department of Medical Laboratory Sciences, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya.
authors: Jesca O
authors: JO
authors: Wesongah
authors: Department of Biomedical Sciences and Technology, Maseno University, Maseno, Kenya.
authors: Elly
authors: E
authors: Munde
authors: Department of Biomedical Sciences and Technology, Maseno University, Maseno, Kenya.
authors: Collins
authors: C
authors: Ouma
authors: Department of Pharmacy and Complementary Medicine, Kenyatta University, Nairobi, Kenya.
authors: Titus M
authors: TM
authors: Kahiga
authors: Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya.
authors: Francisca
authors: F
authors: Ongecha-Owuor
authors: Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
authors: James N
authors: JN
authors: Kiarie
authors: Bomu Hospital, Mombasa, Kenya.
authors: Aabid A
authors: AA
authors: Ahmed
authors: Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors: Ernest P
authors: EP
authors: Makokha
authors: Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya.
authors: Valentine
authors: V
authors: Budambula
keywords: Anti-retroviral treatment; Clinical chemistry markers; HIV-1 infection; Injection heroin user