title: Co-Infection Burden of Hepatitis C Virus and Human Immunodeficiency Virus among Injecting Heroin Users at the Kenyan Coast.
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).
  
  
  CONCLUSIONS
  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.
authors.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.
authors.forename: Ruth S
authors.initials: RS
authors.lastname: Mwatelah
authors.affiliation: Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Raphael M
authors.initials: RM
authors.lastname: Lwembe
authors.affiliation: Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Saida
authors.initials: S
authors.lastname: Osman
authors.affiliation: Centre for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya; Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya; Institute of Healthcare Management, Strathmore University, Nairobi, Kenya.
authors.forename: Bernhards R
authors.initials: BR
authors.lastname: Ogutu
authors.affiliation: Centre for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya; Institute of Healthcare Management, Strathmore University, Nairobi, Kenya; African Center for Clinical Trials, Nairobi, Kenya.
authors.forename: Rashid
authors.initials: R
authors.lastname: Aman
authors.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.
authors.forename: Rose C
authors.initials: RC
authors.lastname: Kitawi
authors.affiliation: Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
authors.forename: Laura N
authors.initials: LN
authors.lastname: Wangai
authors.affiliation: Centre for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya; Technical University of Kenya, Nairobi, Kenya.
authors.forename: Florence A
authors.initials: FA
authors.lastname: Oloo
authors.affiliation: Institute of Healthcare Management, Strathmore University, Nairobi, Kenya.
authors.forename: Gilbert O
authors.initials: GO
authors.lastname: Kokwaro
authors.affiliation: Centre for Research in Therapeutic Sciences, Strathmore University, Nairobi, Kenya; Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya; Institute of Healthcare Management, Strathmore University, Nairobi, Kenya.
authors.forename: Washingtone
authors.initials: W
authors.lastname: Ochieng
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D060085:Coinfection / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology*; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects / Q000502:physiology*; D016174:Hepacivirus / Q000187:drug effects / Q000502:physiology*; D006526:Hepatitis C / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology*; D006556:Heroin Dependence / Q000821:virology*; D054884:Host-Pathogen Interactions / Q000187:drug effects; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence
chemical_list: D044966:Anti-Retroviral Agents