Comparative Study Of Hepatitis B And Hepatitis C Viruses Among Hiv-1 Infected Intravenous Drug Users And Non-Users In Mombasa County

ABSTRACT 

HIV/AIDS is a debilitating disease associated with high mortality and morbidity globally. In Kenya, it is the major cause of mortality across all gender and age groups, in effect, putting a huge demand on the healthcare system and the economy. The HIV 1 positive population faces major challenges such as the drug resistance, severe hepatic coupled with immunological deficiencies and toxicity. The problems are aggravated by co-infection with blood borne diseases, varied responses to the infection and therapy among vulnerable groups. This study purposed to determine and compare; the CD4 counts, HIV viral loads, liver enzyme markers and the prevalence of viral hepatitis among the HIV- 1 positive IDUs and NDUs. A cross-sectional study was carried out in Mombasa County. A structured questionnaire was used to collect information on HIV AIDS, Hepatitis and social demographics. Blood samples were collected, screened and analyzed for HIV, HBV and HCV, CD4+ cell, HIV viral load and liver enzyme markers. Pearson’s Chi square, Student T test and one way Anova were used to analyze data. A P value ≤ 0.05 was considered statistically significant. A total of 200 participants consisting of 78 males and 122 females were recruited. Sero-prevalence of Hepatitis B and Hepatitis C was at 16% and 20% respectively among the IDUs and 11% and 8% respectively among the NDUs. The sero-prevalence of HIV+HBV+/HCV infection among IDUs and NDUs was 6% and 4% respectively. The liver enzyme markers (Alkaline phosphate, Aspartate aminotransferase and Alanine transferase) were markedly elevated among the co-infected participants than the mono-infected in both the NDU and IDU groups. IDUs showed elevated mean liver enzymes than the NDUs. The IDUs had a lower mean CD4+ cell count of 350.2 (±225.27) cells/µl than the NDUs 485.9 (±243.38) cells/µl (P˂0.0001). Participants who were co-infected showed remarkably low mean CD4+ cell counts of 192. 91(±84.08) cells/µl than the mono-infected with mean count of 536.79 (±218.76) cells/µl (P=˂0.0004). A statistically significant high mean viral load of 153392.97(±395699.65) copies/ml was reported among co-infected participants than the mono-infected at 2435.05(±5596.88) copies/ml (P˂0.0001) across the study population. The study established that the coinfection rates with HBVand HCV was higher among the IDUs than the NDUs. The liver profile indices indicated elevated liver enzymes among IDUs than NDUs. Coinfected participants had statistically significant higher liver enzyme markers than the mono-infected. Immunologically, CD4+ cell counts were lower among IDUs than the NDUs. Co-infected individuals had a lower mean CD4+ cell count than the monoinfected. IDUs had a statistically significant higher HIV viral load than the NDUs. The co-infected also indicated a statistically significant higher mean viral load than the mono-infected. This study proposes routine baseline screening of HBV and HCV for IDUs and NDUs owing to the high frequency of co-infections. A people driven campaign is also necessary to create awareness on the effects of the use of substances of abuse in relation to viral infections and treatment. Also the campaign is necessary to create awareness on the HBV vaccination.