Significant fibrosis burden among hepatitis C and human immunodeficiency virus co-infection among injection drug users [IDUs] from Mombasa County, Kenya

Abstract

Globally 36.7 million people have HIV, and in Kenya it is estimated that 1.5 million are infected. The HCV burden is estimated to be 32 million in sub Saharan Africa with Kenya having a prevalence of less <1%. In Kenya Injection Drug Users [IDU’s] are estimated to be 50,000. There is increased public concern on the rising cases of injection substance users, which has also led to increased HIV prevalence in Mombasa County, which stands at 8.6%. This is above Kenya’s prevalence rate, which is at 6.3%. Lymphopaenias among the HIV and HCV co-infected IDU’s has also not been explored and therefore this study was aimed to address this gap. Through this study significant fibrosis and lymphopaenias among HIV- and HCV-co-infected injection substance users were determined. While HIV promotes acceleration of HCV infections towards fibrotic liver disease, HCV increases immunosuppression in HIV infections, leading to early acquired immunodeficiency syndrome (AIDS) and death in untreated cases.  Liver disease related to hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection may affect the immune status of the injection substance users. Limited data exists on significant fibrosis and lymphopaenia among human immunodeficiency virus and hepatitis C virus co-infected injection drug users. This was a cross-sectional study involving consenting adult (≥18 years) IDUs at Bomu Hospital, Mombasa, Kenya. The study groups were HCV-/HIV- IDUs (n=114); HCV-/HIV+ IDUs (n=73); HCV+/HIV- IDUs (n=19); and HCV+/HIV+ co-infected (n=17). A total of 223 participants were recruited. Socio-demographic and clinical characteristics data were collected using a pre-tested structured participant questionnaire. Consenting participants were serologically screened for the hepatitis C virus and also screened for the human immunodeficiency virus using the national algorithm of testing. Immunological status was tested by the BD FACS Calibur flow cytometer. Immunologic staging was based on the CD4 count, where lymphopaenia was a count of <500 cells/µl. Platelets alongside aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were also determined. The aspartate aminotransferase to platelet ratio index (APRI), fibrosis 4 index (FIB 4) and non-alcoholic fatty liver score (NAFLD) were used to determine significant fibrosis. APRI approached significant difference (P=0.054) across the groups. Age showed significance P 0.001 and gender P<0.0001. The AST levels across the groups are P=0.001. In immunological staging, lymphopaenia was more profound in HIV mono-infected injection drug users (65.8%), HCV/HIV co-infected injection substance users (41.2%), HCV/HIV uninfected (21.1%) and lastly HCV mono-infected injection substance users (15.8%). From the results it can be concluded that HCV/HIV co-infection among IDU’s, is associated with high burden of significant fibrosis and lymphopaenia. Significant fibrosis was more pronounced across groups with HCV mono-infected IDUs leading, while lymphopaenia was most severe in HIV mono-infected IDUs (65.8%). The HCV/HIV co-infected burden of both significant fibrosis and lymphopaenia (41.2%) is progressively high. These findings highlight the profound impact of HIV and HCV on liver disease progression and immune suppression. This emphasises the urgent need for early screening, monitoring and integrated management of co-infected individuals to reduce morbidity and mortality in this vulnerable population.