Prevalence of intravenous drug use and hepatitis C infections among patients visiting the Malindi Sub County hospital comprehensive care clinic, Kilifi County, Kenya.

Abstract

Introduction of highly active antiretroviral therapy (HAART) has improved the life of people living with Human Immunodeficiency Virus (HIV). But the persistence of opportunistic infections during HAART still presents a huge burden of disease, which often reverses the direct benefits of anti-retroviral treatment. Hepatitis C virus (HCV) is one of the many known opportunistic infection agents that together or individually, continues to escalate the risk of deaths among HIV/AIDS individuals. This study aimed at determining the prevalence of intravenous drug use and hepatitis C infections among patients attending the comprehensive care clinic (CCC) at the Malindi district hospital. A total of 452 subjects were enrolled into the study from the Malindi sub county Hospital comprehensive care clinic. Socio-demographic information was collected using individual questionnaires. Blood samples were collected in EDTA tubes and processed for downstream application. Approximately 41.2% (186/452) subjects were intravenous drug users (IDUs), of which 152 were aged 40 years or younger while 34 were above 40 years. HCV was solely found among IDUs at a prevalence of 16.4% and not among non-injectors. Due to limited resources, only 25 of the HIV positive samples were sequenced to determine HIV subtype and drug resistance. By HIV subtype, 60% of the infections were due to subtype A (majority of them being A1 at 88.66% while A2 and AE respectively were 6.67%); 12% were subtype C and; 16% were subtype D sixteen percent (4/25) of the virus isolates had mutations that confer resistance to nucleoside reverse transcriptase inhibitor (NRTI) class of antiretroviral drugs, while 24% (6/25) had mutations that confer resistance to non-NRTIs (NNRTIs). For the HCV infections by genotype, 75% were subtype 1a and 25% were subtype 4a. There were no drug resistant mutations among the HCV positive samples. This study has revealed a high prevalence of HCV infections among the IDUs. Public health programs should consider HCV testing alongside HIV testing.