Abstract:
HIV and AIDS has been one of the greatest public health challenges of our
times.Currently, this epidemic is being compounded by co-infections including other
viral infections which share similar modes of transmission and complicated
pathophysiologies. The aim of this study was to determine seroprevalence of selected
HIV co-infections, identify circulating genotypes and CD4 distributon in a population of
HIV infected. To inform diagnostic strategies on selected co-infections, utility of
targeted test kits was also determined. Hepatitis B, Hepatitis C, Herpes simplex virus 2
and syphilis were tested in a population of 1829 HIV infected subjects from different
parts of Kenya. ELISA and rapid test kits were used for serological testing while
polymerase chain reaction, sequencing assays and molecular analysis tools were used to
determine genotypes.The CD4 counts were determine using FacsCalibur. Data generated
was analysed for serostatus, genotypes and CD4 countdistribution. Comparison of test
methods was carried out to determine utility of available test kits. Seroprevalence of
HBV was 29% (530), HCV 14 % (256), HSV2 47% (860) and syphilis 14% (256). In
this study, 71% (1299) of the subjects (were seropositive with any of the four infections
(HBV, HCV, HSV2 and syphilis) while 29% had none.Co-infections ranged from one to
multiple infections with 27% of the population having 2 to 4 infections. Highest
combination of infections was that of HIV, HBV and HSV (34%); HIV, HSV and
syphilis (16%) and HIV, HCV and HSV (10%). Study population mean CD4 count was
382 cells/m
3
, the mean difference between gender was 31.79yrs for female and 32.25yrs
male. Distribution of CD4 count across population groups indicated that 34% of the
study population had counts below 250 cells/m3
. Test algorithm for HBV indicated
Determine kit as the best option for screening while for HCV SD Bioline kit had the best
performance. Molecular analysis of the samples indicated HIV subtypes detected were A
(70%), D (18%), G (7%), and C (5%). For HBV genotypes A (82%), C (9%), D (6%)
and E (3%) were identified in the study population. Genotypes 1(86%) and 2b(14%)
were detected for HCV. In conclusion; there was a higher burden of infections and
molecular variants of co-infections among the HIV infected. It is recommended there is
need to make testing for HBV.HCV, HSV2 and syphilis accesible in health facilities
alongside that of HIV. Since 34% of individuals were categorized as having advanced
HIV disease based on CD4 count, CD4 count monitoring services are necessary in this
particular aspect.Monitoring of circulating genotypes is an important undertaking in
order to determine trends and emergence of new ones.
