Hepatocellular injury and metabolic dysregulation of selected biomarkers in Human Immune Virus-1 - Hepatitis C Virus co-infected individuals using heroin in Mombasa County, Kenya

Abstract

Hepatocellular injury and metabolic dysregulation are significant complications in individuals co-infected with human immunodeficiency virus (HIV-1) and hepatitis C virus (HCV), particularly those who use injection heroin. However, this is less recognized. The combined effect of viral pathogenesis, drug intoxication, compromised bone mineralization, and systemic inflammation contributes to accelerated liver damage and metabolic abnormalities, including osteoporosis. But effective biomarker-based tools for early detection and monitoring remain limited. The current study aimed to characterize and quantify selected biomarkers of hepatocellular injury and metabolic dysregulation in HIV-1 and HCV co-infected injection heroin users, with the intent of developing a laboratory-based diagnostic and monitoring algorithm for early detection and disease progression assessment. This case-control retrospective study was conducted targeting injection heroin users stratified into HIV-1 and HCV co-infected, mono-infected, and uninfected groups. A total of 289 samples from persons aged between 18 and 65 years were analyzed for liver enzymes (alkaline phosphatase (ALP), alanine aminotransferase (ALT), and gamma-glutamyl transaminase (GGT)), albumin, metabolic indicators (high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, calcium, and vitamin D3), and virological parameters (HIV ribonucleic acid (HIV RNA), HCV ribonucleic acid (HCV RNA), and CD4 count). Statistical analyses included group comparisons and correlation modeling to evaluate biomarker association with disease severity. The co-infected group exhibited significantly elevated liver enzymes compared to mono-infected and uninfected participants (ALT P = 0.003; GGT P < 0.0001; ALP P < 0.0001) and significantly low albumin levels in co-infected group 2.7 (1.8-3.6). Although none of the correlations reached statistical significance (P>0.05), there were marked associations between GGT and viral load (positive), GGT and CD4+ (negative), and albumin and CD4+ (negative), and trends were consistent with expected directions of liver injury in HIV/HCV co-infection. The findings of this study demonstrate a clear pattern of progressive hepatocellular injury and dysfunction in relation to HIV-1 and HCV status among injection heroin users (IHUs). The pattern aligns with prior evidence that HIV accelerates HCV-induced liver damage, leading to faster progression to cirrhosis, hepatocellular carcinoma, and liver-related mortality; hence, the need to develop a biomarker-based diagnostic and monitoring algorithm to guide targeted clinical intervention. The findings of this study underscore the importance of integrated clinical care, such as antiretroviral therapy, nutritional support, and harm reduction measures, to mitigate liver injury and metabolic complications in this high-risk population. To improve on clinical management of this population, health systems should strengthen multidisciplinary care models combining hepatology, infectious disease, psychiatry, and addiction medicine for co-infected heroin users.