HIV-1 Drug-Resistance Surveillance among Treatment-Experienced and -Naïve Patients after the Implementation of Antiretroviral Therapy in Ghana

Abstract

BackgroundLimited HIV-1 drug-resistance surveillance has been carried out in Ghana since the implementation of antiretroviral therapy (ART). This study sought to provide data on the profile of HIV-1 drug resistance in ART-experienced and newly diagnosed individuals in Ghana.MethodsSamples were collected from 101 HIV-1-infected patients (32 ART-experienced cases with virological failure and 69 newly diagnosed ART-naïve cases, including 11 children), in Koforidua, Eastern region of Ghana, from February 2009 to January 2010. The pol gene sequences were analyzed by in-house HIV-1 drug-resistance testing.ResultsThe most prevalent HIV-1 subtype was CRF02_AG (66.3%, 67/101) followed by unique recombinant forms (25.7%, 26/101). Among 31 ART-experienced adults, 22 (71.0%) possessed at least one drug-resistance mutation, and 14 (45.2%) had two-class-resistance to nucleoside and non-nucleoside reverse-transcriptase inhibitors used in their first ART regimen. Importantly, the number of accumulated mutations clearly correlated with the duration of ART. The most prevalent mutation was lamivudine-resistance M184V (n = 12, 38.7%) followed by efavirenz/nevirapine-resistance K103N (n = 9, 29.0%), and zidovudine/stavudine-resistance T215Y/F (n = 6, 19.4%). Within the viral protease, the major nelfinavir-resistance mutation L90M was found in one case. No transmitted HIV-1 drug-resistance mutation was found in 59 ART-naïve adults, but K103N and G190S mutations were observed in one ART-naïve child.ConclusionsDespite expanding accessibility to ART in Eastern Ghana, the prevalence of transmitted HIV-1 drug resistance presently appears to be low. As ART provision with limited options is scaled up nationwide in Ghana, careful monitoring of transmitted HIV-1 drug resistance is necessary.

Occurrence of transmitted HIV-1 drug resistance among Drug-naïve pregnant women in selected HIV-care centres in Ghana

“…Although another study in the Eastern regional capital, Koforidua, in 2009, found no major resistance mutations in that ART-naïve group, 18 the results from this study and that of the first-ever threshold survey carried out in Ghana in two different sites in the Eastern Region 10 show an increasing trend. This calls for surveillance for tHIVDR in a larger study population in the eastern region and elsewhere in Ghana to further understand the extent of its spread and introduce appropriate measures to curb its devastating effects on the nation's antiretroviral therapy programme.…”

Effects of Highly Active Antiretroviral Treatment on Complete Blood Count Parameters

“…This shows that more HIV infected individuals are being recruited unto HAART. This results are in agreement with the findings of Atuyambe et al [17] and Nii-Trebi et al [15] who also recorded The mean duration of HAART is denoted by the mean difference between Post HAART age and pre-HAART age. The participants have been on HAART for a long duration as the post-HAART age is significantly higher than the pre-HAART age.…”

“…Better rates of HIV replication suppression is achieved in patients administered with efavirenz-based HAART who received tenofovir-emtricitabine compared with patients who received zidovudine-lamivudine [14]. In order to avoid the toxicities associated with Zidovudine use, especially in individuals with anaemia, global access to tenofovir has been increased [15]. Not many studies on the haematological parameters abnormalities in HIV infected persons have been conducted in sub Saharan Africa.…”

Lifelong antiretroviral therapy or HIV cure: The benefits for the individual patient

“…It would seem, therefore, that the development of resistant quasi-species is inevitable in the event of suboptimal compliance with ART (Condra et al, 1995;Nii-Trebi et al, 2013;Richman et al, 1994). Paterson et al found that the incidence of virologic failure increased with decreasing adherence: 22% of patients had documented virologic failure with 95% or greater adherence whereas failure rates increased to 61% with less than 94.9% adherence (Ickovics et al, 2002;Paterson et al, 2000).…”