Dynamic HIV-1 genetic recombination and genotypic drug resistance among treatment-experienced adults in northern Ghana

• Published in: Journal of medical microbiology Vol. 66; no. 11; pp. 1663 - 1672
• Main Authors: Nii-Trebi, Nicholas Israel, Brandful, James Ashun Mensah, Ibe, Shiro, Sugiura, Wataru, Barnor, Jacob Samson, Bampoh, Patrick Owiredu, Yamaoka, Shoji, Matano, Tetsuro, Yoshimura, Kazuhisa, Ishikawa, Koichi, Ampofo, William Kwabena
• Format: Journal Article
• Language: English
• Published: England 01.11.2017
• Subjects: Adult; Anti-HIV Agents - pharmacology; CD4 Lymphocyte Count; Cross-Sectional Studies; Drug Resistance, Viral - genetics; Female; Genotype; Ghana - epidemiology; HIV Infections - epidemiology; HIV Infections - virology; HIV-1 - genetics; Humans; Male; Mutation; Phylogeny; Prevalence; RNA, Viral; Viral Load; molecular epidemiology; genotypic resistance; recombinant HIV-1; Antiretroviral therapy
• ISSN: 0022-2615; 1473-5644; 1473-5644
• DOI: 10.1099/jmm.0.000621

There have been hardly any reports on the human immunodeficiency virus type 1 (HIV-1) drug-resistance profile from northern Ghana since antiretroviral therapy (ART) was introduced over a decade ago. This study investigated prevailing HIV-1 subtypes and examined the occurrence of drug resistance in ART-experienced patients in Tamale, the capital of the Northern Region of Ghana. A cross-sectional study was carried out on HIV-infected adult patients receiving first-line ART. HIV viral load (VL) and CD4 T-cell counts were measured. The pol gene sequences were analysed for genotypic resistance by an in-house HIV-1 drug-resistance test; the prevailing HIV-1 subtypes were analysed in detail.Results/Key findings. A total of 33 subjects were studied. Participants comprised 11 males (33.3 %) and 22 (66.7 %) females, with a median age of 34.5 years [interquartile range (IQR) 30.0-40.3]. The median duration on ART was 12 months (IQR 8.0-24). Of the 24 subjects successfully genotyped, 10 (41.7 %) viruses possessed at least one mutation conferring resistance to nucleoside or non-nucleoside reverse-transcriptase inhibitors (NRTIs/NNRTIs). Two-class drug resistance to NRTI and NNRTI was mostly detected (25 %, 6/24). The most frequent mutations were lamivudine-resistance M184V and efavirenz/nevirapine-resistance K103N. HIV-1 subtype CRF02_AG was predominant (79.2 %). Other HIV-1 subtypes detected were G (8.3 %), A3 (4.2 %) and importantly two (8.3 %) unique HIV-1 recombinant forms with CRF02_AG/A3 mosaic. HIV-1 shows high genetic diversity and on-going viral genetic recombination in the study region. Nearly 42 % of the patients studied harboured a drug-resistant virus. The study underscores the need for continued surveillance of HIV-1 subtype diversity; and of drug-resistance patterns to guide selection of second-line regimens in northern Ghana.