Generally, cluster of differentiation 4 (CD4) cell counts ranged from 11 to 916 cells/μl. The least (11 cells/μl) and highest (916 cells/μl) CD4 cell count were recorded in the ART-naïve group (Table 2). Patients CD4 cell count taken at baseline and enrollment are shown in Figure 1.
The RT and PR genes were successfully amplified in 5 and 4 samples, respectively. For the RT gene, 4 of the samples amplified were from PBMC and 1 was from plasma. All 5 of these samples were successfully sequenced. Included in this group were sequences obtained from both plasma and PBMC of 1 HIV-2 ART-naïve patient. For the PR gene, 2 were amplified from PBMC and the other 2 from plasma, all from ART-naïve patients. Sequences were only obtained from the PBMC amplicon (Table 3).
Attempts to curb the HIV menace globally are almost exclusively focused on HIV-1. The need for HIV-2 viral load and genotyping protocols to monitor HIV-2 infected patients in regions where HIV-1 and HIV-2 cocirculate is imperative. In this study, we estimated HIV-2 viral loads and detected drug resistance mutations by sequencing the RT and PR genes in HIV-2 strains from HIV-2 and HIV-1/2 dual-infected patients in Ghana.
Ideally, patients with CD4 cell count less than 350 cells/μl should initiate therapy as per the ART guidelines in Ghana but this was observed due to an acute shortage of CD4 reagents. Based on the Ghana National ART guidelines, this HIV-2 patient should not have been on an NNRTI-based regimen.
However, the clinician managed the patient with respect to HIV-1 infection; the predominant virus. This patient had the highest HIV-2 viral load (4.62 IU/ml) among ART-experienced patients and thus a high possibility of transmitting drug-resistant HIV-2. Availability of HIV typing or HIV-2 viral load data at the time of enrollment for this patient would have probably informed a more suitable regimen and curtailed the emergence of resistance mutations. A high viral load (5.45 IU/ml) was also detected in an ART-naïve patient indicating potential high risk of HIV-2 transmission. The lack of an HIV-2 viral load assay to monitor the progress of patients on therapy at the time of sampling is a limitation to this study. Generally, the lack of commercially available assay for HIV-2 viral load is a major limitation in monitoring HIV-2 infected patients on therapy.
The presence of NRTI mutations M184V, K65R, and Y115F found in an ART-experienced person in this study confirms the emergence of ART resistance to the currently available antiretroviral drugs under drug pressure.
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