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Please use this identifier to cite or link to this item: http://hdl.handle.net/123456789/13401

Title: Inadvertent non-nucleoside reverse transcriptase inhibitor (NNRTI)-based antiretroviral therapy in dual HIV-1/2 and HIV-2 seropositive West Africans: a retrospective study
Authors: Sarfo, Fred Stephen
Bibby, David F.
Schwab, Uli
Appiah, Lambert Tetteh
Clark, Duncan A.
Colloni, Paul
Phillips, Richard Odame et.al.
Keywords: Ghana
HIV
Viral load
Issue Date: 23-Jun-2009
Publisher: Journal of Antimicrobial Chemotherapy
Citation: Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkp216 ,23 June 2009
Abstract: HIV-2 or dual HIV-1/2 infection makes up between 4% and 24% of all HIV infections in West Africa, and dual infection 12% of all infections in Ghana.1 HIV-2 infection progresses to AIDS more slowly than HIV-1; however, dual infection appears to progress at a rate similar to that of HIV-1.2 Antiretroviral therapy (ART) has been widely available in Ghana since 2003, with good initial results.3 Non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART is first-line therapy. In many centres HIV testing has not routinely been type-specific, so patients infected with HIV-2 have started ART including NNRTIs that are ineffective against HIV-2. To analyse the impact of NNRTI-based ART in dual HIV-1/2 or HIV-2 seropositive individuals in terms of clinical outcomes, surrogate markers or resistance mutations, we conducted a retrospective study of patients attending a large HIV clinic in Ghana where type-specific HIV testing was not routine. The study was approved by the Committee on Human Research Publications and Ethics at KNUST, Kumasi. Patients were tested for HIV-2 seropositivity using the Immunocomb HIV-1&2 Biospot test (Orgenics, Yavne, Israel). Response to NNRTI-based ART, efavirenz/ nevirapine with two nucleoside reverse transcriptase inhibitors (NRTIs), was compared in 57 dual HIV-1/2 seropositive, 16 HIV-2 seropositive and 197 HIV-1 seropositive patients who had completed at least 12 months of ART. Clinical and laboratory data were collected retrospectively at 6 monthly intervals. Changes in patient weight, total CD4 count and HIV viral load a minimum of 3 months after starting ART were compared. Mean values for (normally distributed) laboratory data were compared using t-tests and x2 tests for categorical data. Baseline characteristics (pre-ART) and responses to ART are shown in Table 1. There were significantly more females in the HIV-2-infected groups. Increases in mean CD4 count at 6 and/or 12 months after starting ART were significantly lower in HIV-2 seropositive compared with HIV-1 and dual seropositive patients, despite starting from higher CD4 counts. Weight gain was also lower in this group. Samples were available to quantify HIV-2 and/or HIV-1 viral loads in a proportion of patients (HIV-2, 63%; dual seropositive, 56%; HIV-1, 22%) after a median of 14 months of ART. Whilst in the majority of dual seropositive and HIV-1 seropositive patients HIV-1+HIV-2 viral loads were suppressed on ART, only 19% of the HIV-2 seropositive patients achieved undetectable HIV-2 viral loads. There was little difference in the rates of AIDS-defining pathology between groups.
Description: An article published in Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkp216 ,23 June 2009
URI: http://hdl.handle.net/123456789/13401
Appears in Collections:College of Health Sciences

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