Research Articles >
College of Health Sciences >
Please use this identifier to cite or link to this item:
|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.
Appiah, Lambert Tetteh
Clark, Duncan A.
Phillips, Richard Odame
|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
|Description: ||An article published in Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkp216 ,23 June 2009|
|Appears in Collections:||College of Health Sciences|
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.