DRUG RESISTANCE MUTATIONS IN HUMAN IMMUNODEFICIENCY VIRUS TYPE 2 STRAINS FROM PATIENTS IN TWO TREATMENT CENTERS IN GHANA

ABSTRACT

Background Antiretroviral therapy (ART) and drug resistance studies have focused almost exclusively on human immunodeficiency virus type 1 (HIV-1). Thus there is limited information on patients infected with HIV type 2 (HIV-2). In Ghana, the HIV epidemic is characterized by the domination of HIV-1 with the co-circulation of HIV-1 and HIV-2. HIV-2 is known to be naturally resistant to some antiretroviral drugs including non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors, due to natural polymorphisms in the viral genes. However, these drugs are used to treat patients irrespective of their HIV type resulting in situations where patients infected with HIV-2 will develop resistance to the ART regimen. Thus, the monitoring of drug resistance against HIV in patients with HIV-2 only or dual HIV-1/2 infections is necessary for the effective clinical management of such patients. Aim The aim of this study was to describe drug resistance mutations in HIV-2 strains in patients in Ghana. Method In this cross sectional study, venous blood was obtained from treatment naive and treatment-experienced HIV-2- and dual HIV-1/2 infected persons from two treatment centers in Southern Ghana. Ribonucleic acid (RNA) and DNA was extracted from plasma and peripheral blood mononuclear cells (PBMC) and used in polymerase chain reaction (PCR) assays to amplify the reverse transcriptase (RT) and the protease (PR)-coding domains of the pol gene. The amplicons were sequenced, and analyzed for drug resistance mutations and subtype information. Results In this study, 18 patients, 11 infected with HIV-2 only and 7 dually HIV-1/2 infected, were enrolled. Sequences were successfully obtained from 4 treatment- naïve and one treatment-experienced patient. There were no drug resistance mutations in the patients that were ART- naïve. The ART-experienced patient however had M184V, K65R and Y115F, which confer resistance against the NRTI drug class. All three mutations were observed in both plasma and PBMC of the patient. Conclusion The results clearly show the presence of drug resistance mutations in HIV-2 strains circulating in Ghana and illustrate the need for regular monitoring of drug resistance to improve clinical management of patients.