Impact of HIV type 1 subtype on drug resistance mutations in Nigerian patients failing first-line therapy

A diverse array of non-subtype B HIV-1 viruses circulates in Africa and dominates the global pandemic. It is important to understand how drug resistance mutations in non-B subtypes may develop differently from the patterns described in subtype B. HIV-1 reverse transcriptase and protease sequences from 338 patients with treatment failure to first-line ART regimens were evaluated. Multivariate logistic regression was used to examine the effect of subtype on each mutation controlling for regimen, time on therapy, and total mutations. The distribution of HIV-1 subtypes included CRF02_AG (45.0%), G (37.9%), CRF06_cpx (4.4%), A (3.6%), and other subtypes or recombinant sequences (9.2%). The most common NRTI mutations were M184V (89.1%) and thymidine analog mutations (TAMs). The most common NNRTI mutations were Y181C (49.7%), K103N (36.4%), G190A (26.3%), and A98G (19.5%). Multivariate analysis showed that CRF02_AG was less likely to have the M41L mutation compared to other subtypes [adjusted odds ratio (AOR) = 0.35; p = 0.022]. Subtype A patients showed a 42.5-fold increased risk (AOR = 42.5, p = 0.001) for the L210W mutation. Among NNRTI mutations, subtype G patients had an increased risk for A98G (AOR = 2.40, p = 0.036) and V106I (AOR = 6.15, p = 0.010), whereas subtype CRF02_AG patients had an increased risk for V90I (AOR = 3.16; p = 0.003) and a decreased risk for A98G (AOR = 0.48, p = 0.019). Five RT mutations were found to vary significantly between different non-B West African subtypes. Further study to understand the clinical impact of subtype-specific diversity on drug resistance will be critically important to the continued success of ART scale-up in resource-limited settings.

Does immunological status affect the prevalence of Hepatitis C virus infection among HIV/AIDS patients?

BACKGROUND

Even though HIV-HCV co-infection rates vary widely according to western reports, not so much has been documented about the situation in our environment. We determined the prevalence of HCV among our HIV cohort as well as described the relationship between the immune and virological status of the patients in this report.

METHODS

Data of 1044 consenting HIV infected patients (confirmed by Western blot assay) receiving treatment at our centre between Sep 2002 and Feb 2005 were analyzed using EpiInfo 2004 retrospectively. The sera of the patients were used to determine their anti-HCVstatus by third generation ELISA (DIA.PRO Diagnostic, Bioprobes srl, Italy). HIV RNA levels and CD4 cell counts were also determined at recruitment by Roche Amplicor 1.5 and Flow Cytometry (Partec, Germany).

RESULTS

Ninety out of 1044 patients (8.6%) were positive for anti-HCV The rate of co-infection was highest among the divorced (10.3%), followed by widows (9.9%) though this did not reach statistical significance. The odds of finding anti-HCV was more than twice with CD4 cell counts >600 cells/microlitre compared to below 200 cells/microlitre (p=0.026). The median HIV RNA levels of HCV co-infected individuals was 514 copies/ml, while it was 200 copies/ml for HIV monoinfected persons (p>0.05).

CONCLUSION

The prevalence of HCV among this HIV cohort is high. There is also an associated higher chance of detecting anti-HCV in sera of the HIV patients whose immunological status is better than severely immunocompromised individuals.

Rapid HIV testing and counselling in labour in a northern Nigerian setting

Between April and August 2004, all pregnant women in labour at JUTH, were offered rapid HIV testing and counselling with opportunity to decline testing. HIV positive women were offered the standard nevirapine mono-therapy prophylaxis regimen (HIVNET 012). Four hundred and thirty (99.8%) of the 431 pregnant women who were offered rapid HIV testing and counselling, agreed to test. A sero-conversion rate of 2.1% (5 of 235) was found among women who had previously tested negative for HIV during the index pregnancy. A seroprevalence rate of 9.6% (16 of 166) was found among women with unknown HIV status. One patient who had an indeterminate HIV status prior to labour tested positive in labour. Rapid HIV testing and counselling in labour is a useful practice in high prevalence settings since it detects a substantial number of HIV-infected women and HIV-exposed babies that would otherwise have missed interventions to prevent MTCT.

HIV infection among pregnant women in Nigeria

OBJECTIVES

To determine risk factors for HIV among pregnant women (N = 2657) receiving antenatal services in Jos, Plateau state, Nigeria.

METHODS

Information about potential risk factors was obtained at interview. Biological samples were collected for detection of HIV and other sexually transmitted infections (STIs).

RESULTS

The prevalence of HIV was 8.2%. Women aged 20-29 years had more than 4-fold increased risk of HIV. Women of Catholic (adjusted odds ratio (AOR) = 1.72, 95% CI = 1.01-2.95) and Pentecostal (AOR = 2.57, 95% CI = 1.46-4.52) denominations were more likely to be HIV-infected when compared to Moslem women. The risk of HIV was also increased among women with multiple marriages and in women married to a banker/accountant. Other predictors of HIV were having a husband with other partners, perceived risk of HIV, STIs, candidiasis and bacterial vaginosis.

CONCLUSIONS

Development of effective interventions, including behavioral change, expansion of perinatal HIV prevention services and STI control, should be given the highest priority.