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  • Title: Predominance of HIV-1 among patients with AIDS and AIDS-related complex in Ghana.
    Author: Brandful JA, Ampofo WK, Apeagyei FA, Asare-Bediako K, Osei-Kwasi M.
    Journal: East Afr Med J; 1997 Jan; 74(1):17-20. PubMed ID: 9145571.
    Abstract:
    We determined the prevalence of HIV among AIDS and AIDS-Related Complex (ARC) patients seen within one year in two hospitals in southern Ghana. Subjects were screened by an ELISA procedure for anti-HIV antibodies. Specific identification of the HIV type was done with a particle agglutination (PA) kit. All PA-determined dual specimens were then confirmed by Western blotting and Pepti-Lav 1/2 monoepitope kit. Virus isolation was attempted from symptomatic patients by co-culturing patient peripheral blood monocyte cells (PBMCs) and CD4+ cell lines. PBMCs and HIV isolates were characterised by PCR. By ELISA, 43.5% of the subjects (253) had anti-HIV antibodies. Of these, 61 (24%) were HIV-1 positive and 42 (18.6%) were dually reactive by PA. However, only 19% were confirmed as true dually-infected cases by western blotting and Pepti-Lav through all 42 samples were HIV-1 positive on the two tests. No subject was infected with HIV-2 alone. Three viruses were isolated. By PCR two of them had both HIV-1 and HIV-2 proviral sequences while the third virus was HIV-1 only. HIV-1 prevalence now predominates over HIV-2 implying a switch in the HIV infection pattern in Ghana. Furthermore mixed infections exist. The predominance of HIV-1 infection in Ghana may indicate a similar trend in other parts of West Africa. Recent studies have suggested that HIV-2 infection is becoming less prevalent in Ghana, while the prevalence of HIV-1 is increasing. To confirm such a modification in the HIV infection profile in Ghana, a 1-year serologic and molecular study was conducted among 253 patients from 2 hospitals in southern Ghana (Accra and Dzodze in the Volta region) with confirmed or suspected AIDS. All 253 serum specimens were screened with enzyme-linked immunosorbent assay (ELISA) and particle agglutination (PA); the 42 dually reactive specimens were subsequently confirmed by Western blot and Pepti-Lav tests. By ELISA, 110 samples (43.5%) were positive for anti-HIV antibodies; this rate was 39.2% in Accra and 81.0% in the Volta region. Of these, 61 (24.1%) were HIV-1 positive and 42 (18.6%) were dually reactive by PA. No case of HIV-2 alone was detected. Most dually reactive cases were a cross-reaction between genetically similar regions of the 2 HIV types. Only 19% of the 42 PA-diagnosed dually reactive specimens were confirmed by Western blot and Pepti-Lav as true cases of HIV-2 only infection, and all these specimens were strongly positive for anti-HIV-1 antibodies. 3 viruses were isolated. By polymerase chain reaction, 2 had both HIV-1 and HIV-2 proviral sequences, while the third was HIV-1 only. This study's findings provide support for the hypothesis that most individuals with antibodies to both HIV-1 and HIV-2 are probably infected with HIV-1 alone. Intensified population surveillance aimed at isolating more HIV strains in West Africa could reveal the true extent of HIV genomic variation and facilitate the design of more specific diagnostic kits.
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