First study of its kind on HIV genetic diversity for Ghana developed by MSc student

By: Geron Malbas

In Ghana, remarkably diverse HIV strains cocirculate, but the full extent of this diversity remains unresolved. Faculty of Health Sciences (FHS) MSc student Anna Appah published a study examining HIV-1 subtype diversity in Ghana, increasing the country’s mere 31 full-genome HIV sequences in the public domain by over 200%.

Up-to-date information on HIV diversity, subtype distribution, drug resistance and coreceptor usage is critical to guide HIV treatment, inform vaccine design, and curative strategies. In Ghana, however, the last HIV drug resistance survey per WHO guidelines occurred in 2013. Additionally, very little literature exists on HIV coreceptor usage despite its relevance in the prescription of entry inhibitors for treatment.

“Taking cognizance of these knowledge gaps in HIV research in the country, this study, the first of its kind to be undertaken, expounds on HIV in Ghana; our results show the ever-growing extent of HIV diversity in Ghana,” Appah explains. “This study is vital; ultimately, HIV diversity has crucial implications for HIV prevention (i.e. vaccine design). Additionally, knowledge on resistance mutations in resource limited regions through research studies and surveys promotes the use of appropriate therapy in these regions.”

While a moderate number of studies from Ghana shed light on HIV subtype diversity and drug resistance, study size and success rates have been relatively low. Her results enhance understanding of pretreatment drug resistance in Ghana, highlighting the importance of periodic HIV drug resistance surveys in the country to guide population-level HIV treatment recommendations.

These findings show that HIV diversity in the country may be much higher than originally described and that a predominant subtype - CRF02_AG - is driving the generation of novel complex recombinants. The high extent of diversity in the country may be indicative of multiple infections in persons living with HIV, as well as increased untreated infection.

“Studies to decipher transmission dynamics - likely importation of the virus into the country through migratory events and barriers to treatment - need to be carried out to provide interventions tailored at mitigating HIV spread in the country,” Appah advises.

Appah notes that the study was initially a concept that materialized because of an international collaboration between researchers in Canada and Ghana, and credits her mentors: FHS professor Zabrina Brumme, and University of Ghana professor Nicholas Nii-Trebi.

“Understanding that there is a knowledge gap that needs to be filled; which, when filled - in the ‘smallest of ways’ - would improve the quality of life of another person spurred me on to join the project,” she explains. “In essence, having the end goal of the impact of this study on subtype diversity in the West African region and HIV therapy in Ghana prompted me to be a part of this work.”