Browsing by Author "Agyei, A.A."
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Item Diagnosis of dual human immunodeficiency virus types 1 and 2 infections in a resource-limited setting.(2009) Sagoe, K.W.C.; Agyei, A.A.; Lartey, M.; Adiku, T.K.; Mingle, J.A.A.; Arens, M.Background: The presence of dual HlV-l/HIV-2 infection in Ghana and the different drug requirements for the treatment of HlV-1 and HIV-2 presents difficulties for the treatment of dual infections with both viruses. Objectives: To determine the prevalence of the dual sero-positive profile in treatment naive patients at a principal ART Clinic in Accra, Ghana and to investigate if rapid screening assays could be useful for diagnosis. Design: A cross-sectional study. Setting: A principal antiretroviral treatment centre in Accra, Ghana. Subjects: Three hundred and twenty eight antiretroviral treatment naive patients. Results: A total of 12 (3.7%) of patients seen were dual seropositive. There was a slight tendency of dual seropositive females being older than their HIV-l counterparts (p=0.088, CI=-l 0.833 to 0.753). Eight of the 12 of the dual seropositives were reactive for Genie II and were considered as possibly infected with both HIV-I and HIV-2. Seven (87.5%) of Genie II dual seropositives had strong intensities (> 1+) on both HIV-2 specific bands (sgp105 and gp36) on Innolia. CD4 counts were not significantly different in dual seropositives as compared to HIV-1 infected patients. Conclusions: Dual HIV-l/HIV-2 seropositives (and possibly infections) may be common especially in older women. The Genie II will be useful as a supplemental rapid test for rapid and accurate differentiation of HIV-l and HIV-2 antibodies at treatment centres.Item Prevalence and impact of hepatitis B and C virus co-infections in antiretroviral treatment naïve patients with HIV infection at a major treatment center in Ghana(Journal of Medical Virology, 2012-01) Sagoe, K.W.C.; Agyei, A.A.; Ziga, F.; Lartey, M.; Adiku, T.K.; Seshi, M.; Arens, M.Q.; Mingle, J.A.A.Data on the effects of the presence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in patients co-infected with these viruses and HIV in West Africa are conflicting and little information is available in Ghana. A cohort of 138 treatment naïve individuals infected with HIV was screened for HBV and HCV serologic markers; HBsAg positive patients were tested for HBeAg, anti-HBe, and anti-HBc IgM. The viral load of HIV-1 in the plasma was determined in 81 patients. Eighteen of the 138 patients (13%) and 5 (3.6%) had HBsAg and anti-HCV, respectively. None of the patients had anti-HBc IgM, but 10 (55.6%) and 8 (44.4%) of the 18 patients who were HBsAg positive had HBeAg and anti-HBe, respectively. In patients with measurement of CD4 + undertaken within 1 month (n=83), CD4 + count was significantly lower in patients with HBeAg (median [IQR], 81 [22-144]) as compared to those with anti-HBe (median [IQR], 210 [197-222]) (P=0.002, CI: -96.46 to 51.21). However, those with HIV mono-infection had similar CD4 + counts (median [IQR], 57 [14-159]) compared to those with HBeAg (P=1.0, CI: -71.75 to 73.66). Similar results were obtained if CD4 + count was measured within 2 months prior to initiation of HAART (n=119). Generally, HBV and anti-HCV did not affect CD4 + and viral loads of HIV-1 in plasma but patients with HIV and HBV co-infection who had HBeAg had more severe immune suppression as compared to those with anti-HBe. This may have implication for initiating HAART in HBV endemic areas. © 2011 Wiley Periodicals, Inc.Item Seropsitivity among treatment naïve patients in a resource limited setting(East African Med. Journal, 2009) Sagoe, K.W.C.; Agyei, A.A.; Lartey, M.; Adiku, T.K.; Mingle, J.A.A.; Arens, M.Q.Item Short-term treatment outcomes in human immunodeficiency virus type-1 and hepatitis B virus co-infections(2016-06-02) Sagoe, K.W.C.; Duedu, K.O.; Ziga, F.; Agyei, A.A.; Adiku, T.K.; Lartey, M.; Mingle, J.A.A.; Arens, M.Abstract Background Co-infection of HIV with HBV is common in West Africa but little information is available on the effects of HBV on short-term therapy for HIV patients. A 28 day longitudinal study was conducted to examine short-term antiretroviral therapy (ART) outcomes in HIV infected individuals with HBV co-infection. Methods Plasma from 18 HIV infected individuals co-infected with HBV and matched controls with only HIV infection were obtained at initiation, and 7 and 28 days after ART. HIV-1 viral load changes were monitored. Clinical and demographic data were also obtained from patient folders, and HIV-1 drug resistance mutation and subtype analysis performed. Results The presence of HBV co-infection did not significantly affect HIV-1 viral load changes within 7 or 28 days. The CD4+ counts on the other hand of patients significantly affected the magnitude of HIV-1 viral load decline after 7 days (ρ = −0.441, p = 0.040), while the pre-ART HIV-1 VL (ρ = 0.844, p = <0.001) and sex (U = 19.0, p = 0.020) also determined HIV-1 viral load outcomes after 28 days of ART. Even though the geometric sensitivity score of HIV-1 strains were influenced by the HIV-1 subtypes (U = 56.00; p = 0.036), it was not a confounder for ART outcomes. Conclusions There may be the need to consider the confounder effects of sex, pre-ART CD4+, and pre-ART HIV-1 viral load in the discourse on HIV and HBV co-infection.Item The Significance of Variceal Haemorrhage in Ghana: A Retrospective Review(Ghana medical journal, 2015-09) Archampong, T.N.; Tachi, K.; Agyei, A.A.; Nkrumah, K.N.Background: This study describes the burden of bleeding oesophageal varices at the main tertiary referral centre in Accra. Design: Retrospective design to describe the endoscopic spectrum and review mortality data following acute upper gastro-intestinal bleeding at the Korle-Bu Teaching Hospital. Endoscopic data was reviewed in the Endoscopy Unit between 2007 and 2010. Mortality data was collated from the Department of Medicine between 2010 and 2013. Interventions: The study questionnaire compiled clinical and demographic characteristics, endoscopic diagnoses, length of hospital admission and treatment regimens. Main outcome measures: Aetiology and time-trend analysis of mortality rates following acute upper gastro- intestinal bleeding; variceal bleeding treatment modalities. Results: On review of the endoscopic diagnoses, gastro- oesophageal varices were identified in 21.9% of cases followed by gastritis 21.7%, duodenal ulcer, 17.0%, and gastric ulcer, 13.2%. Gastro-oesophageal varices were the predominant cause of death from acute upper gastro-intestinal haemorrhage from 46% in 2010 to 76% in 2013. Outcomes following acute upper gastro-intestinal bleeding were dismal with some 38% of fatalities occurring within the first 24 hours. Injection sclerotherapy was the dominant endoscopic modality for secondary prevention of variceal bleeding in comparison with band ligation, mainly as a result of cost and availability. Conclusions: At the tertiary centre in Accra, variceal bleeding is an increasingly common cause of acute upper gastro-intestinal haemorrhage in comparison with previous reviews in Ghana. Its significantly high in-hospital mortality reflects inadequate facilities to deal with this medical emergency. A strategic approach to care with endoscopic services equipped with all the necessary therapeutic interventions will be vital in improving the outcomes of variceal bleeding in Ghana.Item Variability of the human immunodeficiency virus type 1 polymerase gene from treatment naïve patients in Accra, Ghana(Journal of Clinical Virology, 2007-10) Sagoe, K.W.C.; Dwidar, M.; Lartey, M.; Boamah, I.; Agyei, A.A.; Hayford, A.A.; Mingle, J.A.A.; Arens, M.Q.Background: Little is known about the HIV-1 drug resistance mutations in Ghana. Objectives: To determine the background protease (PR) and reverse transcriptase (RT) mutations of HIV-1 from treatment naïve patients in Ghana. Study design: Twenty-five plasma samples randomly selected were analyzed for drug resistance mutations. The molecular phylogeny and recombinant patterns of the polymerase gene of HIV-1 were also analysed. Results: No major drug-resistance mutations were seen in protease or reverse transcriptase genes. The L10I, L10V, V11I and E35G minor mutations were seen in four patients, while the V179E was observed in a patient with subtype G. An insertion of lysine was found at codon 36 of the protease gene of one patient. The predominant subtype was the CRF02_AG strain (n = 22), but 3 (13.6%) of these were recombinants with HIV-1 subtype K and/or A1. Two patients harboured unclassified/complex strains with D/CRF01_AE and G/CRFAG_02 subtypes for the PR and RT, respectively, using the Stanford Database. Viral loads (VL) ranged from 2290 to >1,500,000 c/ml (mean = 339,065 c/ml). Conclusions: Treatment naïve patients in Ghana before scale-up may have minor but not major PR mutations and high viral loads. The clinical effects of minor mutations/polymorphisms in the PR and RT genes and recombinants need to be investigated. © 2007 Elsevier B.V. All rights reserved.