Genetic diversity and drug resistance mutations of HIV-1 in Ghana: a systematic review of two decades

Background Since the roll-out of antiretroviral therapy (ART), there has been a significant reduction in HIV-1-related mortality and morbidity. Nonetheless, drug resistance has emerged significantly affecting treatment outcomes, but there is limited surveillance of HIV-1 drug resistance and subtype diversity, which is critical for clinical decision-making on therapeutic choices as well as public health control measures. The goal of this systematic review was to analyze data from 2004 to 2024 on subtype diversity and DRM among persons living with HIV-1 in Ghana. Methods We searched PubMed, Scopus, Cochrane CENTRAL, CINAHL Complete, Web of Science, and Google Scholar for cross-sectional and longitudinal studies reporting on HIV-1 subtype diversity, drug resistance, or both among individuals in Ghana published from 2004 to 2024 and reviewed according to PRISMA guidelines. The protocol for this review was registered with PROSPERO (CRD42024529606). Results A total of 2472 studies were screened, 28 were selected for full-text review, and 18 were included. The overall sample size was 2001 individuals. The HIV-1 subtypes were CRF02_AG (68.9%), A (3.9%), G (3.5%), CRF06_cpx (3.3%), B (2.1%), C (0.6%), CRF09_cpx (0.6%), and other recombinant forms. Subtypes D and K had only one occurrence in all the included studies. Thirty DRMs (majority; K20I/V (18.2%), M36I/K/T/V (15.4%) and H69K (15.1%)) were found against Protease Inhibitors, 20 (majority; K103N/R (20.5%), V179E/I/F/A (9.0%), A98G/S (8.6%) and V90I (8.2%) against nucleoside reverse transcriptase inhibitors (NRTIs), 20 (majority M184V/I (31.6%), T215A/Y/F/S/I (13.0), and M41L (11.9%)) non-nucleoside reverse transcriptase inhibitors (NNRTIs), and 5 (5163R, L74I/M, E157Q, T97A and D232N) Integrase strand transfer inhibitors (INSTIs). Only two studies analyzed sequences for DRMs from the integrase gene. Conclusion The findings reveal CRF02_AG predominance and a considerable increase in NNRTI DRMs, highlighting the need for tailored therapies and continued surveillance to address emerging resistance in Ghana.