Co-infection of HIV in patients with Buruli ulcer disease in Central Ghana

• Published in: BMC infectious diseases 2021-04, Vol.21 (1), p.331-331, Article 331
• Main Authors: Amoako, Yaw Ampem, Loglo, Aloysius Dzigbordi, Frimpong, Michael, Agbavor, Bernadette, Abass, Mohammed Kabiru, Amofa, George, Ofori, Elizabeth, Ampadu, Edwin, Asiedu, Kingsley, Stienstra, Ymkje, Wansbrough-Jones, Mark, van der Werf, Tjip, Phillips, Richard Odame
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Antibiotics; Antiretroviral drugs; Antiretroviral therapy; Bacterial Load; Buruli ulcer; Buruli Ulcer - drug therapy; Buruli Ulcer - epidemiology; Buruli Ulcer - etiology; Buruli Ulcer - virology; CD4 antigen; CD4 Lymphocyte Count; Coinfection; Coinfection - epidemiology; Coinfection - microbiology; Coinfection - virology; Comorbidity; Dendritic cells; Deoxyribonucleic acid; Disease; DNA; Female; Genomes; Ghana - epidemiology; Hepatitis B; Hepatitis C; HIV; HIV infection; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - microbiology; Hospitals; Human immunodeficiency syndrome; Human immunodeficiency virus; Humans; Immune system; Immunosuppression; Infections; Infectious diseases; Integration; Interferon; Interferon-gamma; Laboratories; Lesions; Male; Middle Aged; Mycobacterium ulcerans - genetics; Mycolactone; Patients; Plasma; Prevalence; Real-Time Polymerase Chain Reaction; Retrospective Studies; Risk factors; RNA, Ribosomal, 16S; RNA-directed DNA polymerase; rRNA 16S; Statistics; Tuberculosis; Ulcers; Viral Load; Wound Healing; Young Adult; γ-Interferon
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-021-06009-7

Previous studies have reported that presence and severity of Buruli ulcer (BU) may reflect the underlying immunosuppression in HIV infected individuals by causing increased incidence of multiple, larger and ulcerated lesions. We report cases of BU-HIV coinfection and the accompanying programmatic challenges encountered in central Ghana. Patients with PCR confirmed BU in central Ghana who were HIV positive were identified and their BU01 forms were retrieved and reviewed in further detail. A combined 16S rRNA reverse transcriptase / IS2404 qPCR assay was used to assess the Mycobacterium ulcerans load. The characteristics of coinfected patients (BU HIV ) were compared with a group of matched controls. The prevalence of HIV in this BU cohort was 2.4% (compared to national HIV prevalence of 1.7%). Eight of 9 BU HIV patients had a single lesion and ulcers were the most common lesion type. The lesions presented were predominantly category II (5/9) followed by category I lesions. The median (IQR) time to healing was 14 (8-28) weeks in the BU HIV compared to 28 (12-33) weeks in the control BU HIV group (p = 0.360). Only one BU HIV developed a paradoxical reaction at week 16 but the lesion healed completely at week 20. The median bacterial load (16SrRNA) of BU HIV patients was 750 copies /ml (95% CI 0-398,000) versus 500 copies/ml (95% CI 0-126,855,500) in BU HIV group. Similarly, the median count using the IS2404 assay was 500 copies/ml (95% CI 0-500) for BU HIV patients versus 500 copies/ml (95% CI 500-31,000) for BU HIV patients. BU HIV patients mounted a significantly higher interferon-γ response compared to the BU HIV co-infected patients with respective median (range) responses of [1687(81.11-4399) pg/ml] versus [137.5(4.436-1406) pg/ml, p = 0.03]. There were challenges with the integration of HIV and BU care in this cohort. The prevalence of HIV in the BU+ infected population was not significantly increased when compared to the prevalence of HIV in the general population. There was no clear relationship between BU lesion severity and HIV viral load or CD4 counts. Efforts should be made to encourage the integration of care of patients with BU-HIV coinfection.