Introduction Initial evidence from resource-limited countries using the WHO HIV drugresistance (HIVDR) threshold survey suggests that transmission of drug-resistance strains islikely to be limited. However, as access to ART is expanded, increased emergence of HIVDR isfeared as a potential consequence. We have performed a surveillance survey of transmittedHIVDR among recently infected persons in the geographic setting of Accra, Ghana.

Methods As part of a cross-sectional survey, 2 large voluntary counselling and testing centres inAccra enrolled 50 newly HIV-diagnosed, antiretroviral drug-naïve adults aged 18 to 25 years.Virus from plasma samples with >1,000 HIV RNA copies/mL (Roche Amplicor v1.5) weresequenced in the pol gene. Transmitted drug resistance-associated mutations (TDRM) wereidentified according to the WHO 2009 Surveillance DRM list, using Stanford CPR tool (v 5.0beta). Phylogenetic relationships of the newly characterised viruses were estimated bycomparison with HIV-1 reference sequences from the Los Alamos database, by using theClustalW alignment program implemented.

Results Subtypes were predominantly D (39/70, 55.7%), A (29/70, 41.4%), and C (2/70; 2,9%). Seven nucleotide sequences harboured a major TDRM (3 NNRTI, 3 NRTI, and 1 PI-associated mutation); HIVDR point prevalence was 10.0% (95%CI 4.1% to 19.5%). The identified TDRM were D67G (1.3%), L210W (2.6%); G190A (1.3%); G190S (1.3%); K101E(1.3%), and N88D (1.3%) for PI.

Conclusion In Accra the capital city of Ghana, we found a rate of transmitted HIVDR, which,according to the WHO threshold survey method, falls into the moderate (5% to 15%) category.This is a considerable increase compared to the rate of among women attending an antenatal clinic in mamobi. As ART programs expand throughoutAfrica, incident infections should be monitored for the presence of transmitted drug resistance inorder to guide ART regimen policie.