Prevalence of respiratory viruses and nasal colonization by antimicrobial-resistant bacteria among people living with HIV in Ghana

Respiratory infections are prevalent among individuals with compromised immune systems. While these infections are typically self-limiting, they can cause severe morbidity and mortality among immunocompromised individuals, particularly people living with human immunodeficiency virus (PLWH). Despite the substantial burden of HIV in the sub-Saharan region, there is scarcity of data on respiratory infections among PLWH. Therefore, we carried out a cross-sectional study among PLWH on antiretroviral therapy (ART) in three hospitals in the Greater Accra region of Ghana from January to May 2023. Participants' HIV serostatus was confirmed, and HIV type was determined using Multisure HIV Rapid Test kit (MP Diagnostics). The plasma HIV viral load was measured for each participant. We collected nasopharyngeal and oropharyngeal swab for the detection of bacterial or viral respiratory pathogens. Real time polymerase chain reaction, Matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) and antimicrobial susceptibility testing were employed. The zone of inhibition for the antimicrobial testing was interpreted according to the CLSI guidelines (CLSI, 2023), 33rd Edition (CLSI_M100-Ed33). Among the 240 participants enrolled, 32% tested positive for at least one respiratory pathogen, while 28% harboured at least one respiratory bacterium. The predominant virus was human coronavirus the Netherlands 63 (HCoV-NL63) detected in 52 (21.7%) participants, Staphylococcus aureus was the prevalent bacteria in 38 (15.8%) of the participants. Notably, we observed the highest co-occurrence (39.1%) of NL63 and S. aureus. We also observed antimicrobial resistant bacteria, particularly against Trimethoprim/Sulfamethoxazole, tetracycline, cephalosporins, ampicillin, chloramphenicol, and ampicillin-clavulanate. The prevalence of respiratory virus or bacteria was not associated with HIV viral load or respiratory symptoms. Bacteria isolated from the nose tended to be antimicrobial resistant.