Elite Research Institute

Abstract Background : Sexually transmitted infections (STIs) remain a major public health burden in low- and middle-income countries, particularly in sub-Saharan Africa where diagnostic limitations and asymptomatic infections contribute to under-reporting. However, in Ghana, data on the co-occurrence of HIV with other STIs in outpatient settings are limited. This study assessed the prevalence and co-infection patterns of HIV, syphilis, hepatitis B virus (HBV), hepatitis C virus (HCV), and gonorrhea among outpatients in the Greater Accra Region of Ghana. Methods: A retrospective cross-sectional study involving 1,578 outpatients was conducted at a primary healthcare facility between January and December 2024. Sociodemographic and laboratory data were extracted from the hospital information management system. Descriptive statistics summarized prevalence of HIV and other STIs. Chi-square tests and binary logistic regression were used to determine associations and predictors of HIV infection. A p-value < 0.05 was considered statistically significant. Results: Of the 1,578 participants, 54.9% were female, and most (50.5%) were aged 25–45 years. Overall HIV prevalence was 6.4%, while HBV, HCV, syphilis, and gonorrhea were 13.0%, 5.5%, 6.0%, and 15.6%, respectively. HIV–STI co-infection represented 2.0% of all HIV-positive cases. Age was significantly associated with HIV status (p = 0.002), with the highest positivity recorded among individuals >45 years. Logistic regression showed that participants aged 1–25 years (aOR = 0.30; 95% CI: 0.14–0.63; p < 0.001) and 26–45 years (aOR = 0.50; 95% CI: 0.31–0.83; p = 0.003) had significantly lower odds of HIV infection compared to those >45 years. Gender and the presence of other STIs were not significantly associated with HIV positivity (p > 0.05). Conclusion: A considerable burden of HIV and other STIs was observed, with low but notable co-infection rates. Individuals older than 45 years were at highest risk of HIV infection. Strengthening integrated HIV/STI screening, promoting early diagnosis, and targeting age-specific health education particularly for older adults are critical to improving prevention and control strategies in Ghanaian outpatient settings.

The pharmacokinetics and safety of velpatasvir, a potent pangenotypic hepatitis C virus NS5A inhibitor, were evaluated in two hepatic impairment studies: a phase I study in hepatitis C virus-uninfected subjects and a phase III study (ASTRAL-4) in hepatitis C virus-infected patients. In the phase I study, subjects with moderate or severe hepatic impairment (Child-Pugh-Turcotte Class B or C), and demographically matched subjects with normal hepatic function received a single dose of velpatasvir 100mg. Pharmacokinetics and safety assessments were performed, and pharmacokinetic parameters were calculated using non-compartmental methods and summarized using descriptive statistics and compared statistically by geometric least-squares mean ratios and 90% confidence intervals. In ASTRAL-4, subjects with decompensated cirrhosis (Child-Pugh-Turcotte Class B) were randomized to receive treatment with either sofosbuvir/velpatasvir±ribavirin for 12weeks or sofosbuvir/velpatasvir for 24weeks. Pharmacokinetic and safety assessments were performed and pharmacokinetic parameters were calculated using a non-compartmental analysis and summarized using descriptive statistics and were compared to pharmacokinetics from ASTRAL-1 [subjects without cirrhosis or with compensated (Child-Pugh-Turcotte Class A) cirrhosis]. In the phase I study, plasma exposures (area under the concentration-time curve) were similar in subjects with Child-Pugh-Turcotte Class B (n=10) or Child-Pugh-Turcotte Class C hepatic impairment (n=10) compared with normal hepatic function (n=13). Percent free velpatasvir was similar in subjects without or with any degree of hepatic impairment. In the phase III study, velpatasvir overall exposure (area under the concentration-time curve over the 24-h dosing interval; AUCtau) was similar and sofosbuvir exposures were higher (~100%) for patients with Child-Pugh-Turcotte Class B hepatic impairment compared with the ASTRAL-1 population, which was not considered clinically relevant. No sofosbuvir/velpatasvir dose modification is warranted for patients with any degree of hepatic impairment.