HIV-1 Drug-Resistance Surveillance among Treatment-Experienced and -Naïve Patients after the Implementation of Antiretroviral Therapy in Ghana
Identifieur interne : 000303 ( Pmc/Checkpoint ); précédent : 000302; suivant : 000304HIV-1 Drug-Resistance Surveillance among Treatment-Experienced and -Naïve Patients after the Implementation of Antiretroviral Therapy in Ghana
Auteurs : Nicholas I. Nii-Trebi [Ghana] ; Shiro Ibe [Japon] ; Jacob S. Barnor [Ghana] ; Koichi Ishikawa [Japon] ; James A. M. Brandful [Ghana] ; Sampson B. Ofori [Ghana] ; Shoji Yamaoka [Japon] ; William K. Ampofo [Ghana] ; Wataru Sugiura [Japon]Source :
- PLoS ONE [ 1932-6203 ] ; 2013.
Abstract
Limited HIV-1 drug-resistance surveillance has been carried out in Ghana since the implementation of antiretroviral therapy (ART). This study sought to provide data on the profile of HIV-1 drug resistance in ART-experienced and newly diagnosed individuals in Ghana.
Samples were collected from 101 HIV-1-infected patients (32 ART-experienced cases with virological failure and 69 newly diagnosed ART-naïve cases, including 11 children), in Koforidua, Eastern region of Ghana, from February 2009 to January 2010. The
The most prevalent HIV-1 subtype was CRF02_AG (66.3%, 67/101) followed by unique recombinant forms (25.7%, 26/101). Among 31 ART-experienced adults, 22 (71.0%) possessed at least one drug-resistance mutation, and 14 (45.2%) had two-class-resistance to nucleoside and non-nucleoside reverse-transcriptase inhibitors used in their first ART regimen. Importantly, the number of accumulated mutations clearly correlated with the duration of ART. The most prevalent mutation was lamivudine-resistance M184V (
Despite expanding accessibility to ART in Eastern Ghana, the prevalence of transmitted HIV-1 drug resistance presently appears to be low. As ART provision with limited options is scaled up nationwide in Ghana, careful monitoring of transmitted HIV-1 drug resistance is necessary.
Url:
DOI: 10.1371/journal.pone.0071972
PubMed: 23977189
PubMed Central: 3747072
Affiliations:
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Ampofo</name><affiliation wicri:level="4"><nlm:aff id="aff3"><addr-line>Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName><orgName type="university">Université du Ghana</orgName></affiliation></author><author><name sortKey="Sugiura, Wataru" sort="Sugiura, Wataru" uniqKey="Sugiura W" first="Wataru" last="Sugiura">Wataru Sugiura</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Infection and Immunology, Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Infection and Immunology, Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya</wicri:regionArea><wicri:noRegion>Nagoya</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Department of AIDS Research, Nagoya University Graduate School of Medicine, Nagoya, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of AIDS Research, Nagoya University Graduate School of Medicine, Nagoya</wicri:regionArea><wicri:noRegion>Nagoya</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23977189</idno><idno type="pmc">3747072</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3747072</idno><idno type="RBID">PMC:3747072</idno><idno type="doi">10.1371/journal.pone.0071972</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">000486</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000486</idno><idno type="wicri:Area/Pmc/Curation">000485</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000485</idno><idno type="wicri:Area/Pmc/Checkpoint">000303</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000303</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">HIV-1 Drug-Resistance Surveillance among Treatment-Experienced and -Naïve Patients after the Implementation of Antiretroviral Therapy in Ghana</title><author><name sortKey="Nii Trebi, Nicholas I" sort="Nii Trebi, Nicholas I" uniqKey="Nii Trebi N" first="Nicholas I." last="Nii-Trebi">Nicholas I. Nii-Trebi</name><affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Ghana, Accra, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Ghana, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName><orgName type="university">Université du Ghana</orgName></affiliation></author><author><name sortKey="Ibe, Shiro" sort="Ibe, Shiro" uniqKey="Ibe S" first="Shiro" last="Ibe">Shiro Ibe</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Infection and Immunology, Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Infection and Immunology, Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya</wicri:regionArea><wicri:noRegion>Nagoya</wicri:noRegion></affiliation></author><author><name sortKey="Barnor, Jacob S" sort="Barnor, Jacob S" uniqKey="Barnor J" first="Jacob S." last="Barnor">Jacob S. Barnor</name><affiliation wicri:level="4"><nlm:aff id="aff3"><addr-line>Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName><orgName type="university">Université du Ghana</orgName></affiliation></author><author><name sortKey="Ishikawa, Koichi" sort="Ishikawa, Koichi" uniqKey="Ishikawa K" first="Koichi" last="Ishikawa">Koichi Ishikawa</name><affiliation wicri:level="3"><nlm:aff id="aff4"><addr-line>AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>AIDS Research Center, National Institute of Infectious Diseases, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Brandful, James A M" sort="Brandful, James A M" uniqKey="Brandful J" first="James A. M." last="Brandful">James A. M. Brandful</name><affiliation wicri:level="4"><nlm:aff id="aff3"><addr-line>Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName><orgName type="university">Université du Ghana</orgName></affiliation></author><author><name sortKey="Ofori, Sampson B" sort="Ofori, Sampson B" uniqKey="Ofori S" first="Sampson B." last="Ofori">Sampson B. Ofori</name><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>Department of Medicine, Koforidua Regional Hospital, Koforidua, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Medicine, Koforidua Regional Hospital, Koforidua</wicri:regionArea><wicri:noRegion>Koforidua</wicri:noRegion></affiliation></author><author><name sortKey="Yamaoka, Shoji" sort="Yamaoka, Shoji" uniqKey="Yamaoka S" first="Shoji" last="Yamaoka">Shoji Yamaoka</name><affiliation wicri:level="3"><nlm:aff id="aff6"><addr-line>Department of Molecular Virology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Molecular Virology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Ampofo, William K" sort="Ampofo, William K" uniqKey="Ampofo W" first="William K." last="Ampofo">William K. Ampofo</name><affiliation wicri:level="4"><nlm:aff id="aff3"><addr-line>Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName><orgName type="university">Université du Ghana</orgName></affiliation></author><author><name sortKey="Sugiura, Wataru" sort="Sugiura, Wataru" uniqKey="Sugiura W" first="Wataru" last="Sugiura">Wataru Sugiura</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Infection and Immunology, Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Infection and Immunology, Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya</wicri:regionArea><wicri:noRegion>Nagoya</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Department of AIDS Research, Nagoya University Graduate School of Medicine, Nagoya, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of AIDS Research, Nagoya University Graduate School of Medicine, Nagoya</wicri:regionArea><wicri:noRegion>Nagoya</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Limited HIV-1 drug-resistance surveillance has been carried out in Ghana since the implementation of antiretroviral therapy (ART). This study sought to provide data on the profile of HIV-1 drug resistance in ART-experienced and newly diagnosed individuals in Ghana.</p></sec><sec><title>Methods</title><p>Samples were collected from 101 HIV-1-infected patients (32 ART-experienced cases with virological failure and 69 newly diagnosed ART-naïve cases, including 11 children), in Koforidua, Eastern region of Ghana, from February 2009 to January 2010. The <italic>pol</italic> gene sequences were analyzed by in-house HIV-1 drug-resistance testing.</p></sec><sec><title>Results</title><p>The most prevalent HIV-1 subtype was CRF02_AG (66.3%, 67/101) followed by unique recombinant forms (25.7%, 26/101). Among 31 ART-experienced adults, 22 (71.0%) possessed at least one drug-resistance mutation, and 14 (45.2%) had two-class-resistance to nucleoside and non-nucleoside reverse-transcriptase inhibitors used in their first ART regimen. Importantly, the number of accumulated mutations clearly correlated with the duration of ART. The most prevalent mutation was lamivudine-resistance M184V (<italic>n</italic> = 12, 38.7%) followed by efavirenz/nevirapine-resistance K103N (<italic>n</italic> = 9, 29.0%), and zidovudine/stavudine-resistance T215Y/F (<italic>n</italic> = 6, 19.4%). Within the viral protease, the major nelfinavir-resistance mutation L90M was found in one case. No transmitted HIV-1 drug-resistance mutation was found in 59 ART-naïve adults, but K103N and G190S mutations were observed in one ART-naïve child.</p></sec><sec><title>Conclusions</title><p>Despite expanding accessibility to ART in Eastern Ghana, the prevalence of transmitted HIV-1 drug resistance presently appears to be low. As ART provision with limited options is scaled up nationwide in Ghana, careful monitoring of transmitted HIV-1 drug resistance is necessary.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Frentz, D" uniqKey="Frentz D">D Frentz</name></author><author><name sortKey="Boucher, Cab" uniqKey="Boucher C">CAB Boucher</name></author><author><name sortKey="Van De Vijver, Damc" uniqKey="Van De Vijver D">DAMC van de Vijver</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sagoe, Kwc" uniqKey="Sagoe K">KWC Sagoe</name></author><author><name sortKey="Dwidar, M" uniqKey="Dwidar M">M Dwidar</name></author><author><name sortKey="Lartey, M" uniqKey="Lartey M">M Lartey</name></author><author><name sortKey="Boamah, I" uniqKey="Boamah I">I Boamah</name></author><author><name sortKey="Agyei, Aa" uniqKey="Agyei A">AA 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23977189</article-id><article-id pub-id-type="pmc">3747072</article-id><article-id pub-id-type="publisher-id">PONE-D-13-14356</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0071972</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Biology</subject><subj-group><subject>Microbiology</subject><subj-group><subject>Virology</subject><subj-group><subject>Viral Transmission and Infection</subject><subj-group><subject>Viral Load</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Mathematics</subject><subj-group><subject>Statistics</subject><subj-group><subject>Biostatistics</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine</subject><subj-group><subject>Epidemiology</subject><subj-group><subject>Molecular Epidemiology</subject></subj-group></subj-group><subj-group><subject>Infectious Diseases</subject><subj-group><subject>Viral Diseases</subject><subj-group><subject>HIV</subject><subj-group><subject>HIV diagnosis and management</subject><subject>HIV epidemiology</subject><subject>Retrovirology and HIV immunopathogenesis</subject></subj-group></subj-group></subj-group></subj-group><subj-group><subject>Public Health</subject><subj-group><subject>Health Screening</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>HIV-1 Drug-Resistance Surveillance among Treatment-Experienced and -Naïve Patients after the Implementation of Antiretroviral Therapy in Ghana</article-title><alt-title alt-title-type="running-head">HIV-1 Drug-Resistance Surveillance in Ghana</alt-title></title-group><contrib-group><contrib contrib-type="author" equal-contrib="yes"><name><surname>Nii-Trebi</surname><given-names>Nicholas I.</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Ibe</surname><given-names>Shiro</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Barnor</surname><given-names>Jacob S.</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ishikawa</surname><given-names>Koichi</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Brandful</surname><given-names>James A. M.</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ofori</surname><given-names>Sampson B.</given-names></name><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Yamaoka</surname><given-names>Shoji</given-names></name><xref ref-type="aff" rid="aff6"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ampofo</surname><given-names>William K.</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sugiura</surname><given-names>Wataru</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff7"><sup>7</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Ghana, Accra, Ghana</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Department of Infection and Immunology, Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan</addr-line></aff><aff id="aff3"><label>3</label><addr-line>Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana</addr-line></aff><aff id="aff4"><label>4</label><addr-line>AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan</addr-line></aff><aff id="aff5"><label>5</label><addr-line>Department of Medicine, Koforidua Regional Hospital, Koforidua, Ghana</addr-line></aff><aff id="aff6"><label>6</label><addr-line>Department of Molecular Virology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan</addr-line></aff><aff id="aff7"><label>7</label><addr-line>Department of AIDS Research, Nagoya University Graduate School of Medicine, Nagoya, Japan</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Barbour</surname><given-names>Jason D.</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>University of Hawaii Manoa, United States of America</addr-line></aff><author-notes><corresp id="cor1">* E-mail: <email>wsugiura@nnh.hosp.go.jp</email></corresp><fn fn-type="conflict"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con"><p>Conceived and designed the experiments: NIN SI JSB KI JAMB SBO SY WKA WS. Performed the experiments: NIN SI JSB KI JAMB. Wrote the paper: NIN SI WS. Organized the study team: KI SY WKA WS. Enrolled patients into the study: SBO. Prepared a clinical database: NIN JSB KI SBO. Revised the manuscript critically JSB KI JAMB SBO SY WKA.</p></fn></author-notes><pub-date pub-type="collection"><year>2013</year></pub-date><pub-date pub-type="epub"><day>19</day><month>8</month><year>2013</year></pub-date><volume>8</volume><issue>8</issue><elocation-id>e71972</elocation-id><history><date date-type="received"><day>7</day><month>4</month><year>2013</year></date><date date-type="accepted"><day>7</day><month>7</month><year>2013</year></date></history><permissions><copyright-year>2013</copyright-year><copyright-holder>Nii-Trebi et al</copyright-holder><license><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><abstract><sec><title>Background</title><p>Limited HIV-1 drug-resistance surveillance has been carried out in Ghana since the implementation of antiretroviral therapy (ART). This study sought to provide data on the profile of HIV-1 drug resistance in ART-experienced and newly diagnosed individuals in Ghana.</p></sec><sec><title>Methods</title><p>Samples were collected from 101 HIV-1-infected patients (32 ART-experienced cases with virological failure and 69 newly diagnosed ART-naïve cases, including 11 children), in Koforidua, Eastern region of Ghana, from February 2009 to January 2010. The <italic>pol</italic> gene sequences were analyzed by in-house HIV-1 drug-resistance testing.</p></sec><sec><title>Results</title><p>The most prevalent HIV-1 subtype was CRF02_AG (66.3%, 67/101) followed by unique recombinant forms (25.7%, 26/101). Among 31 ART-experienced adults, 22 (71.0%) possessed at least one drug-resistance mutation, and 14 (45.2%) had two-class-resistance to nucleoside and non-nucleoside reverse-transcriptase inhibitors used in their first ART regimen. Importantly, the number of accumulated mutations clearly correlated with the duration of ART. The most prevalent mutation was lamivudine-resistance M184V (<italic>n</italic> = 12, 38.7%) followed by efavirenz/nevirapine-resistance K103N (<italic>n</italic> = 9, 29.0%), and zidovudine/stavudine-resistance T215Y/F (<italic>n</italic> = 6, 19.4%). Within the viral protease, the major nelfinavir-resistance mutation L90M was found in one case. No transmitted HIV-1 drug-resistance mutation was found in 59 ART-naïve adults, but K103N and G190S mutations were observed in one ART-naïve child.</p></sec><sec><title>Conclusions</title><p>Despite expanding accessibility to ART in Eastern Ghana, the prevalence of transmitted HIV-1 drug resistance presently appears to be low. As ART provision with limited options is scaled up nationwide in Ghana, careful monitoring of transmitted HIV-1 drug resistance is necessary.</p></sec></abstract><funding-group><funding-statement>This study was supported by a grant of the Japan Initiative for Global Research Network on Infectious Diseases from the Ministry of Education, Culture, Sports, Science and Technology of Japan to the University of Ghana; the Tokyo Medical and Dental University; a Grant-in-Aid for AIDS Research from the Ministry of Health, Labour and Welfare of Japan (H22-AIDS-004); and a grant from the HIV Research Trust, United Kingdom. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement></funding-group><counts><page-count count="8"></page-count></counts></article-meta></front></pmc><affiliations><list><country><li>Ghana</li><li>Japon</li></country><region><li>Région de Kantō</li><li>Région du Grand Accra</li></region><settlement><li>Accra</li><li>Tokyo</li></settlement><orgName><li>Université du Ghana</li></orgName></list><tree><country name="Ghana"><region name="Région du Grand Accra"><name sortKey="Nii Trebi, Nicholas I" sort="Nii Trebi, Nicholas I" uniqKey="Nii Trebi N" first="Nicholas I." last="Nii-Trebi">Nicholas I. Nii-Trebi</name></region><name sortKey="Ampofo, William K" sort="Ampofo, William K" uniqKey="Ampofo W" first="William K." last="Ampofo">William K. Ampofo</name><name sortKey="Barnor, Jacob S" sort="Barnor, Jacob S" uniqKey="Barnor J" first="Jacob S." last="Barnor">Jacob S. Barnor</name><name sortKey="Brandful, James A M" sort="Brandful, James A M" uniqKey="Brandful J" first="James A. M." last="Brandful">James A. M. Brandful</name><name sortKey="Ofori, Sampson B" sort="Ofori, Sampson B" uniqKey="Ofori S" first="Sampson B." last="Ofori">Sampson B. Ofori</name></country><country name="Japon"><noRegion><name sortKey="Ibe, Shiro" sort="Ibe, Shiro" uniqKey="Ibe S" first="Shiro" last="Ibe">Shiro Ibe</name></noRegion><name sortKey="Ishikawa, Koichi" sort="Ishikawa, Koichi" uniqKey="Ishikawa K" first="Koichi" last="Ishikawa">Koichi Ishikawa</name><name sortKey="Sugiura, Wataru" sort="Sugiura, Wataru" uniqKey="Sugiura W" first="Wataru" last="Sugiura">Wataru Sugiura</name><name sortKey="Sugiura, Wataru" sort="Sugiura, Wataru" uniqKey="Sugiura W" first="Wataru" last="Sugiura">Wataru Sugiura</name><name sortKey="Yamaoka, Shoji" sort="Yamaoka, Shoji" uniqKey="Yamaoka S" first="Shoji" last="Yamaoka">Shoji Yamaoka</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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