From the Guidelines
The CDC does not recommend routine testing for HIV-2 in settings other than blood centers, unless demographic or behavioral information suggests that HIV-2 infection might be present.
Key Points
- The prevalence of HIV-2 in the United States is extremely low 1
- Those at risk for HIV-2 infection include persons from a country in which HIV-2 is endemic or the sex partners of such persons, particularly from West Africa 1
- Testing for HIV-2 should be conducted when there is clinical evidence or suspicion of HIV disease in the absence of a positive test for antibodies to HIV-1 1
- The Multispot rapid test is FDA approved for differentiating HIV-1 from HIV-2 infection, but no serologic tests are approved for confirmation of HIV-2 infection 1
- Providers should consult their state health departments for assistance in the diagnosis of HIV-2 infection 1
Diagnosis and Testing
- HIV-2 infection should be suspected in persons of West African origin who have clinical conditions suggestive of HIV infection but have atypical serologic test results 1
- A positive oral rapid test result should be routinely confirmed with a whole blood rapid test because of the potential for a higher frequency of false-positive results with the oral rapid test 1
- Specimens reactive on screening tests are interpreted to be “preliminary positive” and must be confirmed by Western blot or indirect immunofluorescence assay 1
From the Research
CDC Guidelines for HIV-2
The Centers for Disease Control and Prevention (CDC) has not explicitly outlined specific guidelines for HIV-2 in the provided studies. However, the following information can be gathered:
- HIV-2 infection is mainly found in West Africa, but cases have been recognized in Europe, India, and the United States 2, 3.
- The diagnosis of HIV-2 infection can be complicated due to antibody cross-reactivity with HIV-1, and HIV-1 viral load testing does not detect HIV-2 3.
- HIV-2 should be ruled out in persons presenting for HIV testing who originate in or travel to West Africa and other areas in which HIV-2 is endemic 3.
- The management of individuals living with HIV-2 in Europe requires differential characteristics of HIV-2 regarding diagnostic procedures, the clinical course, and antiretroviral therapy 4.
- Key aspects of HIV-2 management include:
- Diagnosis: using a comprehensive algorithm to differentiate between HIV-1 and HIV-2 infection 3.
- Monitoring: regular monitoring of HIV-2 viral load and CD4 cell count 4.
- Treatment: selection of antiretroviral therapy that is effective against HIV-2, with suggestions for first- and second-line treatments 4.
- Prevention: strategies for preventing mother-to-child transmission and post-exposure prophylaxis 4.
- The CDC has provided general information and education activities for the prevention and control of HIV infection and AIDS in the United States, including guidelines for effective school health education and community health education and risk reduction interventions 5.
Key Considerations
- HIV-2 is less pathogenic than HIV-1, but it can still lead to immunosuppression and clinical AIDS 3, 6.
- The clinical course of HIV-2 infection can be different from HIV-1, with a slower progression to AIDS 6.
- Antiretroviral therapy for HIV-2 requires careful selection of drugs that are effective against the virus 4.