From the Guidelines
Management of HIV-2 is similar to HIV-1.
Key Differences
- The period between infection and disease may be longer for persons with HIV-2 than for those with HIV-1 1.
- Antiviral therapy effectiveness for HIV-2 infection is not well established, but patients with HIV-2 are managed similarly to those with HIV-1 1.
Management Approach
- Preventive counseling is the same for persons with either HIV-1 or HIV-2, as the modes of transmission are the same 1.
- Epidemiologic testing to define the virus type should be considered for persons with epidemiologic risk factors for infection with HIV-2 1.
- Patients with confirmed HIV-2 infection should receive similar management as those with confirmed HIV-1 infection, due to limited data on antiviral therapy effectiveness for HIV-2 1.
From the Research
Management Differences for HIV-2
The management of Human Immunodeficiency Virus type 2 (HIV-2) differs from HIV-1 in several aspects:
- Epidemiology: HIV-2 is largely confined to West Africa, whereas HIV-1 is found worldwide 2.
- Clinical Progression: HIV-2 infected individuals are more likely to remain long-term non-progressors, and when clinical progression occurs, it happens at higher CD4 counts 2.
- Viral Load: Plasma viral loads are consistently lower in HIV-2, and average levels of immune activation are also lower 2.
- Immune Response: The immune response to HIV-2 appears more protective against disease progression, with cellular responses tending to be more polyfunctional and producing more IL-2 2.
- Antiretroviral Therapy: Highly active antiretroviral therapy (HAART) regimens used for HIV-1 are not as efficacious for HIV-2, and controlled clinical trials are needed to provide therapeutic guidance 3.
- Drug Resistance Testing: Next-generation sequencing (NGS) protocols can be used to detect drug resistance mutations in HIV-2, providing more comprehensive data for clinicians to adjust antiretroviral therapy (ART) regimens 4.
- Novel Inhibitors: Several novel drugs, such as 5-azacytidine, clofarabine, gemcitabine, and resveratrol, have been found to have potent anti-HIV-2 activity, targeting reverse transcription 5.
- Viral Trafficking: HIV-2 Gag is trafficked in an AP-3 and AP-5 dependent manner, differing from HIV-1, which may contribute to the lower viral load and slower progression to AIDS in HIV-2 infection 6.