From the Guidelines

HIV-2 management differs from HIV-1 in terms of diagnosis and consideration of geographic exposure.

Geographic exposure: HIV-2 should be considered in persons who were born in, have traveled to, have received blood products from, or have had a sexual partner from West Africa, as well as those who have been similarly exposed to HIV-2-infected persons in any geographic area 1.
Diagnostic approach: The laboratory diagnosis of HIV-2 infection is similar to HIV-1, but requires specific tests to distinguish between the two types, such as an antibody immunoassay that distinguishes HIV-1 from HIV-2 antibodies 1.
Testing algorithm: The testing algorithm for HIV-2 involves an initial screening assay, followed by a differentiation assay to distinguish between HIV-1 and HIV-2 antibodies, and further testing with a qualitative or quantitative NAAT if necessary 1.

Fourth generation assays: These assays incorporate HIV p24 antigen detection, allowing for earlier diagnosis of infection, and are recommended as initial screening tests for diagnosis of HIV infection 1.
HIV-2 EIA: This test is specifically designed to detect antibodies to HIV-2 and is based on a disrupted whole-virus antigen obtained by purification of HIV-2 grown in cell culture 1.

Prevalence: HIV-2 infection is relatively rare in the United States, but more common in West Africa 1.
Transmission: HIV-2 can be transmitted through blood transfusion, sexual contact, and mother-to-child transmission, similar to HIV-1 1.

From the Research

The management of Human Immunodeficiency Virus (HIV) type 2 differs from that of HIV type 1 in several aspects, including:

Transmission and Epidemiology: HIV-2 is largely confined to West Africa, whereas HIV-1 is widespread globally 2.
Clinical Progression: HIV-2 infected individuals tend to have a slower progression to AIDS, with lower viral loads and higher CD4 counts compared to HIV-1 infected individuals 2, 3.
Immune Response: The immune response to HIV-2 appears to be more protective against disease progression, with more polyfunctional cellular responses and lower levels of immune activation 2.
Antiretroviral Therapy: HIV-2 is inherently resistant to non-nucleoside reverse transcriptase inhibitors, and treatment options are limited compared to HIV-1 4, 5.
Drug Resistance: HIV-2 can develop resistance to antiretroviral drugs, including dolutegravir and lenacapavir, which requires careful monitoring and adjustment of treatment regimens 4.
Diagnostic Procedures: Diagnostic procedures for HIV-2 may differ from those for HIV-1, and expertise in diagnosing and managing HIV-2 is limited in non-endemic countries 5.

Treatment options for HIV-2 are limited, and the choice of antiretroviral therapy depends on various factors, including:

Integrase Strand Transfer Inhibitors: Dolutegravir and other integrase strand transfer inhibitors are effective against HIV-2, but resistance can develop 4.
Capsid Inhibitors: Lenacapavir is a novel antiretroviral capsid inhibitor that offers additional therapeutic options for HIV-2, but resistance can also develop 4.
Nucleoside Reverse Transcriptase Inhibitors: These drugs are less effective against HIV-2 due to inherent resistance, but may still be used in combination with other antiretroviral agents 5.
Post-Exposure Prophylaxis: Post-exposure prophylaxis and prevention of mother-to-child transmission strategies for HIV-2 are similar to those for HIV-1, but require careful consideration of the limited treatment options 5.