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New York State HIV Guidelines- NEW: Human Immunodeficiency Virus Type 2 (HIV-2)
  Human Immunodeficiency Virus Type 2 (HIV-2)


HIV-2 was first described in 19851 and was isolated in 1986 in West Africa,2 where it is currently endemic. The Centers for Disease Control and Prevention (CDC) reported that, from 1988 to June 2010, 166 cases had met the CDC case definition of HIV-2 infection in the United States.3 The largest number of cases were from the Northeast, including 77 from New York City.3 The majority of cases had a West African origin or connection.3 However, a report from New York City suggests that HIV-2 may be underreported because antibody cross-reactivity between HIV-1 and HIV-2 is common and frequently results in misdiagnosis of HIV-2 as HIV-1 or dual infection.4 Incorporating a type-differentiating immunoassay into the HIV screening protocol can assist in identifying the type.4
HIV-2 is associated with lower viral load levels and slower rates of CD4 decline and clinical progression compared with HIV-15,6; 86% to 95% of people infected with HIV-2 are long-term nonprogressors.7,8 Recent data show that survival of persons with undetectable HIV-2 viral load is similar to that of the general population.8 However, HIV-2 can cause immunosuppression, as well as AIDS characterized by the same signs, symptoms, and opportunistic infections that are seen in HIV-1. HIV-2-associated AIDS may often be associated with lower viral load levels than HIV-1 (>10,000 copies/mL in HIV-2 versus sometimes millions of copies/mL in HIV-1).8
In contrast to the detailed knowledge base for the management of HIV-1, no clinical trials have been conducted to date to guide decision-making in the management of HIV-2-related immunosuppression and progression of disease. Studies of virologic and immunologic responses to antiretroviral therapy (ART) have demonstrated a higher CD4 cell increase in HIV-1-infected patients compared with HIV-2-infected patients after initiation of therapy.9-11 These factors, combined with the absence of controlled trials of ART for HIV-2, contribute to the challenge of optimal treatment of HIV-2.
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