Absence of routine molecular testing and prevalence of HIV-2 infection in regions hardest-hit by HIV infection

Abstract

Introduction: Investigating the incidence and dynamics of HIV-2 and false-negative HIV test results in a highly sexually active population where frequent opportunities exist for acquiring and transmitting infections provides additional understanding of the epidemiology of the virus in Africa. Methodology: The HIV status of 900 active female sex workers (FSWs) was determined using two lateral flow rapid assays in series. The second rapid test device incorporates type-specific recombinant peptides that discriminate between HIV-1 and HIV-2 infection. HIV seronegative samples were re-tested for HIV infection and their viral loads determined using the NucliSENS real-time nucleic acid sequencebased amplification (NASBA) platform. Results: In total, 335 FSWs were determined to be HIV positive, the majority (227; 67.8%) of whom were between the ages of 20 and 30 years. Eighteen (5.4%) were found to have evidence of HIV-2 infection, 17 of whom were co-infected with HIV-1. Only one HIV-2 monoinfection was observed. Out of 565 HIV-negative individuals determined by serology, 11(1.9%; p>0.05) were found to be HIV-1 positive when tested via the NASBA platform. Conclusion: False negative test results, HIV-2 infection, and complex transmission networks among FSWs may aid in fueling the HIV epidemic in the Nigerian population. These findings demonstrate the need to reevaluate the quality of HIV serological diagnostics, control services, and stress the need for widespread introduction of molecular testing among high-risk populations in the country.

An Evaluation of Selected Populations for HIV-1 Vaccine Cohort Development in Nigeria

“…Molecular analysis of 224 HIV positive samples indicated that CRF02_AG, G/CRF02_AG and G were major circulating recombinant forms and subtypes, respectively in our study [27]. This analysis may represent one of the largest HIV genotypic analyses at the population level across Nigeria.…”

“…More recent studies of long distance truck drivers (N = 100) in the Niger Delta Zone of Nigeria indicated a 10% HIV prevalence in this population, with only one HIV-2 infection (1%) identified, but not confirmed [23]. Forbi et al [27] reported 18 HIV-2 infections (5.4%) out of 335 HIV infected female sex workers. Of the 18 HIV-2 cases, 17 were co-infected with HIV-1.…”

Delayed disease progression in HIV-2: the importance of TRIM5α and the retroviral capsid

“…An estimate of HIV-2 prevalence of 1-2 million infected people worldwide is widely cited [3]. However, as HIV-2 is not regularly included in national testing strategies and requires specialist laboratory facilities for accurate diagnosis [4] the current prevalence is unknown. The recent falls in national HIV-2 prevalence in some West African countries [5] have led to predictions that the epidemic will reach extinction in approximately 2068 [3,6].…”