Antiretroviral therapy response among HIV-2 infected patients: a systematic review

Abstract

BackgroundFew data are available on antiretroviral therapy (ART) response among HIV-2 infected patients. We conducted a systematic review on treatment outcomes among HIV-2 infected patients on ART, focusing on the immunological and virological responses in adults.MethodsData were extracted from articles that were selected after screening of PubMed/MEDLINE up to November 2012 and abstracts of the 1996–2012 international conferences. Observational cohorts, clinical trials and program reports were eligible as long as they reported data on ART response (clinical, immunological or virological) among HIV-2 infected patients. The determinants investigated included patients’ demographic characteristics, CD4 cell count at baseline and ART received.ResultsSeventeen reports (involving 976 HIV-2 only and 454 HIV1&2 dually reactive patients) were included in the final review, and the analysis presented in this report are related to HIV-2 infected patients only. There was no randomized controlled trial and only two cohorts had enrolled more than 100 HIV-2 only infected patients. The median CD4 count at ART initiation was 165 cells/mm3, [IQR; 137–201] and the median age at ART initiation was 44 years (IQR: 42–48 years). Ten studies included 103 patients treated with three nucleoside reverse transcriptase inhibitors (NRTI). Protease inhibitor (PI) based regimens were reported by 16 studies. Before 2009, the most frequent PIs used were Nelfinavir and Indinavir, whereas it was Lopinavir/ritonavir thereafter. The immunological response at month-12 was reported in six studies and the mean CD4 cell count increase was +118 cells/μL (min-max: 45–200 cells/μL).ConclusionOverall, clinical and immuno-virologic outcomes in HIV-2 infected individuals treated with ART are suboptimal. There is a need of randomized controlled trials to improve the management and outcomes of people living with HIV-2 infection.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-461) contains supplementary material, which is available to authorized users.

The Nucleoside Analog BMS-986001 Shows GreaterIn VitroActivity against HIV-2 than against HIV-1

“…Novel HIV-2-active antiretrovirals are urgently needed in West Africa and other areas where the virus is prevalent (5,58). In the present study, we examined the ability of the investigational nucleoside analog BMS-986001 (Fig.…”

“…Historically, in West Africa, ART for HIV-2 infection has been characterized by high rates of immunovirologic failure and multiclass (NRTI and PI) drug resistance (22,58,(64)(65)(66). Newer ARVs, including generic FTC and tenofovir disoproxil fumarate (TDF), ritonavir-boosted darunavir, and the INSTI raltegravir, have recently been made available to a limited number of HIV-2-infected patients in some West African HIV treatment programs.…”

Mortality and survival patterns of people living with HIV-2

“…With the rapid scaling up of ART, mortality has been widely explored in HIV-1 infected patients receiving ART (31–33) but not so much in the context of HIV-2 infection. Indeed, some papers have described immune recovery and viral suppression (34*,35), but just a few of them described mortality and survival patterns of cohorts so far (36–39) (Table 2). …”

“…When available, they are usually presented as crude mortality rates (34*–36,40), and very few are using the most appropriate statistical methods (25,39). Most of the cohorts lacked power to detect any statistical difference when investigating factors associated with mortality and some of them lumped together HIV-2 and HIV-1 + HIV-2 dually reactive patients.…”

MK-8591 (4′-Ethynyl-2-Fluoro-2′-Deoxyadenosine) Exhibits Potent Activity against HIV-2 Isolates and Drug-Resistant HIV-2 Mutants in Culture

“…A ntiretroviral therapy (ART) can prolong the life spans of individuals infected with human immunodeficiency virus type 1 (HIV-1) by years or even decades, but these benefits have yet to be formally demonstrated in clinical trials involving human immunodeficiency virus type 2 (HIV-2) and HIV-1/2 dually infected patients (1)(2)(3). HIV-2 is endemic in West Africa and is also prevalent in other areas with socioeconomic ties to the region (4,5).…”