Characteristics of HIV-2 and HIV-1/HIV-2 Dually Seropositive Adults in West Africa Presenting for Care and Antiretroviral Therapy: The IeDEA-West Africa HIV-2 Cohort Study

Abstract

BackgroundHIV-2 is endemic in West Africa. There is a lack of evidence-based guidelines on the diagnosis, management and antiretroviral therapy (ART) for HIV-2 or HIV-1/HIV-2 dual infections. Because of these issues, we designed a West African collaborative cohort for HIV-2 infection within the framework of the International epidemiological Databases to Evaluate AIDS (IeDEA).MethodsWe collected data on all HIV-2 and HIV-1/HIV-2 dually seropositive patients (both ARV-naive and starting ART) and followed-up in clinical centres in the IeDEA-WA network including a total of 13 clinics in five countries: Benin, Burkina-Faso Côte d’Ivoire, Mali, and Senegal, in the West Africa region.ResultsData was merged for 1,754 patients (56% female), including 1,021 HIV-2 infected patients (551 on ART) and 733 dually seropositive for both HIV-1 and HIV 2 (463 on ART). At ART initiation, the median age of HIV-2 patients was 45.3 years, IQR: (38.3–51.7) and 42.4 years, IQR (37.0–47.3) for dually seropositive patients (p = 0.048). Overall, 16.7% of HIV-2 patients on ART had an advanced clinical stage (WHO IV or CDC-C). The median CD4 count at the ART initiation is 166 cells/mm3, IQR (83–247) among HIV-2 infected patients and 146 cells/mm3, IQR (55–249) among dually seropositive patients. Overall, in ART-treated patients, the CD4 count increased 126 cells/mm3 after 24 months on ART for HIV-2 patients and 169 cells/mm3 for dually seropositive patients. Of 551 HIV-2 patients on ART, 5.8% died and 10.2% were lost to follow-up during the median time on ART of 2.4 years, IQR (0.7–4.3).ConclusionsThis large multi-country study of HIV-2 and HIV-1/HIV-2 dual infection in West Africa suggests that routine clinical care is less than optimal and that management and treatment of HIV-2 could be further informed by ongoing studies and randomized clinical trials in this population.

Low Level of HIV-2 Replication in Patients on Long-Term Antiretroviral Therapy in Togo

“…Unfortunately we had no information on the clinical stage of the patients at ART initiation. In the same study, the median CD4 count at the ART initiation was 166 cells/mm 3 , IQR (83-247) among HIV-2 infected patients and 146 cells/mm 3 , IQR (55-249) among dually seropositive [19]. Certainly because of long-term triple therapy, median CD4…”

“…Thus, a previous study reported in 2013, in both ARV-naive and starting ART and followed-up in clinical centres in West Africa, that overall, 16.7% of HIV-2 patients on ART had an advanced clinical stage (WHO IV or CDC-C) [19]. Unfortunately we had no information on the clinical stage of the patients at ART initiation.…”

Assessment of the Cavidi ExaVir Load Assay for Monitoring Plasma Viral Load in HIV-2-Infected Patients

“…In such settings, commercial nonnucleic acid-based methods, such as the Cavidi ExaVir Load assay, can be a good alternative considering the low cost, simple and standardized procedure, and limited physical requirements (60). Moreover, in African countries such as Cape Verde (13,14,61), Guinea-Bissau (62), Gambia (63), and Senegal (64,65), where HIV-1 and HIV-2 cocirculate, but also in Portugal (38)(39)(40) and France (66,67), the characteristics of the ExaVir Load assay make it useful to measure viral load in patients infected with HIV-1 and/or HIV-2, provided that the serologic diagnosis of HIV-1 or HIV-2 infection is well established in advance.…”

A Multiplex PCR Approach for Detecting Dual Infections and Recombinants Involving Major HIV Variants

“…In these regions, the cocirculation of HIV-1/M and HIV-2 or HIV-1/O leads to dual infections (12)(13)(14)(15)(16)(17)(18)(19)(20)(21). In West Africa, dual infections with HIV-1 and HIV-2 (referred to as HIV-1ϩHIV-2) are thought to account for 1 to 8% of HIV infections (17,22), although no HIV-1/2 recombinant has yet been described. In West-Central Africa, including Cameroon in particular, the frequency of HIV-1/MϩO dual infections has been estimated to be 10% in the HIV-1/O-seropositive population (20,23,24).…”

“…They also have an impact on clinical practice, because they may interfere with the results obtained with serological and molecular tools for diagnosis and patient follow-up. Some serological tools are less sensitive to HIV-1/O (30) or HIV-2 (22,31) and may behave similarly with recombinants carrying a group O-derived envelope or with cryptic HIV-1ϩHIV-2 infections (17). Similarly, variants may affect the determination of viral load (VL) by quantitative RT-PCR (32)(33)(34)(35).…”