Clinical manifestations and diagnosis of HIV-2 infection
- Geoffrey S Gottlieb, MD, PhD
Geoffrey S Gottlieb, MD, PhD
- Professor of Medicine/Infectious Diseases
- Adjunct Professor of Global Health
- University of Washington School of Medicine
Although HIV-1 infection is associated with most of the global AIDS pandemic, HIV-2 is an important cause of disease in West Africa, where it is endemic. HIV-2 infection has also been described in locales with cultural and socioeconomic ties to West Africa, including the United States. It is an important consideration in patients with an AIDS-like illness or among persons with epidemiologic risk factors for infection . Epidemiologic risk factors are similar to HIV-1 infection and include a past history of blood transfusion or having a sex partner or needle-sharing partner with HIV-2 infection.
This topic will address the clinical manifestations and diagnosis of HIV-2 infection. The epidemiology, transmission, natural history, pathogenesis and treatment of HIV-2 are discussed elsewhere. (See "Epidemiology, transmission, natural history, and pathogenesis of HIV-2 infection" and "Treatment of HIV-2 infection".)
STAGING OF DISEASE
In HIV-1 infected patients, two important laboratory determinants of the rate of progression are the CD4 cell count and the plasma viral load [2,3]. In untreated patients, the average rate of decline of CD4 cells ("CD4 slope") is about 50/mm3 per year and the average plasma RNA viral load (without therapy) is 30,000 to 50,000 copies/mL [2-4]. Patients with a CD4 cell count <200 cells/mm3 are considered to have AIDS; such patients are at significantly increased risk for opportunistic infections and AIDS-related malignancies. (See "Factors affecting HIV progression".)
There are far fewer data on the CD4 threshold that is associated with an increased risk of AIDS and opportunistic infections among HIV-2 infected patients. Most experts apply the same CD4 cell count threshold (<200 cells/mm3) as a laboratory parameter indicating AIDS in HIV-2 infected patients.
Laboratory monitoring for HIV-2 RNA viral load is problematic since testing availability in limited. Most commercial laboratories do not offer testing for HIV-2 RNA viral load and the few that do offer only qualitative testing (eg, Focus and Quest Diagnostics laboratories). Quantitative HIV-2 RNA viral load testing may be obtained from the following few laboratories [5-8]:
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- STAGING OF DISEASE
- RISK FACTORS FOR CLINICAL PROGRESSION
- CLINICAL MANIFESTATIONS
- Primary HIV-2 infection
- Chronic infection
- TESTING FOR HIV-2 INFECTION
- Which tests to order?
- DIAGNOSTIC ISSUES RELATED TO HIV-1 WESTERN BLOT TESTING
- General background
- Interpretation of Western blot test results
- - A reactive HIV-1 Western blot
- - An indeterminate HIV-1 Western blot
- - A negative HIV-1 Western blot
- WHEN TO SUSPECT HIV-2 INFECTION
- Clinical clues to possible HIV-2 infection
- Laboratory clues for possible HIV-2 infection
- WHO SHOULD BE SCREENED?
- SUMMARY AND RECOMMENDATIONS