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 or perinatal transmission from an HIV-2-infected mother.
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 is more limited. Most commercial laboratories do not offer testing for HIV-2 RNA viral load and the few that do offer only qualitative testing (eg, Quest Diagnostics laboratories). Quantitative HIV-2 RNA viral load testing may be obtained from the following few laboratories [5-8]:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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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?
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS