471. HIV-2 Infection in Rhode Island from 2002 – 2011: Diagnostic and Treatment Strategies    
Session: Poster Abstract Session: HIV Primary Care
Friday, October 21, 2011
Room: Poster Hall B1
Background:  

HIV-2 infection is uncommon in the U.S., with the majority of cases originating in Western Africa. Antiretroviral (ARV) treatment options for HIV-2 are limited given  non-nucleoside reverse transcriptase inhibitors are not effective.  In contrast to HIV-1 infection, little is known about the natural disease course of HIV-2 and response to ARVs. We describe a cohort of HIV-2 infected patients, focusing on method of diagnosis, ARV treatment, and complications.

Methods: 

Through a retrospective review of medical records at our center, we identified 12 cases of HIV-2 infection in our clinic population (1400 active patients) who received care between 2002 and 2011.  We summarized clinical characteristics, ARV treatment and outcomes.

Results: 

Seven cases were male and five were female.  All patients were born in West African countries.  Eight cases were likely contracted in Western Africa, one case was acquired in the U.S., and the location of infection was not known in three cases. The mode of transmission was heterosexual intercourse in eleven patients, and intravenous drug use in one patient. In all cases, an HIV-1/2 antibody test was positive and HIV-1 western blot was negative or indeterminate.  Confirmatory testing with HIV-2 western blot was positive in all patients. The median CD4 count at time of diagnosis was 668/ml (range 23/ml to 1,546/ml). Several patients had HIV-2 quantitative viral load measurements through a research lab or an HIV-2 qualitative viral load assay completed, but use of these tests was not uniform. Four patients were treated with protease inhibitor-based ARV regimens, with a mean increase in CD4 count of 183/ml (range 43/ml – 341/ml). The other eight patients have been observed off ARVs. Two patients experienced complications from HIV, one patient had HIV encephalopathy and molluscom contagiosum, and another had microsporidiosis infection in the setting of AIDS.

Conclusion: 

Our results confirm previous studies that HIV-2 has a more indolent disease course than HIV-1, with a spectrum of disease ranging from asymptomatic to AIDS.  Development of a reliable quantitative HIV-2 viral load assay to guide management is needed.  Further research studies are needed to establish the best time to start ARV treatment in HIV-2-infected patients.


Subject Category: H. HIV/AIDS and other retroviruses

Brian Hollenbeck, MD, Medicine, Alpert Medical School of Brown University, Providence, RI and Curt Beckwith, MD, Medicine, Miriam Hospital/Alpert Medical School of Brown University, Providence, RI

Disclosures:

B. Hollenbeck, None

C. Beckwith, None

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