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Antiretroviral Therapy for HIV2 Infected Patients

Antiretroviral Therapy for HIV2 Infected Patients,10.1053/jinf.2001.0792,Journal of Infection,N. A. Smith,T. Shaw,N. Berry,C. Vella,L. Okorafor,D. Tay

Antiretroviral Therapy for HIV2 Infected Patients   (Citations: 17)
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N. A. Smith, T. Shaw, N. Berry, C. Vella, L. Okorafor, D. Taylor, J. Ainsworth, A. Choudhury, R. S. Daniels, S. El-Gadi, A. Fakoya, G. Moylehttp://academic.research.microsoft.com/io.ashx?type=5&id=37147863&selfId1=0&selfId2=0&maxNumber=12&query=
Objectives: To evaluate clinical and RNA load response to antiretroviral therapy amongst patients infected with HIV-2 and to study the development of drug resistance.Methods: Seven HIV-2 seropositive patients were monitored with clinical examination, CD4 cell count and HIV-2 viral RNA load. Viruses from four subjects were genotyped and in vitro recovery of virus by co-cultivation with PBMCs and HVS T-cells was attempted. Viruses isolated from two subjects were assayed for phenotypic antiviral resistance. The main outcome measures were the relationship between disease stage, viral load, CD4 cell count, viral subtype and the clinical course of HIV-2 infection and the effect of combination antiretroviral therapy on disease progression, CD4 cell count, HIV-2 RNA viral load and drug resistance.Results: The median time of follow-up was 3 years (range 0–8 years). Three patients had AIDS, and one had symptomatic disease. Of the four patients genotyped, three were infected with HIV-2 subtype B and one with subtype A. Viraemia was detectable only at CD4 counts of less than 300 × 106/ml. Two patients with high viral loads failed to respond to antiretroviral therapy although their treatment may not have been optimal. One developed in vitro phenotypic antiviral resistance. The genotype of this patient's viral reverse transcriptase is being analysed.Conclusions: In contrast to HIV-1, HIV-2 RNA levels were often undetectable despite advanced disease and low CD4 cell counts. However, HIV-2 was clearly capable of causing CD4 cell depletion resulting in symptomatic disease. The principles of highly active antiretroviral therapy seem to apply to HIV-2 and suboptimal therapy may lead to drug resistance. The timing of therapy initiation, monitoring of response and the measurement of resistance remain unresolved issues and conclusions cannot be extrapolated from HIV-1.
Journal: Journal of Infection - J INFECTION , vol. 42, no. 2, pp. 126-133, 2001
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    • ...the diagnosis of HIV-2 infection has implications for choice of antiretroviral therapy...

    S Douganet al. Diagnoses of HIV1 and HIV2 in England, Wales, and Northern Ireland ass...

    • ...In practice, HIV-2 viral load is detectable in only 8% of individuals with CD4 counts >500 cells/mm 3 but can be detected in 62% of those with CD4 counts <300 cells/mm 3 and in 53% of individuals with an AIDS defining illness [21]...
    • ...CD4 count rise in response to antiretroviral therapy is well documented [21-23] however it is often blunted when compared to treatment response in HIV-1...
    • ...Q151M (+/-V111I) and K65R seem to develop much faster in HIV-2 individuals than in those infected with HIV-1 and is the main resistance pathways [21,28-34] [15,30,35]...
    • ...Codon mutations K70R, S215Y and Q151M have been documented in HIV-2 positive individuals treated with zidovudine causing NRTI treatment failure [21,28-32]...
    • ...Nelfinavir failure is associated with frequent virological failure and the emergence of L90M and is not recommended [21]...
    • ...Patients treated successfully have so far been treated mainly with 2 NRTIs plus Indinavir/Ritonavir or Lopinavir/Ritonavir [19-21]...

    Yvonne Gilleeceet al. The British HIV Association Guidelines for Antiretroviral Treatment of...

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