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Joakim Esbjornsson, PhDNew research challenges the previous perception that HIV-2 is milder than its sister HIV-1 virus.
In a long-term study conducted by Swedish, British and Bissau-Guinean researchers, HIV-2 has proven to be as lethal as HIV-1, even though it was evolving at a slower pace. They argue that physicians should consider using antiretroviral therapy earlier than in the past.
The first author, Joakim Esbjornsson, PhD, head of the system virology group at the Swedish University of Lund, said the reputation of HIV-2 is due in part to a lack of research. Specifically, there is limited data available on the time elapsed between infection and AIDS progression in HIV-2 patients and HIV-2 mortality rates.
"Many doctors who come across HIV-2 infected patients do not know when antiretroviral therapy should be started," he said. MD Magazine®. "This contrasts with patients infected with HIV-1, for whom antiretroviral therapy is usually offered immediately after diagnosis (in accordance with current treatment guidelines)."
To better understand the implications of HIV-2 infection, scientists examined two decades (1990-2009) of data on police health in Guinea-Bissau. Patients in this group who had been diagnosed with HIV-1 and HIV-2 were followed for another 4 years.
The investigators calculated temporal estimates of the transition to AIDS, as well as T-cell dynamics and mortality. Mortality rates were compared to nearly 3000 non-HIV-infected patients to constitute a control group.
Of the patients in the study, 408 had HIV-1 (before or during the study) and 464 patients had HIV-2. Of these, 225 patients in total were infected with HIV-1 during the study period and 87 contracted HIV-2 during the study.
The data showed that it took more years for AIDS (14.3 vs. 6.2) for HIV-2 patients, and a median survival of 15.6 years for HIV-positive patients. HIV, compared with 8.2 years for HIV-1 patients.
However, in the end, nearly half of the HIV-2 infected patients during the study period (43%) developed AIDS. This corresponds to 54% of patients who contracted HIV-1 during the study period. In the same group, 46% of HIV-1 patients died, while 30% of HIV-2 patients died.
Although HIV-2 appears to be progressing more slowly, Esbjornsson said that the prognosis for HIV-2 infected patients is similar to that for HIV-1 infected people.
"Our study is the first to present reliable estimates of HIV-2 infection to AIDS or HIV-related deaths, and our results show that the trajectory of the disease is almost identical to that observed in the US. HIV-1 infection, but at a slower pace, "he explained. "We interpret this as an HIV-2 infection that will result in AIDS and HIV-related death without antiretroviral therapy in the vast majority of people infected, such as in HIV-1 infection."
He said the data is an urgent case that doctors should consider starting antiretroviral therapy immediately after the diagnosis of HIV-2, as they do with HIV-1.
"In addition, he reiterates his earlier appeals to the urgency of a randomized clinical trial on antiretroviral therapy in HIV-2 infection," he added.
Esbjornsson said part of this research should focus on identifying combinations of antiretroviral treatments best suited for HIV-2, given that some effective HIV-1 antiretroviral therapies are ineffective against HIV-2.
The study "Long-term follow-up of HIV-2-related AIDS and mortality in Guinea-Bissau: an open cohort prospective study" was published online in The HIV Lancet.
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