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Fifth International CongressDrug Therapy in HIV Infection22-26 October, 2000
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PLASMA AND TISSUE HIV-1 AND HIV-2 VIRAL LOAD IN HIV-2 AND DUAL HIV-1/HIV-2 INFECTED INDIVIDUALS: IMPLICATIONS FOR STARTING HAART
M. Schutten, M.E. van der Ende, K. Tenner-Racz, P. Racz, H.G.M. Niesters and A.D.M.E. Osterhaus
University Hospital Rotterdam, Department of Virology, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
Int Cong Drug Therapy HIV 2000 Oct 22-26;5:Abstract No. PL3.6
AIDS 2000, Oct 22-26;14(Suppl. 4);S3
PURPOSE OF STUDY: Within the Rotterdam area approximately 20 HIV-2 seropositive (HIV-2+) individuals have been reported. Quantitative plasma and tissue HIV-1/HIV-2 RNA levels were measured to determine the most optimal treatment strategy for HIV-2+ individuals.
METHODS: EDTA plasma samples were collected from HIV-1+, HIV-2+ and dual HIV-1/HIV-2+ individuals in 1999 and stored at –80C. HIV-2 plasma viral loads measured with a newly developed assay based on the Taqman realtime PCR detection method were compared with HIV-1 plasma viral loads measured with the Cobas Amplicor v1.5. The number of virus producing cells per mm2 of lymphoid tissue were determined by in situ hybridization.
RESULTS: The plasma and tissue HIV RNA load in HIV-2+ patients with < 200 CD4+ cells was significantly lower as compared to HIV-1+ patients. None of the HIV-2+ patients with > 200 CD4+ cells had plasma HIV-2 RNA levels that would urge starting therapy (> 5000 copies/ml). Two HIV- 1/HIV-2+ patients with < 200CD4+ cells proved to have significant levels of both HIV-1 and HIV-2 RNA before start of therapy. Interestingly after start of antiretroviral therapy (ART) in both patients (RTV/SQV and combivir/ NFV) the plasma HIV-1 RNA level decreased to and remained undetectable. The plasma HIV-2 RNA showed a rebound in both patients within 6 months despite a reported good adherence to their therapy [1].
CONCLUSIONS: On basis of these results and the limited options for treating HIV-2 (inadequate efficacy of NNRTIs and most probably also nelfinavir and amprenavir) we recommend starting ART as late as possible (CD4+ cells < 300/µl or plasma HIV-2 RNA levels > 5000 copies/ml). The fact that both HIV-1 and HIV-2 may actively replicate in dual HIV-1/HIV-2+ individuals also indicate that it is wise to refrain from treating such individuals with antivirals that are not efficacious against HIV-2.
Reference:
1. Schutten M, van der Ende ME, Osterhaus ADME. "Antiretroviral therapy in patients with dual infection with human immunodeficiency virus types 1 and 2", N Engl J Med. 2000 Jun 8;342(23):1758-60.
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2000-10-22
PL3-6
Originally published in AIDS Volume 14, Supplement 4 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701
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