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HIV-2: any tried and true HAART regimens?
Jan 5, 2004

Dr, Pierone, How many drugs have been approved for treatment of HIV? Of these, how many are NNRTI's?

I am asking, because I was stunned to have been diagnosed with HIV-2 (especially because I was infected in the US! I know that there are various drug regimens tried and proven for HIV-1 and the HHS Department has recommended frontline regimens, such as Combivir and Sustiva or Viread, Epivir and Sustiva/Viramune.

Are there tried and proven regimens for HIV-2? Could you recommend some specific drug combinations that have been shown effective in treating HIV-2 (for example, is there a potent one that includes Viread and Epivir?). I am quite scared that, because HIV-2 gets scant research, we patients will have drug regimens used that are unproven...and because there are no VL tests for HIV-2, we wouldn't know if there is drug resistance).

Can you please help out and advise whether there are established and proven effective drug regimens for HIV-2? (I just know that non Nukes like Sustiva and Viramune cannot be used).

Hoping to hear from you.

Many thanks.

Response from Dr. Pierone

Hello, as you may know, HIV-2 tends to progress more slowly than HIV-1, so you may not need treatment for some time depending on how your numbers turn out. Getting a viral load for HIV-2 used to be a problem, but is now available commercially.

There are limited data on treatment of HIV-2, but clearly protease inhibitor-based therapy is effective for treatment of HIV-2. There are some caveats with the protease inhibitors - amprenivir is ineffective (so Lexiva would presumably not work as well), nefinavir (Viracept) may not be active based on a position 77 mutation in the protease gene.

So, if you do require treatment, it should be a boosted protease regimen with 2 nukes. My thoughts would be either Kaletra, Viread, Epivir or Reyetaz/ritonavir, Viread, Epivir. As a disclaimer, please realize that I have not ever treated HIV-2, but base these suggestions from the limited treatment information that is available. Good luck!



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