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Your response on HIV-2 HAART regimens
Jan 5, 2004

Dear Dr. Pierone,

Thank you very much for your answer on HIV-2 regimens (even with your caveat that you have not personally treated HIV-2). It was very reassuring, both the fact that there are now VL tests for HIV-2 and that there are proven HAART regimens. I must say that your answers are always especially informative and you convey a real sense of decency and compassion.

I would like to say that everyone should get tested for HIV-2. I am Caucasian, heterosexual and live in the USA. I got very sick weeks after an unprotected sexual exposure with a very smart, accomplished and pretty woman from a European country who would have charmed the pants off any guy...she was in the US for a few years, assigned by her multinational company. She had claimed to have been tested for HIV, but to have been negative. So, off came the condoms and on came the passion! Either she didn't know that she had HIV-2 at the time or she had been less than honest.

My life was hell since then - the doctors in the US tested me for every form of HIV-1...after all, the woman was Caucasian European and there was no obvious African connection. One HIV-2 Elisa test was negative after the window period, but either HIV-2 antibody creation can take longer (Maybe because HIV-2 is a bit less virulent than HIV-1?) or my metabolism was slow. So, after dozens of other tests and Cat Scans etc., the doctors said that maybe this could be anxiety driven!

Over a year after exposure, I had another HIV-2 Elisa and DNA PCR test for HIV-2. They were positive and the doctors rationalized their positions by saying that this was a one in millions chance. But these chances do happen and, if I had just used condoms, my life would not have been wrecked as it was. Fact is that HIV is also here in the US and I think people should also insist that their doctors test them for this when testing for HIV-1.

I also did some further research. Seems that, while there are regimens that are better for HIV-2, none have been tested with the same rigor as regimens for HIV-1 and there are higher rates of drug resistance for HIV-2. So, the "good news" is that I have a form of HIV that kills CD4 cells at a slower rate than HIV-1, but the bad news is that none of the drugs has been proven highly effective against HIV-2. Every drug for HIV-2 was developed for HIV-1 and is used if it happens to show some activity against HIV-2. So far, it appears that none of the drugs show a lot of activity against HIV-2...considering that HIV-2 is a weaker virus than HIV-1, it seems logical that drug development could create some highly effective HIV-2 meds. But, since virtually all of the HIV-2 cases involve people from poor African countries, the drug companies don't divert resources to creating drugs for people who cannot afford them. Ironic, all of this - to have HIV-2, a slower rate of CD4 decline than with HIV-1 (though with some symptoms), but unless there is a dramatic change in the next 5-7 years, to face treatment with less effective drugs...when all I had to do was use condoms and the nightmare of symptoms over the past year plus would have been avoided.

Anyway, thanks again for your answer and suggestions of HAART, which I will discuss with my HIV doctor (who also has no HIV-2 patients).

Regards.

Response from Dr. Pierone

Thanks for the follow up and details related to your infection.

This brings up the point that HIV (1 and 2) does not play favorites. I have quite a few heterosexual Caucasian men in my practice that did not consider themselves to be at risk for HIV, but nonetheless became infected from a female sexual partner.

Although HIV-2 is becoming more common in Europe, it remains exceedingly rare in the United States. We will see certainly see more cases in the future and your experience demonstrates one way that someone in the U.S. can become infected with HIV-2.

I think that there are some very good reasons to be optimistic about your circumstances. HIV-2 does progress more slowly and this suggests that treatment may not be necessary for quite a few years. By that time we will have some studies done on response of HIV-2 to various regimens. Even though the NNRTI class is not useful for treatment, boosted protease inhibitors with NRTI's should work well. Additionally, the newer agents targeting other viral proteins will likely have activity against HIV-2.

Once you have more information about the viral load and CD4 count please keep us informed. Best of luck!



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