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Comment about your response to Janet on HIV-2 window period
Feb 24, 2004

Dr. Pierone, I read Janet's question and your response on the question of whether the window period for HIV-2 could be longer due to the fact that HIV-2 is less virulent.

I am the person diagnosed with HIV-2 and wanted to make it clear that I was purely speculating about a generally longer window period, because of what happened to me. There seemed to be a logic to a less virulent virus causing a delayed antibody response.

But, as you note, there is little to no research on HIV-2, largely because it is not yet very prevalent in the US, though it is increasing in Europe and India (and I got it from a European woman whom, if you met her, you'd think was the last person to have HIV in any form).

I do think it's important that readers of this forum not overreact to my unusual situation. As to window periods, probably for 99.9 of people, the 3-6 month window is valid, certainly for HIV-1. My body is not doing a great job handling this HIV-2 virus, so there may be very unusual circumstances here relating to my immune system's ability to develop antibodies within certain time frames. I believe the CDC would say that the window period for both HIV-1 and HIV-2 is the same and this is probably true for virtually everyone. There will always be the outlier and exceptional cases that are very rare.

I do think that HIV-2 needs to be studied more, because it is here to stay and will likely increase in numbers, just as non B HIV-1 subtypes will. When I first got ill, I went to an HIV specialist who has treated patients since the start of the HIV epidemic. I had already received negative HIV-1 ELISA and PCR RNA test results. I asked for a bDNA test to catch any non B subtypes and he had never, in all his years of experience, ordered a bDNA. He had to do some research before agreeing. That test was negative and so were all the ELISA tests in that first year.

It is a shock to be in this situation. This disease has also caused me to develop very high insulin levels. Since, as you wrote, protease inhibitors are the only class of drugs proven effective against HIV-1 and since they can cause insulin problems, I fear being unable to have druugs that will keep the virus at bay. Right now, what is puzzling is that I am really ill, yet my doctor has no access to a viral load test for HIV-2. If you know of a VL test for HIV-2, I would appreciate your advising. The Roche 1.5 and bDNA find no detectable VL, but my immune system is clearly breaking down - developed thrush, angular cheilitis, other rashes, sweats, physical weakness, peripheral neuropathy. My CD4's are a good number, but my doctor tells me that there may be a problem with their quality, due to all these symptoms.

So, again, I wanted to emphasize that I was only speculating about why I took so long to seroconvert. It is just as possible that there is some problem with my immune system to begin with which would explain it, and would also explain why I have all these symptoms from a form of HIV that is supposed to be less virulent.

I hope more reasearch will be done into HIV-2 diagnosis and treatments, though imagine that it won't be for a long time to come. Virtually all those with HIV-2 are not able to afford HAART drugs, so the drug companies have little incentive to develop targeted HIV-2 drugs and all resources at those companies and in research are rightfully focused on the vast majority of HIV infections - HIV-1, Group M and usually B or C subtypes.

Dr. Pierone, thanks for your constant willingness to research and answer questions on HIV variants. Unfortunately, a lot of clinicians are not really interested in dealing with the unusual cases - their waiting rooms are filled with the usual cases where they are more experienced and familiar with treatments and issues. Again, if there is a VL test out there for HIV-2, I would greatly appreciate your letting me know. There are HIV-2 DNA PCR tests as I know all too well now (they were done on me), but those of course are just qualitative and do not provide viral loads. It would help a lot to know of a quantitative PCR test for HIV-2.

Dr. Pierone, thank you very much for always being so helpful, supportive and willing to tackle some of the tougher questions about variant strains of HIV.

Response from Dr. Pierone

Hello again and thanks for posting.

I think that I may have erroneously stated in an earlier post that quantitative HIV-2 viral load tests were commercially available in the United States. This lack of a viral load test for HIV-2 makes management more challenging, of course. I would think that a research lab somewhere at one of the academic centers would be willing and able to do the test though.

More research is being done on HIV-2 treatment as efforts are gearing up to provide active treatment in Africa. In fact, this surprising abstract was presented at the recent Retrovirus conference in San Francisco indicating resistance of HIV-2 to AZT.

I should emphasize the point that your situation although not unique, is very unusual. HIV-2 has not yet made major inroads into the U.S., although the incidence is increasing in Europe. I say this not to minimize your personal situation, but simply to deflect a rash of posts from the "worried well" to this forum on HIV treatment.

I will ask around and see if anyone knows of any U.S. research labs that will perform HIV-2 viral loads. Good luck!



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