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Antiretroviral Therapy for HIV-2 Infection in Non-Endemic Regions.
AIDS Reviews ( IF 2.2 ) Pub Date : 2020-3-14 , DOI: 10.24875/aidsrev.m20000029
Carmen de Mendoza , Ana B. Lozano , Estrella Caballero , Teresa Cabezas , José Manuel Ramos , Vicente Soriano

Human immunodeficiency virus type 2 (HIV-2) was isolated in AIDS patients in 1986. Around 1-2 million people are infected worldwide. The virus is less transmissible than HIV-1, being sexual contacts the most frequent route of acquisition. In the absence of antiretroviral therapy, most HIV-2 carriers will develop AIDS; however, it takes longer than in HIV-1 infection. There is no global pandemic caused by HIV-2, as the virus is largely confined to West Africa. Due to historical ties, HIV-2 is also prevalent in Portugal and its former colonies in Brazil, India, Mozambique, and Angola. Other European countries with hundreds to thousands of HIV-2 infections are France, Belgium, and Spain. A few hundred have been reported in North America, mostly in West African foreigners. Globally, HIV-2 infections are steadily declining. Although CD4 declines occur more slowly in HIV-2 than in HIV-1 patients, the CD4 recovery with antiretroviral treatment is smaller in the former. HIV-2 is naturally resistant to non-nucleoside reverse transcriptase inhibitors (NNRTIs) and some protease inhibitors. In contrast, HIV-2 is susceptible to all NRTIs and integrase inhibitors. Drug resistance in HIV-2 may develop earlier than in HIV-1 and select for mutations at distinct sites. Misdiagnosis of HIV-2 in patients wrongly considered as HIV-1 positive or in those dually infected may result in treatment failures with undetectable HIV-1RNA. Given the relatively large number of West Africans migrated to the European Union and North America, HIV-2 infection either alone or as coinfection with HIV-1 should be excluded at least once in all HIV-seroreactive persons. This should be stressed in the face of atypical HIV serological profiles, immunovirological disconnect (CD4 cell count loss despite undetectable HIV-1 viremia), and/or high epidemiological risks (birth in or sex partners from HIV-2 endemic regions). Superinfection with any HIV variant may occur in persons infected with the other, since there is no cross-protection. Thus, earlier antiretroviral therapy is warranted for either HIV-1 or HIV-2, given that it would protect from each other superinfection in persons at risk.

中文翻译:

非流行地区HIV-2感染的抗逆转录病毒疗法。

1986年在AIDS患者中分离出2型人类免疫缺陷病毒(HIV-2)。全世界大约有1-2百万人被感染。该病毒不像HIV-1那样传播,它是性接触中最常见的获取途径。在没有抗逆转录病毒疗法的情况下,大多数HIV-2携带者会发展为艾滋病;但是,它需要比HIV-1感染更长的时间。由于该病毒主要限于西非,因此没有由HIV-2引起的全球大流行。由于历史渊源,HIV-2在葡萄牙及其前殖民地巴西,印度,莫桑比克和安哥拉也很普遍。法国,比利时和西班牙是其他具有成百上千HIV-2感染的欧洲国家。据报道,北美有数百人,其中大多数是西非外国人。在全球范围内,HIV-2感染正在稳步下降。尽管CD-2下降在HIV-2中比在HIV-1患者中发生得更慢,但前者使用抗逆转录病毒治疗的CD4回收率较小。HIV-2对非核苷类逆转录酶抑制剂(NNRTIs)和某些蛋白酶抑制剂具有天然抗性。相反,HIV-2对所有NRTI和整合酶抑制剂均敏感。HIV-2的耐药性可能早于HIV-1的耐药性,并选择在不同位点的突变。错误地将HIV-1阳性或双重感染的患者误诊为HIV-2可能会导致无法检测到的HIV-1RNA导致治疗失败。鉴于迁移到欧盟和北美的西非人数量相对较多,在所有与HIV抗体反应阳性的人中,至少应单独排除一次HIV-2感染或与HIV-1共感染。面对非典型的HIV血清学特征,免疫病毒学断开连接(尽管无法检测到HIV-1病毒血症,CD4细胞计数减少)和/或流行病学风险高(来自HIV-2流行地区的出生或性伴侣),应该强调这一点。由于没有交叉保护作用,在感染了另一种艾滋病毒的人中可能会发生任何艾滋病毒的双重感染。因此,有必要对HIV-1或HIV-2进行更早的抗逆转录病毒治疗,因为它可以保护处于危险中的人免受彼此的过度感染。
更新日期:2020-08-21
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