HIV-2: an overview
Keywords:HIV-2, Raltegravir, Ritonavir boosted Lopinavir
AbstractHIV-2 is much less common compared to HIV-1, has to be confirmed by HIV-2 Western Blot test and is resistant to Efavirinz and Nevirapine. There are two HIV viruses, HIV-1 and HIV-2. HIV-2 is relatively rare in India. The clinical course of HIV-2 infection is slower, plasma HIV-2 RNA levels are lower as compared to HIV-1 infection, but once the illness progresses to AIDS, the course is similar to HIV-1. In few cases, there may be mixed infection with both HIV-1 and HIV-2,but the course of the illness is like in HIV-1 However ,even in mixed infections, one has to give the therapy as we would in isolated HIV-2 infection. In general it is accepted that therapy in cases of HIV-2 infection should be started before there is clinical progression. Studies recommend starting therapy when CD4 count drops below 500. HIV-2 is intrinsically resistant to non-nucleoside reverse transcriptase inhibitors. Therapy in HIV-2 patients should include two nucleoside reverse transcriptase inhibitors plus an HIV-2 active boosted protease inhibitor or integrase strand transfer inhibitors. Monitoring of CD4 cell counts and clinical improvement should be used to assess response to treatment. Drugs used in Government ART centres in India under the umbrella of NACO are Tenofovir 300mg + Lamivudine 300 mg + Lopinavir 200 mg + Ritonavir 50 mg and are observed to be beneficial clinically in terms of weight gain, increase in CD4 levels ,prevention and control of opportunistic infections and improved sense of well-being.
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