Abstract

BackgroundHuman immunodeficiency virus 2 infection is endemic in West Africa but is also found in parts of Europe, North and South America, and India where it is thought to have been introduced secondary to migration and commercial trade ties. It is less common than Human immunodeficiency virus 1, with differences in pathogenicity, lower rates of transmission, longer asymptomatic period and slower progression to acquired immunodeficiency syndrome. Human immunodeficiency virus 2 is also associated with diagnostic challenges given the lack of commercially available diagnostic tests, and management challenges given intrinsic resistance to many anti-retroviral therapies.Case presentationWe describe a case of a 65 year old South Indian female, visiting her family in Australia, who presented with weight loss, pancytopaenia and generalised lymphadenopathy on a background of newly diagnosed congestive cardiac failure. Multiple investigations were performed to elucidate the cause of her presentation, with the eventual unexpected diagnosis of human immunodeficiency virus 2. She was commenced on anti-retroviral treatment and made a remarkable recovery.ConclusionWe describe the challenges associated with diagnosis of human immunodeficiency virus 2 due to lack of commercially available diagnostics, as well as the treatment and management challenges including the fact that human immunodeficiency virus 2 is intrinsically resistant to non-nucleoside reverse transcriptase inhibitors. Human immunodeficiency virus 2 infection should be considered in patients who present with symptoms and signs that do not point towards a clear diagnosis, such as unexplained pancytopaenia or lymphadenopathy, and who have risk factors such as being from an endemic area or having had blood transfusions, especially prior to the commencement of blood-borne virus screening of blood donors.

Highlights

  • Human immunodeficiency virus 2 infection is endemic in West Africa but is found in parts of Europe, North and South America, and India where it is thought to have been introduced secondary to migration and commercial trade ties

  • We describe the challenges associated with diagnosis of human immunodeficiency virus 2 due to lack of commercially available diagnostics, as well as the treatment and management challenges including the fact that human immunodeficiency virus 2 is intrinsically resistant to non-nucleoside reverse transcriptase inhibitors

  • Human immunodeficiency virus 2 infection should be considered in patients who present with symptoms and signs that do not point towards a clear diagnosis, such as unexplained pancytopaenia or lymphadenopathy, and who have risk factors such as being from an endemic area or having had blood transfusions, especially prior to the commencement of blood-borne virus screening of blood donors

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Summary

Conclusion

In conclusion HIV-2 infection was an unexpected diagnosis in Mrs M.R, with the only risk factors identified being a blood transfusion in 1991 and being from India where HIV-2 is not uncommon. Management of HIV-2 differs from HIV-1; NNRTIs and fusion inhibitors cannot be used, and current guidelines recommend the use of 2 NRTIs and a boosted PI or INSTI. This case highlights the importance of undertaking HIV testing in patients with a constellation of symptoms and signs that do not point towards a clear diagnosis and to consider HIV-2 in patients who come from an endemic area or have other risk factors such as blood transfusions and sexual contact with someone from an endemic area. Author details 1 Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg, VIC, Australia.

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