Abstract
Human immunodeficiency virus 2 (HIV-2) is found predominantly in West Africa. It is not unlikely, however, that HIV-2 may also be found in South Africa, due to the influx of immigrants into this country. It is important to distinguish between HIV-1 and HIV-2 since the clinical courses and treatment responses of these viruses are different. Routine serological methods for diagnosing HIV do not differentiate between HIV-1 and -2 infections, while rapid tests, viral load quantification and PCR are HIV-type--specific. The objective of this study was to describe the seroprevalence and molecular epidemiology of HIV-2 in KwaZulu-Natal, one of the regions with the highest HIV prevalence in the world and home of the two largest harbors in South Africa. HIV-1 positive samples were screened for antibodies against HIV-2, using a rapid test. The confirmation of HIV-2 positive samples was done by PCR. Of the 2,123 samples screened, 319 (15%) were identified as positive by the rapid test. None of these samples were confirmed positive by PCR. To explore this discrepancy in the results, a subset (n = 52) of the rapid HIV-2 positive samples was subjected to Western blotting. Thirty-seven (71%) of these were positive, yielding an overall HIV-2 seroprevalence of 10.6%. Three out of 28 (10.7%) Western blot positive samples were positive by a Pepti-LAV assay. This discrepancy between serological and molecular confirmation may be attributed to non-specific or cross-reacting antibodies. The use of rapid tests and Western blots for HIV-2 diagnosis in South Africa should be interpreted with caution.
Highlights
While the human immunodeficiency virus (HIV) type 1 is predominant worldwide, Human immunodeficiency virus 2 (HIV-2) is concentrated mainly in West Africa [Zeh et al, 2005]
There is no information on the prevalence of HIV-2 in South Africa which has the highest prevalence of HIV-1 in the world, with KwaZulu-Natal being the province which is affected the worst [UNAIDS, 2010]
Selected HIV-2 Western blot results are shown in Figure 2, in which a clear reactivity to both gp36 and gp125/gp105 env antigens of HIV-2 was observed for sample 51
Summary
While the human immunodeficiency virus (HIV) type 1 is predominant worldwide, HIV-2 is concentrated mainly in West Africa [Zeh et al, 2005]. It is quite possible that HIV-2 is present in South Africa in view of the high levels of immigration to the country [Anonymous, 2011] and the fact that approximately 3–4% of the total national population is foreign [Polzer, 2010]. KwaZulu-Natal hosts the two largest harbors in the country (Durban and Richards Bay), which are the point of entry for an increasing number of foreign individuals [Young, 2012]. HIV-2 cases have been reported in Europe, India, and the United States, as well as areas with historical and socio-economic ties to West Africa. There is no information on the prevalence of HIV-2 in South Africa which has the highest prevalence of HIV-1 in the world, with KwaZulu-Natal being the province which is affected the worst [UNAIDS, 2010]. The epidemic in South Africa is dominated by subtype C
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