HIV-2 diagnosis and quantification in high-risk patients

Philip A Chan,Timothy Flanigan,Sarah E Wakeman,Erna Kojic,Rami Kantor,Susan Cu-Uvin

doi:10.1186/1742-6405-5-18

Abstract

Current diagnostic assays for HIV-1 do not always test for the presence of HIV-2 in the United States. We present the case of a patient from Cape Verde, who was admitted to our hospital with rapidly deteriorating neurological function and multiple white matter lesions on MRI likely secondary to progressive multifocal leukoencephalopathy (PML). Initially, the patient had a positive EIA for HIV, but a negative HIV-1 Western Blot and no viral load detected on a branched-DNA assay. A repeat viral load by reverse transcriptase methodology (RT-DNA) detected 121,000 copies and an HIV-2 Western Blot was positive. The case highlights an extremely rare presentation of HIV-2 with severe neurological disease. We discuss the different tests available for the diagnosis and monitoring of HIV-2 in the United States.

Highlights

HIV-2, the second AIDS-causing virus, is found predominantly in the Portuguese speaking countries of West Africa, with the highest rates of infection in Guinea-Bissau [1]
We present the case of a patient of Cape Verdean descent with likely progressive multifocal leukoencephalopathy (PML) in the setting of HIV-2, and discuss the difficulties of diagnosing HIV-2 in the United States
We present a case report of an unusual and challenging diagnosis of HIV-2 in the United States

Summary

Background

HIV-2, the second AIDS-causing virus, is found predominantly in the Portuguese speaking countries of West Africa, with the highest rates of infection in Guinea-Bissau [1]. The patient took no medications and was born in Cape Verde, immigrating to the United States six years earlier While he admitted to having multiple recent female sexual partners, he denied any drug use or any male sexual partners. Based on the patient's clinical history, CD4 count, positive EIA, and recent immigration from Western Africa, it was felt that the patient was most likely suffering from an HIV-related neurological process. He was started on the anti-retroviral regimen of ritonavirboosted atazanavir (ATV), tenofovir (TDF), and emtricitabine (FTC), and a plasma viral load was sent. The patient was discharged on HAART in stable condition, but with persistent neurological deficits

Discussion

Factsheet C

Findings

DeParle J