British HIV Association guidelines for the management of HIV‐2 2021

Reeves, Iain; Cromarty, Ben; Deayton, Jane R; Dhairyawan, Rageshri; Kidd, Mike; Taylor, Chris; Thornhill, John; Tickell‐Painter, Maya; Halsema, Clare van

doi:10.1111/hiv.13204

Cited by 10 publications

(11 citation statements)

References 133 publications

(209 reference statements)

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“…Resistance testing was not always done at baseline and at virological failure. Many factors limit availability of resistance testing, including a significant minority having an undetectable viral load, limited availability 7 and a relatively high limit of quantification (≥500 copies/ml). 7 However, there remained several individuals for whom resistance testing was not performed despite these factors, some of whom subsequently experienced virological failure.…”

Section: Discussionmentioning

confidence: 99%

“…The 2010 guideline has now been replaced by the BHIVA guidelines for the management of HIV-2, 2021. 7 ART is now recommended for all individuals living with HIV-2, regardless of CD4 count and viral load. Most individuals living with HIV-2 in the UK have already initiated ART, with the commonest indications being clinical disease and pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…The 2010 guideline has now been replaced by the BHIVA guidelines for the management of HIV-2, 2021. 7…”

Section: Discussionmentioning

confidence: 99%

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A national audit of the management of HIV-2 in adults in the UK

et al. 2022

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Background HIV-2 is rare in the UK. Many UK centres therefore only treat small numbers of people and there are few clinical trials to guide treatment. The British HIV Association (BHIVA) 2010 guidelines for management of HIV-2 formed the basis for this national audit, which aims to describe current practice and adherence to guidelines. Methods All UK centres providing HIV care were contacted via the BHIVA “Members Matters” newsletter, and asked to submit anonymised, retrospective data for individuals living with HIV-2 accessing care at their service. Results Thirty-five sites responded and data were analysed for 167 individuals. Nearly half of individuals accessed care at one of four large London centres (77/167, 46%). Most people living with HIV-2 have taken antiretroviral therapy (ART) (132/167, 79%). The most common reasons for initiating treatment were clinical disease (34/89, 38%) and pregnancy (11/89, 12%). Most treatment-naïve individuals were initiated on a protease inhibitor based regimen (70/89, 79%). The use of integrase strand transfer inhibitor based regimens has increased over time. A significant minority of patients did not have baseline drug resistance testing performed, despite having a detectable viral load (15/52, 29%). Virological failure occurred in a minority of individuals (21/132, 16%); the most common drug regimen change in this context was the addition of an integrase strand transfer inhibitor (12/26 regimen changes, 46%). Conclusions Most individuals living with HIV-2 were managed according to national guidance, with key areas for improvement including the choice of ART, drug resistance testing and the management of virological failure. It is hoped that this national audit, performed in conjunction with the updated 2021 BHIVA guidelines will improve the care of individuals living with HIV-2 in the UK.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A national audit of the management of HIV-2 in adults in the UK

et al. 2022

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“…Therefore, the use of ENF and NNRTI is not recommended in HIV-2 patients and is only limited to HIV-1 52 ENF; however, it is not extensively used in HIV guidelines and is not recommended for HIV-1 initial therapy. 53 ENF displays a relatively low volume of distribution, inadequate systemic clearance, and a high degree of protein binding in the plasma.…”

Section: Fusion Inhibitorsmentioning

confidence: 99%

“…Contrary to this, patients with HIV‐2 are intrinsically resistant to ENF. Therefore, the use of ENF and NNRTI is not recommended in HIV‐2 patients and is only limited to HIV‐1 52 ENF; however, it is not extensively used in HIV guidelines and is not recommended for HIV‐1 initial therapy 53 …”

Section: Current Hiv‐1 Anti‐retrovirals and The Mechanisms Of Actionmentioning

confidence: 99%

Pharmacological advances in anti‐retroviral therapy for human immunodeficiency virus‐1 infection: A comprehensive review

Azzman,

Gill,

Hassan

et al. 2024

Reviews in Medical Virology

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The discovery of anti‐retroviral (ARV) drugs over the past 36 years has introduced various classes, including nucleoside/nucleotide reverse transcriptase inhibitors, non‐nucleoside reverse transcriptase inhibitors, protease inhibitor, fusion, and integrase strand transfer inhibitors inhibitors. The introduction of combined highly active anti‐retroviral therapies in 1996 was later proven to combat further ARV drug resistance along with enhancing human immunodeficiency virus (HIV) suppression. As though the development of ARV therapies was continuously expanding, the variation of action caused by ARV drugs, along with its current updates, was not comprehensively discussed, particularly for HIV‐1 infection. Thus, a range of HIV‐1 ARV medications is covered in this review, including new developments in ARV therapy based on the drug's mechanism of action, the challenges related to HIV‐1, and the need for combination therapy. Optimistically, this article will consolidate the overall updates of HIV‐1 ARV treatments and conclude the significance of HIV‐1‐related pharmacotherapy research to combat the global threat of HIV infection.

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Clinical Outcomes of Integrase Strand Transfer Inhibitors Containing Antiretroviral Therapy in HIV-2: A Narrative Review

Boschloo,

van Welzen

2024

Infect Dis Ther

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The human immunodeficiency virus type 2 (HIV-2) is a particular subtype of HIV, which is endemic in West Africa and is characterized by a more indolent course than HIV-1. As people living with HIV-2 (PWH-2) are at risk for the development of acquired immunodeficiency syndrome and can transmit the virus, antiretroviral therapy is usually indicated. However, the optimal treatment of HIV-2 is unknown and historically the protease inhibitors (PIs) were a regular part of therapy. Nowadays, the use of integrase strand transfer inhibitors (INSTIs) in HIV-2 is increasing but the evidence supporting this approach is limited. In this narrative review, we outline the clinical data on the use of INSTI-containing antiretroviral therapy in HIV-2. We found that in the setting of treatment-naïve PWH-2, the use of INSTIs is successful, but also noted large heterogeneity in reported outcomes and that most cohorts are small with limited follow-up time. There is a lack of studies comparing the efficacy of INSTIs to other first-line options. For treatment-experienced PWH-2, the efficacy of INSTI is highly variable.

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British HIV Association guidelines for the management of HIV‐2 2021

Cited by 10 publications

References 133 publications

A national audit of the management of HIV-2 in adults in the UK

A national audit of the management of HIV-2 in adults in the UK

Pharmacological advances in anti‐retroviral therapy for human immunodeficiency virus‐1 infection: A comprehensive review

Clinical Outcomes of Integrase Strand Transfer Inhibitors Containing Antiretroviral Therapy in HIV-2: A Narrative Review

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