New insights are game-changers in HIV-2 disease management – Authors' reply

Esbjörnsson, Joakim; Månsson, Fredrik; Lindman, Jacob; Rowland‐Jones, Sarah; Jansson, Marianne; Medstrand, Patrik; Norrgren, Hans

doi:10.1016/s2352-3018(19)30089-x

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…However, CD4 + T cell count and clinical monitoring should be used to diagnose treatment failure if VL is not widely available as is the case in Guinea-Bissau [51]. Previous studies from Guinea-Bissau have also shown that both CD4+ T cell counts (particularly CD4 percentages) and VL are strongly correlated with disease progression in both HIV-1 and HIV-2 infection [10,24,33,52]. Immunological treatment failure is common among patients in the Bissau HIV Cohort.…”

Section: Monitoring Of Treatment and Failurementioning

confidence: 99%

“…This is especially true for Guinea-Bissau. Poor adherence, high rates of loss to follow-up, lack of HIV viral load (VL) measurements, lack of reliable diagnostic tests for opportunistic infections, inadequate laboratory facilities (including transportation of reagents and service of equipment) as well as low numbers of sufficiently trained staff are just some of the challenges faced [5][6][7][8][9][10]. The aim of this status article is to give an overview of HIV treatment outcomes in Guinea-Bissau.…”

Section: Introductionmentioning

confidence: 99%

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HIV treatment in Guinea-Bissau: room for improvement and time for new treatment options

et al. 2020

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Despite advances in the treatment quality of HIV throughout the world, several countries are still facing numerous obstacles in delivering HIV treatment at a sufficiently high quality, putting patients’ lives in jeopardy. The aim of this status article is to give an overview of HIV treatment outcomes in the West African country, Guinea-Bissau, and to assess how newer treatment strategies such as long-acting injectable drugs or an HIV cure may limit or stop the HIV epidemic in this politically unstable and low-resource setting. Several HIV cohorts in Guinea-Bissau have been established and are used as platforms for epidemiological, virological, immunological and clinical studies often with a special focus on HIV-2, which is prevalent in the country. The Bandim Health Project, a demographic surveillance site, has performed epidemiological HIV surveys since 1987 among an urban population in the capital Bissau. The Police cohort, an occupational cohort of police officers, has enabled analyses of persons seroconverting with estimated times of seroconversion among HIV-1 and HIV-2-infected individuals, allowing incidence measurements while the Bissau HIV Cohort and a newer Nationwide HIV Cohort have provided clinical data on large numbers of HIV-infected patients. The HIV cohorts in Guinea-Bissau are unique platforms for research and represent real life in many African countries. Poor adherence, lack of HIV viral load measurements, inadequate laboratory facilities, high rates of loss to follow-up, mortality, treatment failure and resistance development, are just some of the challenges faced putting the goal of “90–90–90″ for Guinea-Bissau well out of reach by 2020. Maintaining undetectable viral loads on treatment as a prerequisite of a cure strategy seems not possible at the moment. Thinking beyond one-pill-once-a-day, long-acting antiretroviral treatment options such as injectable drugs or implants may be a better treatment option in settings like Guinea-Bissau and may even pave the way for an HIV cure. If the delivery of antiretroviral treatment in sub-Saharan Africa in a sustainable way for the future should be improved by focusing on existing treatment options or through focusing on new treatment options remains to be determined.

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Section: Monitoring Of Treatment and Failurementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

HIV treatment in Guinea-Bissau: room for improvement and time for new treatment options

et al. 2020

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“…These biases will create a contradiction that will be difficult to adjust for when estimating true disease progression rates. In 2018, data from individuals with an estimated date of infection showed that the disease trajectory was almost identical between HIV-1 and HIV-2 infections, albeit at approximately half the rate among HIV-2 infected individuals [12, 25, 26]. Importantly, this showed that AIDS will develop among the majority of HIV-2 infected individuals without antiretroviral treatment (ART).…”

Section: Hiv-1 and Hiv-2 Epidemiology And Pathogenesismentioning

confidence: 99%

HIV-2 as a model to identify a functional HIV cure

et al. 2019

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Two HIV virus types exist: HIV-1 is pandemic and aggressive, whereas HIV-2 is confined mainly to West Africa and less pathogenic. Despite the fact that it has been almost 40 years since the discovery of AIDS, there is still no cure or vaccine against HIV. Consequently, the concepts of functional vaccines and cures that aim to limit HIV disease progression and spread by persistent control of viral replication without life-long treatment have been suggested as more feasible options to control the HIV pandemic. To identify virus-host mechanisms that could be targeted for functional cure development, researchers have focused on a small fraction of HIV-1 infected individuals that control their infection spontaneously, so-called elite controllers. However, these efforts have not been able to unravel the key mechanisms of the infection control. This is partly due to lack in statistical power since only 0.15% of HIV-1 infected individuals are natural elite controllers. The proportion of long-term viral control is larger in HIV-2 infection compared with HIV-1 infection. We therefore present the idea of using HIV-2 as a model for finding a functional cure against HIV. Understanding the key differences between HIV-1 and HIV-2 infections, and the cross-reactive effects in HIV-1/HIV-2 dual-infection could provide novel insights in developing functional HIV cures and vaccines.

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HIV-2 Infection: Latest Advances

Gunaratne

Gandhi

2019

Curr Treat Options Infect Dis

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New insights are game-changers in HIV-2 disease management – Authors' reply

Cited by 4 publications

References 5 publications

HIV treatment in Guinea-Bissau: room for improvement and time for new treatment options

HIV treatment in Guinea-Bissau: room for improvement and time for new treatment options

HIV-2 as a model to identify a functional HIV cure

HIV-2 Infection: Latest Advances

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