Trends in HIV-2 Diagnoses and Use of the HIV-1/HIV-2 Differentiation Test — United States, 2010–2017

Peruski, Anne Harwood; Wesolowski, Laura G.; Delaney, Kevin P.; Chavez, Pollyanna R; Owen, S. Michele; Granade, Timothy C.; Sullivan, Vickie; Switzer, William M.; Dong, Xiao-yuan; Brooks, John T.; Joyce, Mary

doi:10.15585/mmwr.mm6903a2

Cited by 26 publications

(20 citation statements)

References 6 publications

(5 reference statements)

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“…There are 2 genetically different subtypes of HIV, HIV‐1 and HIV‐2. HIV‐1 accounts for the vast majority of HIV infections worldwide and more than 99% of the HIV infections within the United States, whereas HIV‐2 is endemic to West Africa 13 . Both subtypes are transmitted through blood, sexual contact, and perinatally via vertical transmission; if untreated, both types of HIV infection will eventually lead to AIDS.…”

Section: Hiv: An Overviewmentioning

confidence: 99%

Pre‐Exposure Prophylaxis for HIV Infection and the Role of the Women's Health Care Provider in HIV Prevention

Ruppe

Spencer

Kriebs³

2021

J Midwife Womens Health

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HIV infection is a major public health problem for women in the United States. Prevention of new HIV infections is essential to the goal of eliminating HIV in the United States. Pre‐exposure prophylaxis (PrEP) is an effective and safe HIV prevention method recommended for women at increased risk for HIV infection, including during pregnancy and lactation. The recommended PrEP regimen is a fixed‐dose combination of tenofovir disoproxil fumarate and emtricitabine administered as a single daily dose. The initial evaluation for individuals desiring PrEP for HIV prevention includes obtaining a history, laboratory evaluation, and evaluation of the accessibility and acceptability of PrEP. Individuals using PrEP medications are seen every 3 months for follow‐up. These follow‐up visits include evaluation for signs and symptoms of seroconversion, management of side effects and adverse reactions, and evaluation of adherence to PrEP. Follow‐up visits also include testing for HIV, sexually transmitted infections, and renal function and a review of HIV prevention and risk reduction methods. Despite known safety and efficacy of PrEP among women, PrEP use in women in the United States remains low. Gaps exist in HIV prevention that can in part be addressed by women's health care providers through risk screening and provision of HIV prevention methods. All providers of comprehensive sexual health care can and should assess individuals for risk factors for HIV infection and offer HIV prevention methods, including PrEP, to individuals at risk for HIV.

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Section: Hiv: An Overviewmentioning

confidence: 99%

Pre‐Exposure Prophylaxis for HIV Infection and the Role of the Women's Health Care Provider in HIV Prevention

Ruppe

Spencer

Kriebs³

2021

J Midwife Womens Health

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“…Correct diagnosis of HIV-2 infections is clinically important given the varying clinical courses of these infections and because some antiretroviral agents effective against HIV-1 are not effective against HIV-2. In the USA, a testing algorithm is used to distinguish HIV-1 and HIV-2 [65,66], in which diagnostic tests, to detect HIV-2 infection, use fourth-generation immunoassays that incorporate specific antigens to detect antibodies directed against both HIV-1 and HIV-2. When HIV-1/HIV-2 immunoassays are repeatedly reactive and positive for both the HIV-1 and HIV-2 antibody (so-called HIV untypable or undifferentiated), the WHO and CDC also recommend the use of specific testing for HIV-2 for specimens with negative or indeterminate HIV-1 western blot results, such as nucleic acid-based differential testing.…”

Section: Testingmentioning

confidence: 99%

“…When HIV-1/HIV-2 immunoassays are repeatedly reactive and positive for both the HIV-1 and HIV-2 antibody (so-called HIV untypable or undifferentiated), the WHO and CDC also recommend the use of specific testing for HIV-2 for specimens with negative or indeterminate HIV-1 western blot results, such as nucleic acid-based differential testing. However, due to the absence of the US Food and Drug Administration (FDA)-approved nucleic acid test (NAT) confirming HIV-2 infection, samples are not clearly addressed in the algorithm [66].…”

Section: Testingmentioning

confidence: 99%

Human Immunodeficiency Virus Type 2: The Neglected Threat

et al. 2021

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West Africa has the highest prevalence of human immunodeficiency virus (HIV)-2 infection in the world, but a high number of cases has been recognized in Europe, India, and the United States. The virus is less transmissible than HIV-1, with sexual contacts being the most frequent route of acquisition. In the absence of specific antiretroviral therapy, most HIV-2 carriers will develop AIDS. Although, it requires more time than HIV-1 infection, CD4+ T cell decline occurs more slowly in HIV-2 than in HIV-1 patients. HIV-2 is resistant to non-nucleoside reverse transcriptase inhibitors (NNRTIs) and some protease inhibitors. Misdiagnosis of HIV-2 in patients mistakenly considered HIV-1-positive or in those with dual infections can cause treatment failures with undetectable HIV-1 RNA. In this era of global integration, clinicians must be aware of when to consider the diagnosis of HIV-2 infection and how to test for this virus. Although there is debate regarding when therapy should be initiated and which regimen should be chosen, recent trials have provided important information on treatment options for HIV-2 infection. In this review, we focus mainly on data available and on the insight they offer about molecular epidemiology, clinical presentation, antiretroviral therapy, and diagnostic tests of HIV-2 infection.

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“…Coinfection has no effect on the rate of progression to AIDS, but does complicate viral load monitoring and antiviral treatment (2,3). As HIV-2 has spread outside of West Africa, the United States Centers for Disease Control and Prevention (CDC) algorithm for HIV diagnosis includes testing for HIV-2 antibodies to enable differentiation from HIV-1 infections (5,6).…”

Section: Introductionmentioning

confidence: 99%

“…Coinfection has no effect on the rate of progression to AIDS but does complicate viral load monitoring and antiviral treatment ( 1 , 2 ). As HIV-2 has spread outside West Africa, the U.S. Centers for Disease Control and Prevention (CDC) algorithm for HIV diagnosis includes testing for HIV-2 antibodies to enable differentiation from HIV-1 infections ( 4 , 5 ). The European guidelines on HIV testing and several European country guidelines also recommend differentiation between HIV-1 and HIV-2 ( 6 – 8 ).…”

Section: Introductionmentioning

confidence: 99%

An HIV Diagnostic Testing Algorithm Using the cobas HIV-1/HIV-2 Qualitative Assay for HIV Type Differentiation and Confirmation

Duncan

Krämer

et al. 2021

J Clin Microbiol

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HIV-1 and HIV-2 diagnostic testing algorithms recommended by the Centers for Disease Control involve up to three tests and rely mostly on detection of viral antigen and host antibody responses. HIV-1 p24 antigen/HIV-1/2 antibody reactive specimens are confirmed with an immunochromatographic HIV-1/HIV-2 antibody differentiation assay and negative or indeterminate results from the differentiation assay are resolved by an HIV-1-specific nucleic acid amplification test (NAT). The performance of a proposed alternative algorithm using the cobas HIV-1/HIV-2 Qualitative NAT as the differentiation assay was evaluated in subjects known to be infected with HIV-1 (N=876) or HIV-2 (N=139), at low (N=6017) or high (N=1020) risk of HIV-1 infection, or at high-risk for HIV-2 infection (N=498) (Study A). The performance of the cobas HIV-1/HIV-2 Qualitative test was also evaluated by comparison to an HIV-1 or HIV-2 alternative NAT (Study B). The HIV-1 and HIV-2 overall percent agreements (OPA) in Study A ranged from 95%-100% in all groups. The positive percent agreements (PPA) for HIV-1 and HIV-2 were 100% (876/876) and 99.4% (167/168) respectively for known positive groups. The negative percent agreement in the HIV low-risk group was 100% for both HIV-1 and HIV-2. In Study B, the HIV-1 and HIV-2 OPA ranged from 99%-100% in all groups evaluated (N: 183 to 1030), and the PPA for HIV-1 and HIV-2 were 100% and 99.5% respectively for known positive groups. The cobas HIV-1/HIV-2 Qualitative Assay can discriminate between HIV-1 and HIV-2 based on HIV RNA, and can be included in an alternative diagnostic algorithm for HIV.

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Trends in HIV-2 Diagnoses and Use of the HIV-1/HIV-2 Differentiation Test — United States, 2010–2017

Abstract: * A positive quantitative or qualitative nucleic acid test result or molecular sequence data for an HIV-1 genotypic drug-resistance test.

Cited by 26 publications

References 6 publications

Pre‐Exposure Prophylaxis for HIV Infection and the Role of the Women's Health Care Provider in HIV Prevention

Pre‐Exposure Prophylaxis for HIV Infection and the Role of the Women's Health Care Provider in HIV Prevention

Human Immunodeficiency Virus Type 2: The Neglected Threat

An HIV Diagnostic Testing Algorithm Using the cobas HIV-1/HIV-2 Qualitative Assay for HIV Type Differentiation and Confirmation

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