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Epidemiology of HIV-2 infection in the U.S, 1996-2006

Epidemiology of HIV-2 infection in the U.S, 1996-2006. Lata Kumar MS, MPH Richard Selik MD Division of HIV/AIDS Prevention National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention

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Epidemiology of HIV-2 infection in the U.S, 1996-2006

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  1. Epidemiology of HIV-2 infectionin the U.S, 1996-2006 Lata Kumar MS, MPH Richard Selik MD Division of HIV/AIDS Prevention National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention 2007 HIV Diagnostics Conference, Dec 5-7, 2007 The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

  2. Outline • Background • Methods • Diagnostic criteria • Results • Discussion • Conclusion • Recommendation

  3. Background

  4. Background • HIV-2 first isolated 1986 – West Africa • HIV-1 and HIV-2 - 60-70% homologous

  5. HIV HIV-1 HIV-2 GroupO GroupN Group M * SubtypesA-G SubtypesA - K *HIV-1, subtype B most common in U.S. HIV Groups and Subtypes

  6. HIV-2 Prevalence Highest in West Africa Ivory Coast Guinea Bissau The Gambia Guinea Senegal

  7. Other Countries Reporting HIV-2 Infections < 1% HIV-2

  8. HIV-2 – Transmission • Same modes of transmission as HIV-1 • Male-to-male sexual contact (MSM) • Injection drug use (IDU) • Both MSM and IDU (MSM/IDU) • High-risk heterosexual contact* (HRH) • Other ' • * Heterosexual contact with a person known to have or to be at high risk for HIV infection • ‘ Includes persons that acquired HIV due to hemophilia or a blood transfusion and person whose risk factor was not reported or identified

  9. HIV-2 – Clinical Aspects • - Less transmissible • - Progresses more slowly to AIDS • - Lower mortality • Source • Marlink R., “Lessons learned from the second AIDS Virus, HIV-2”, AIDS 10: 689-699. 1996

  10. HIV-2 – Risk Factors • Native of West Africa • Sexual contact or needle sharing with • - a person from this endemic region • - a person with known HIV-2 infection • Children of women with or at-risk for HIV-2

  11. Methods

  12. HIV-2 – Surveillance Methods • Laboratory component: • Identify and confirm infections • Interview component: • Determine exposures, risk factors, and country of origin

  13. DataSource • CDC maintains supplemental database for reports on HIV-2 infection to ensure completeness of reporting

  14. Diagnostic Criteria

  15. HIV-2 EIA Indeterminate Indeterminate Positive Positive Negative Negative Repeatedly Reactive Figure 1. Centers for Disease Control/Food and Drug Administration testing algorithm for use with combination HIV-1/HIV-2* enzyme immunoassays(EIAs) • HIV-1/HIV-2 EIA HIV-1 Western Blot@ Report as HIV positive ^ HIV-2 Supplemental Test ( e.g., Western blot) * HIV- human immunodeficiency virus @ An Immunofluoresence assay (IFA) for HIV-1 antibodies has recently been licensed by the Food and Drug Administration and can be used instead of Western blot. Positive and negative IFA results should be interpreted in the same manner as similar results from Western blot tests. An indeterminate IFA should first be tested by Western blot and then as indicated by the Western blot results. ^ Perform HIV-2 EIA only if there is an identified risk factor for HIV-2 infection

  16. notFDA licensed HIV-2 – Laboratory Diagnosis • Screening HIV-1/2 ( EIA) • 2. Perform HIV-1 Western Blot • - Rule out HIV-1 first * • 3. Bio-Rad HIV-1/ HIV-2 Multispot • 4. Detect/Confirm HIV-2 antibodies • - HIV-2 Western blot • - PCR for unique sequences • * HIV-2 antibodies can react with bands on HIV-1

  17. Results

  18. Distribution of HIV-2 cases in the U.S by Country of Birth, 1996-2006 (N=68) Other Countries 2% India 12% India 12% Other Africa 7% East Africa 11% West Africa 66% East Africa 11% West Africa 66%

  19. Distribution of HIV-2 cases among the different regions in the U.S, 1996-2006

  20. Disease category of HIV-2 cases at diagnosis, United States, 1996-2006 • Among the 68 reported • 19 cases had AIDS • 29 cases did not have AIDS • 20 cases did not have sufficient information to know status

  21. Distribution of HIV-2 cases by Race/Ethnicity, United States,1996-2006

  22. Discussion

  23. Discussion • HIV-2 infection continues to be of low prevalence in the U.S • Majority of the cases reported are from persons of West African origin • Diagnosis of HIV-2 continues to be a challenge – absence of FDA approved confirmatory test

  24. Limitation • Incomplete reporting since not all states have reported HIV-2 consistently to CDC? • The total cases here may be an under estimation of the true cases

  25. Conclusion • Although HIV-2 continues to be of low prevalence in the US, monitoring the type of HIV infection needs to continue in the U.S • Since antiretroviral treatment (ARV) is different for HIV-2 infection • Misdiagnosis of HIV-2 to be HIV-1 due to cross-reactivity

  26. Recommendation • When HIV-2 is suspected, the following steps should be followed : • Send specimens to CDC laboratory for confirmation • Contact CDC coordinator for “Cases of Public Health Importance” (COPHI)

  27. Questions ? • Lata Kumar • lkumar@cdc.gov • Tel: 404-639-3893

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