1
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Reeves I, Cromarty B, Deayton J, Dhairyawan R, Kidd M, Taylor C, Thornhill J, Tickell-Painter M, van Halsema C. British HIV Association guidelines for the management of HIV-2 2021. HIV Med 2021; 22 Suppl 4:1-29. [PMID: 34927347 DOI: 10.1111/hiv.13204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Iain Reeves
- Consultant in HIV Medicine, Homerton University Hospital NHS Trust, London, UK
| | | | - Jane Deayton
- Clinical Senior Lecturer in HIV, Barts and the London, Queen Mary University of London, London, UK
| | - Rageshri Dhairyawan
- Consultant in Sexual Health and HIV Medicine, Barts Health NHS Trust, London, UK
| | - Mike Kidd
- Consultant Virologist, National Infection Service, Public Health England, UK
| | - Chris Taylor
- Consultant Physician Sexual Health and HIV, Kings College Hospital, London, UK
| | - John Thornhill
- Consultant in Sexual Health and HIV Medicine, Barts Health NHS Trust, London, UK
| | - Maya Tickell-Painter
- Specialist Registrar in Infectious Diseases and Microbiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Clare van Halsema
- Consultant in Infectious Diseases, North Manchester General Hospital, Manchester, UK
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2
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Ceccarelli G, Giovanetti M, Sagnelli C, Ciccozzi A, d’Ettorre G, Angeletti S, Borsetti A, Ciccozzi M. Human Immunodeficiency Virus Type 2: The Neglected Threat. Pathogens 2021; 10:pathogens10111377. [PMID: 34832533 PMCID: PMC8621479 DOI: 10.3390/pathogens10111377] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/15/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
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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Affiliation(s)
- Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (G.C.); (G.d.)
| | - Marta Giovanetti
- Laboratório de Flavivírus, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, Brazil;
- Laboratório de Genética Celular e Molecular, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Caterina Sagnelli
- Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy;
| | - Alessandra Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, 00100 Rome, Italy;
| | - Gabriella d’Ettorre
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (G.C.); (G.d.)
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, 00100 Rome, Italy;
| | - Alessandra Borsetti
- National HIV/AIDS Research Center, Istituto Superiore di Sanità, 00100 Rome, Italy;
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, 00100 Rome, Italy;
- Correspondence: ; Tel.: +39-06-22541-9187
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3
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Troyano-Hernáez P, Reinosa R, Burgos MC, Holguín Á. Short Communication: Update in Natural Antiretroviral Resistance-Associated Mutations Among HIV Type 2 Variants and Discrepancies Across HIV Type 2 Resistance Interpretation Tools. AIDS Res Hum Retroviruses 2021; 37:793-795. [PMID: 33586996 DOI: 10.1089/aid.2020.0180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
HIV variants carry natural polymorphisms related to drug resistance (R-markers) fixed during viral evolution in the absence of antiretroviral therapy (ART) that may impact on drug susceptibility and resistance pathways. We aimed to identify the HIV type 2 (HIV-2) variant-specific R-markers at Pol in all available sequences from ART-naive subjects deposited in Los Alamos database according to reported HIV-2 drug resistance-associated mutations (DRMs) and report the performance of two online HIV-2 resistance interpretation tools (HIV2EU Tool and Stanford HIVdb Program for HIV-2) to detect them. From a total of 587 sequences, we found 23 R-markers in low frequency, in groups A, B, and G. Four were present in >10% of the sequences with no direct impact on antiretroviral susceptibility. HIV2EU Tool detected one, whereas Stanford program all four. Stanford new tool, although still under development, seems effective in detecting HIV-2 DRMs and may prove a useful tool for HIV-2 resistance interpretation when fully developed.
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Affiliation(s)
- Paloma Troyano-Hernáez
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology and Parasitology, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, CIBER en Epidemiología y Salud Pública (CIBERESP), Red en Investigación Translacional en Infecciones Pediátricas (RITIP), Madrid, Spain
| | - Roberto Reinosa
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology and Parasitology, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, CIBER en Epidemiología y Salud Pública (CIBERESP), Red en Investigación Translacional en Infecciones Pediátricas (RITIP), Madrid, Spain
| | - María Concepción Burgos
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology and Parasitology, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, CIBER en Epidemiología y Salud Pública (CIBERESP), Red en Investigación Translacional en Infecciones Pediátricas (RITIP), Madrid, Spain
| | - África Holguín
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology and Parasitology, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, CIBER en Epidemiología y Salud Pública (CIBERESP), Red en Investigación Translacional en Infecciones Pediátricas (RITIP), Madrid, Spain
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4
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Berzow D, Descamps D, Obermeier M, Charpentier C, Kaiser R, Guertler L, Eberle J, Wensing A, Sierra S, Ruelle J, Gomes P, Mansinho K, Taylor N, Jensen B, Döring M, Stürmer M, Rockstroh J, Camacho R. Human Immunodeficiency Virus-2 (HIV-2): A Summary of the Present Standard of Care and Treatment Options for Individuals Living with HIV-2 in Western Europe. Clin Infect Dis 2021; 72:503-509. [PMID: 32227124 DOI: 10.1093/cid/ciaa275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/12/2020] [Indexed: 11/13/2022] Open
Abstract
Human immunodeficiency virus-2 (HIV-2) is endemic in some countries in West Africa. Due to the lower prevalence in industrialized countries, there is limited experience and knowledge on the management of individuals living with HIV-2 in Europe. Compared to HIV-1, there are differential characteristics of HIV-2 regarding diagnostic procedures, the clinical course, and, most importantly, antiretroviral therapy. We integrated the published literature on HIV-2 (studies and reports on epidemiology, diagnostics, the clinical course, and treatment), as well as expert experience in diagnosing and clinical care, to provide recommendations for a present standard of medical care of those living with HIV-2 in Western European countries, including an overview of strategies for diagnosis, monitoring, and treatment, with suggestions for effective drug combinations for first- and second-line treatments, post-exposure prophylaxis, and the prevention of mother-to-child transmission, as well as listings of mutations related to HIV-2 drug resistance and C-C motif chemokine receptor type 5 and C-X-C motif chemokine receptor type 4 coreceptor tropism.
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Affiliation(s)
- Dirk Berzow
- Praxis for Infectiology, Hamburg, Germany.,Deutsche Arbeitsgemeinschaft niedergelassener Ärzte in der Versorgung HIV-Infizierter (DAGNAE) Berlin, Germany
| | - Diane Descamps
- Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Paris, France.,Université de Paris, Institut national de la santé et de la recherche médicale (INSERM), Unité mixte de recherche (UMR),1137, Laboratory Infection, Antimicrobials, Modelling, Evolution (IAME), Paris, France
| | - Martin Obermeier
- Deutsche Arbeitsgemeinschaft niedergelassener Ärzte in der Versorgung HIV-Infizierter (DAGNAE) Berlin, Germany.,Medical Center for Infectious Diseases, Berlin, Germany.,Gesellschaft für Virologie e.V., Freiburg, Germany
| | - Charlotte Charpentier
- Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Paris, France.,Université de Paris, Institut national de la santé et de la recherche médicale (INSERM), Unité mixte de recherche (UMR),1137, Laboratory Infection, Antimicrobials, Modelling, Evolution (IAME), Paris, France
| | - Rolf Kaiser
- Gesellschaft für Virologie e.V., Freiburg, Germany.,Institute of Virology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,German AIDS Society (Deutsche AIDS-Gesellschaft, DAIG), Hamburg, Germany.,Paul-Ehrlich-Gesellschaft für Chemotherapie, Rheinbach, Germany
| | - Lutz Guertler
- Gesellschaft für Virologie e.V., Freiburg, Germany.,German AIDS Society (Deutsche AIDS-Gesellschaft, DAIG), Hamburg, Germany.,National Reference Center for Retroviruses, Max von Pettenkofer Institute for Hygiene and Medical Microbiology, University of Munich, Munich, Germany
| | - Josef Eberle
- Gesellschaft für Virologie e.V., Freiburg, Germany.,German AIDS Society (Deutsche AIDS-Gesellschaft, DAIG), Hamburg, Germany.,National Reference Center for Retroviruses, Max von Pettenkofer Institute for Hygiene and Medical Microbiology, University of Munich, Munich, Germany
| | - Annemarie Wensing
- European AIDS Clinical Society, Brussels, Belgium.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Saleta Sierra
- Institute of Virology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Jean Ruelle
- Laboratories Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Perpetua Gomes
- Instituto Universitário Egas Moniz, Lisboa, Portugal.,Molecular Biology Laboratory, Laboratório de Biologia Molecular, Centro Hospitalar de Lisboa Ocidental, Egas Moniz Hospital, Lisboa, Portugal
| | - Kamal Mansinho
- Centro Hospitalar de Lisboa Occidental, Hospital de Egas Moniz, Lisboa, Portugal
| | - Ninon Taylor
- Third Medical Department with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Björn Jensen
- Paul-Ehrlich-Gesellschaft für Chemotherapie, Rheinbach, Germany.,Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine University Hospital, Düsseldorf, Germany
| | - Matthias Döring
- Department for Computational Biology and Applied Algorithmics, Max-Planck Institute for Informatics, Saarland Informatics Campus, Saarbrücken, Germany
| | - Martin Stürmer
- Medizinisches Versorgungszentrum, Frankfurt am Main, Germany
| | - Jürgen Rockstroh
- European AIDS Clinical Society, Brussels, Belgium.,Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | - Ricardo Camacho
- Katholieke Universiteit, Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Leuven, Belgium
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5
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Shepherd SJ, Sykes C, Jackson C, Bell DJ, Gunson RN. The first case of HIV-2 in Scotland. Access Microbiol 2020; 2:acmi000087. [PMID: 32974567 PMCID: PMC7470315 DOI: 10.1099/acmi.0.000087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/15/2019] [Indexed: 12/25/2022] Open
Abstract
HIV-1 infects an estimated 37 million people worldwide, while the rarer HIV-2 infects 1–2 million worldwide. HIV-2 is mainly restricted to West African countries. The majority of patients in Scotland are diagnosed with HIV-1, but in 2013 the West of Scotland Specialist Virology Centre (WoSSVC) diagnosed Scotland’s first HIV-2 positive case in a patient from Côte d’Ivoire. HIV-2 differs from HIV-1 in terms of structural viral proteins, viral transmissibility, prolonged period of latency, intrinsic resistance to certain antivirals and how to monitor the effectiveness of treatment. Over the course of 5 years the patient has required several changes in treatment due to both side effects and pill burden. This case highlights the complexity of HIV-2 patient management over time.
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Affiliation(s)
- S J Shepherd
- West of Scotland Specialist Virology Centre, Level 5 New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, G31 2ER, UK
| | - C Sykes
- Infectious Diseases Unit, The Brownlee Centre, Gartnavel General Hospital, Glasgow G12 0YN, UK
| | - C Jackson
- West of Scotland Specialist Virology Centre, Level 5 New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, G31 2ER, UK
| | - D J Bell
- Infectious Diseases Unit, The Brownlee Centre, Gartnavel General Hospital, Glasgow G12 0YN, UK
| | - R N Gunson
- West of Scotland Specialist Virology Centre, Level 5 New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, G31 2ER, UK
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6
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Requena S, Lozano AB, Caballero E, García F, Nieto MC, Téllez R, Fernández JM, Trigo M, Rodríguez-Avial I, Martín-Carbonero L, Miralles P, Soriano V, de Mendoza C. Clinical experience with integrase inhibitors in HIV-2-infected individuals in Spain. J Antimicrob Chemother 2020; 74:1357-1362. [PMID: 30753573 DOI: 10.1093/jac/dkz007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/26/2018] [Accepted: 12/31/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND HIV-2 is a neglected virus despite estimates of 1-2 million people being infected worldwide. The virus is naturally resistant to some antiretrovirals used to treat HIV-1 and therapeutic options are limited for patients with HIV-2. METHODS In this retrospective observational study, we analysed all HIV-2-infected individuals treated with integrase strand transfer inhibitors (INSTIs) recorded in the Spanish HIV-2 cohort. Demographics, treatment modalities, laboratory values, quantitative HIV-2 RNA and CD4 counts as well as drug resistance were analysed. RESULTS From a total of 354 HIV-2-infected patients recruited by the Spanish HIV-2 cohort as of December 2017, INSTIs had been given to 44, in 18 as first-line therapy and in 26 after failing other antiretroviral regimens. After a median follow-up of 13 months of INSTI-based therapy, undetectable viraemia for HIV-2 was achieved in 89% of treatment-naive and in 65.4% of treatment-experienced patients. In parallel, CD4 gains were 82 and 126 cells/mm3, respectively. Treatment failure occurred in 15 patients, 2 being treatment-naive and 13 treatment-experienced. INSTI resistance changes were recognized in 12 patients: N155H (5), Q148H/R (3), Y143C/G (3) and R263K (1). CONCLUSIONS Combinations based on INSTIs are effective and safe treatment options for HIV-2-infected individuals. However, resistance mutations to INSTIs are selected frequently in failing patients, reducing the already limited treatment options.
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Affiliation(s)
- S Requena
- Puerta de Hierro University Hospital and Research Institute, Madrid, Spain
| | | | | | - F García
- Hospital Universitario San Cecilio, Instituto de Investigación Ibs, Granada, Spain
| | | | - R Téllez
- Fundación Jiménez-Díaz, Madrid, Spain
| | | | - M Trigo
- Complejo Hospitalario, Pontevedra, Spain
| | | | | | - P Miralles
- Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - V Soriano
- Hospital Universitario La Paz, Madrid, Spain.,UNIR Health Sciences School, Madrid, Spain
| | - C de Mendoza
- Puerta de Hierro University Hospital and Research Institute, Madrid, Spain.,Universidad San Pablo CEU, Madrid, Spain
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7
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Le Hingrat Q, Collin G, Lê M, Peytavin G, Visseaux B, Bertine M, Tubiana R, Karmochkine M, Valin N, Collin F, Lemaignen A, Bernard L, Damond F, Matheron S, Descamps D, Charpentier C. A New Mechanism of Resistance of Human Immunodeficiency Virus Type 2 to Integrase Inhibitors: A 5-Amino-Acid Insertion in the Integrase C-Terminal Domain. Clin Infect Dis 2020; 69:657-667. [PMID: 30383215 DOI: 10.1093/cid/ciy940] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/30/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Integrase strand transfer inhibitors (INSTIs) are crucial for the treatment of human immunodeficiency virus (HIV) type 2 infection, due to limited available therapeutic options. Recently, bictegravir has been approved for HIV-1, but no data are currently available for HIV-2. METHODS We assessed the phenotypic susceptibility of 12 HIV-2 clinical isolates, obtained from 2 antiretroviral-naive and 10 antiretroviral-experienced patients, to 5 INSTIs (bictegravir, cabotegravir, dolutegravir, elvitegravir, and raltegravir) at the virological failure of an INSTI-based regimen. The 50% inhibitory concentrations (IC50s) were determined. Phenotypic inhibitory quotients were determined using trough INSTI plasma concentrations. RESULTS Wild-type viruses were susceptible to the 5 INSTIs, with IC50s in the nanomolar range. Bictegravir had a lower IC50 than the other INSTIs on those HIV-2 isolates bearing major, resistance-associated mutations (codons 143, 148, and 155). We identified a new resistance profile-a 5-amino-acid insertion at codon 231 of the HIV-2 integrase (231INS)-in 6 patients at the virological failure of a raltegravir-based regimen. Those patients had adequate raltegravir concentrations, but harbored multiresistant viruses with low genotypic susceptibility scores (median = 1.5). This insertion rendered isolates highly resistant to raltegravir and elvitegravir, and moderately resistant to dolutegravir and cabotegravir. Regarding bictegravir, 2 isolates remained susceptible and 2 had a slight increase in IC50 (3- to 5-fold change). CONCLUSIONS Our results confirm the potency of INSTI on HIV-2 clinical isolates with wild-type integrase. In addition, we identified a new resistance pathway, 231INS, selected in antiretroviral-experienced patients with multiresistant HIV-2 viruses. This highlights the need of close follow-up of those patients initiating an INSTI-based regimen.
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Affiliation(s)
- Quentin Le Hingrat
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Laboratoire de Virologie, Hôpital St-Antoine, Paris
| | - Gilles Collin
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Laboratoire de Virologie, Hôpital St-Antoine, Paris
| | - Minh Lê
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Laboratoire de Pharmacologie, Hôpital Bichat, AP-HP, Hôpital St-Antoine, Paris
| | - Gilles Peytavin
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Laboratoire de Pharmacologie, Hôpital Bichat, AP-HP, Hôpital St-Antoine, Paris
| | - Benoit Visseaux
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Laboratoire de Virologie, Hôpital St-Antoine, Paris
| | - Mélanie Bertine
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Laboratoire de Virologie, Hôpital St-Antoine, Paris
| | - Roland Tubiana
- Service de Maladies Infectieuses, Hôpital Pitié-Salpêtrière, AP-HP, Hôpital St-Antoine, Paris.,Sorbonne Universités, Université Paris 6-Pierre et Marie Curie, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (UMRS 1136), Hôpital St-Antoine, Paris
| | - Marina Karmochkine
- Service d'Immunologie Clinique, Hôpital Européen Georges Pompidou, Hôpital St-Antoine, Paris
| | - Nadia Valin
- Service de Maladies Infectieuses et Tropicales, Hôpital St-Antoine, Paris
| | - Fidéline Collin
- Bordeaux Population Health Center, UMR 1219, INSERM, AP-HP, Paris, France.,Centre Hospitalier Universitaire de Bordeaux, AP-HP, Paris, France
| | - Adrien Lemaignen
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Tours, AP-HP, Paris, France
| | - Louis Bernard
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Tours, AP-HP, Paris, France
| | - Florence Damond
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Laboratoire de Virologie, Hôpital St-Antoine, Paris
| | - Sophie Matheron
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, AP-HP, Paris, France
| | - Diane Descamps
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Laboratoire de Virologie, Hôpital St-Antoine, Paris
| | - Charlotte Charpentier
- Infections Antimicrobials Modelling Evolution, Unité Mixte de Recherche (UMR) 1137, Institut national de la santé et de la recherche médicale (INSERM), Université Paris Diderot, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital St-Antoine, Paris.,Laboratoire de Virologie, Hôpital St-Antoine, Paris
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8
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Jespersen S, Månsson F, Lindman J, Wejse C, Medina C, da Silva ZJ, Te D, Medstrand P, Esbjörnsson J, Hønge BL. HIV treatment in Guinea-Bissau: room for improvement and time for new treatment options. AIDS Res Ther 2020; 17:3. [PMID: 32019545 PMCID: PMC6998355 DOI: 10.1186/s12981-020-0259-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 01/21/2020] [Indexed: 11/10/2022] Open
Abstract
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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9
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Matheron S, Descamps D, Gallien S, Besseghir A, Sellier P, Blum L, Mortier E, Charpentier C, Tubiana R, Damond F, Peytavin G, Ponscarme D, Collin F, Brun-Vezinet F, Chene G. First-line Raltegravir/Emtricitabine/Tenofovir Combination in Human Immunodeficiency Virus Type 2 (HIV-2) Infection: A Phase 2, Noncomparative Trial (ANRS 159 HIV-2). Clin Infect Dis 2019; 67:1161-1167. [PMID: 29590335 PMCID: PMC6160602 DOI: 10.1093/cid/ciy245] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/22/2018] [Indexed: 01/28/2023] Open
Abstract
Background New options for first-line treatment of human immunodeficiency virus type 2 (HIV-2) infection are needed. We evaluated an integrase inhibitor (raltegravir)–containing regimen. Methods Antiretroviral therapy (ART)–naive adults with symptomatic infection by HIV-2 only, CD4 count <500 cells/μL or CD4 decrease >50 cells/μL/year over the past 3 years, or a confirmed plasma HIV-2 RNA (pVL) load ≥100 copies/mL were eligible for this noncomparative trial. The composite primary endpoint was survival at 48 weeks without any of the following: CD4 gain from baseline <100 cells/μL, confirmed pVL ≥40 copies/mL from week 24, raltegravir permanent discontinuation, or incident B or C event. HIV-2 ultrasensitive pVL (uspVL) and total DNA were assessed using in-house polymerase chain reaction (PCR) assays. Results Baseline median CD4 count of 30 enrolled individuals (67% women) was 436 cells/µL (interquartile range [IQR], 314–507 cells/µL); pVL was ≥40 copies/mL in 67% of them, uspVL was ≥5 copies/mL in 92%, and total DNA was >6 copies by PCR in 32%. At week 48, the composite endpoint of success was reached in 40% [95% confidence interval, 22.7%–59.4%]. Failure was mainly (50%) due to CD4 gain <100 cells/µL; uspVL was <5 copies/mL in 87% and total DNA >6 copies by PCR in 12% of participants. Median CD4 gain was 87 cells/µL (IQR, 38–213 cells/µL; n = 28). No serious adverse reactions were reported. Conclusions Raltegravir-containing ART is a safe option for first-line treatment of HIV-2 infection, yielding a comparable success rate to protease inhibitors. Clinical Trials Registration NCT 01605890.
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Affiliation(s)
- Sophie Matheron
- Hopital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP).,Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche (UMR) 1137.,Université Paris Diderot, Sorbonne Paris Cité
| | - Diane Descamps
- Hopital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP).,Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche (UMR) 1137.,Université Paris Diderot, Sorbonne Paris Cité
| | | | - Amel Besseghir
- INSERM, Bordeaux Population Health Research Center, UMR 1219, Université Bordeaux, Institut de santé publique, d'épidémiologie et de développement, Centre Hospitalier Universitaire Bordeaux
| | | | | | | | - Charlotte Charpentier
- Hopital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP).,Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche (UMR) 1137.,Université Paris Diderot, Sorbonne Paris Cité
| | - Roland Tubiana
- Hopital Pitié-Salpetriere, AP-HP, Université Paris 6, INSERM, Institut Pierre-Louis Epidémiologie et Santé Publique, UMR en Santé 1136, Paris, France
| | - Florence Damond
- Hopital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP).,Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche (UMR) 1137.,Université Paris Diderot, Sorbonne Paris Cité
| | - Gilles Peytavin
- Hopital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP).,Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche (UMR) 1137.,Université Paris Diderot, Sorbonne Paris Cité
| | | | - Fideline Collin
- INSERM, Bordeaux Population Health Research Center, UMR 1219, Université Bordeaux, Institut de santé publique, d'épidémiologie et de développement, Centre Hospitalier Universitaire Bordeaux
| | | | - Genevieve Chene
- INSERM, Bordeaux Population Health Research Center, UMR 1219, Université Bordeaux, Institut de santé publique, d'épidémiologie et de développement, Centre Hospitalier Universitaire Bordeaux
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10
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Ba S, Raugi DN, Smith RA, Sall F, Faye K, Hawes SE, Sow PS, Seydi M, Gottlieb GS. A Trial of a Single-tablet Regimen of Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Disoproxil Fumarate for the Initial Treatment of Human Immunodeficiency Virus Type 2 Infection in a Resource-limited Setting: 48-Week Results From Senegal, West Africa. Clin Infect Dis 2019; 67:1588-1594. [PMID: 29672676 DOI: 10.1093/cid/ciy324] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/13/2018] [Indexed: 11/13/2022] Open
Abstract
Background There is an urgent need for safe and effective antiretroviral therapy (ART) for human immunodeficiency virus type 2 (HIV-2) infection. We undertook the first clinical trial of a single-tablet regimen containing elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate (E/C/F/TDF) to assess its effectiveness in HIV-2-infected individuals in Senegal, West Africa. Methods HIV-2-infected, ART-naive adults with World Health Organization stage 3-4 disease or CD4 count <750 cells/μL were eligible for this 48-week, open-label trial. We analyzed HIV-2 viral loads (VL), CD4 counts, clinical and adverse events, mortality, and loss to follow-up. Results We enrolled 30 subjects who initiated E/C/F/TDF. Twenty-nine subjects completed 48 weeks of follow-up. The majority were female (80%). There were no deaths, no new AIDS-associated clinical events, and 1 loss to follow-up. The median baseline CD4 count was 408 (range, 34-747) cells/μL, which increased by a median 161 (range, 27-547) cells/μL at week 48. Twenty-five subjects had baseline HIV-2 VL of <50 copies/mL of plasma. In those with detectable HIV-2 VL, the median was 41 (range, 10-6135) copies/mL. Using a modified intent-to-treat analysis (US Food and Drug Administration Snapshot method), 28 of 30 (93.3%; 95% confidence interval, 77.9%-99.2%) had viral suppression at 48 weeks. The 1 subject with virologic failure had multidrug-resistant HIV-2 (reverse transcriptase mutation: K65R; integrase mutations: G140S and Q148R) detected at week 48. There were 8 grade 3-4 adverse events; none were deemed study related. Adherence and acceptability were good. Conclusions Our data suggest that E/C/F/TDF, a once-daily, single-tablet-regimen, is safe, effective, and well tolerated. Our findings support the use of integrase inhibitor-based regimens for HIV-2 treatment. Clinical Trials Registration NCT02180438.
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Affiliation(s)
- Selly Ba
- Service des Maladies Infectieuses et Tropicales Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Senegal; and Departments of
| | | | | | - Fatima Sall
- Service des Maladies Infectieuses et Tropicales Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Senegal; and Departments of
| | - Khadim Faye
- Service des Maladies Infectieuses et Tropicales Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Senegal; and Departments of
| | - Stephen E Hawes
- Epidemiology.,Global Health, University of Washington, Seattle
| | - Papa Salif Sow
- Service des Maladies Infectieuses et Tropicales Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Senegal; and Departments of
| | - Moussa Seydi
- Service des Maladies Infectieuses et Tropicales Ibrahima Diop Mar, Centre Hospitalier National Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Senegal; and Departments of
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11
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Storto A, Visseaux B, Bertine M, Le Hingrat Q, Collin G, Damond F, Khuong MA, Blum L, Tubiana R, Karmochkine M, Cazanave C, Matheron S, Descamps D, Charpentier C. Minority resistant variants are also present in HIV-2-infected antiretroviral-naive patients. J Antimicrob Chemother 2019; 73:1173-1176. [PMID: 29415189 DOI: 10.1093/jac/dkx530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 12/14/2017] [Indexed: 12/26/2022] Open
Abstract
Objectives To assess the prevalence of minority resistant variants (MRV) and X4-tropic minority variants in ART-naive HIV-2-infected patients. Patients and methods ART-naive HIV-2-infected patients with detectable plasma viral load (>100 copies/mL) included in the ANRS HIV-2 CO5 Cohort were assessed. We performed ultra-deep sequencing (UDS) of protease, RT, integrase and gp105 regions. Only mutations in the HIV-2 ANRS list >1% were considered. HIV-2 tropism was assessed by V3 loop region UDS, and each read was interpreted with determinants of CXCR4-coreceptor use. Results Among the 47 patients assessed, three displayed plasma viruses with a resistance-associated mutation (RAM) above the 20% detection threshold, all in RT, resulting in a prevalence of transmitted drug resistance for NRTI of 7.9% (95% CI 0.0%-16.5%). No RAM above the 20% detection threshold was found in protease or integrase. At the 1% detection threshold the transmitted drug resistance prevalence was 9.8% (95% CI 0.6%-19.0%), 13.2% (95% CI 3.5%-22.9%) and 4.5% (95% CI 0%-17.5%) for PI, NRTI and integrase inhibitors. The most prevalent MRV was the PI RAM I50V detected in three samples. Tropism analysis showed that 21% of patients (4 of 19) exhibited X4-tropic viruses: two in majority proportion and two in minority proportions (1.5% and 1.9%). Conclusions In this first study assessing the prevalence of MRV in HIV-2 infection among ART-naive patients, we observed a 2-3-fold higher prevalence of RAM when a 1% detection threshold of mutations was used compared with a 20% threshold. Similarly, the proportion of patients with X4-tropic viruses was twice as high when UDS was used.
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Affiliation(s)
- Alexandre Storto
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Benoit Visseaux
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Mélanie Bertine
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Quentin Le Hingrat
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Gilles Collin
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Florence Damond
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Marie-Aude Khuong
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Saint Denis, Saint-Denis, France
| | - Laurent Blum
- Service de pathologies infectieuses, VIH, Centre Hospitalier René Dubos, Pontoise, France
| | - Roland Tubiana
- Department of Infectious Diseases, AP-HP Hôpital Pitié-Salpêtrière, Paris, Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75013 Paris, France
| | - Marina Karmochkine
- Service d'Immunologie Clinique, Hôpital Européen Georges Pompidou, Paris, France
| | - Charles Cazanave
- CHU Bordeaux, Services des Maladies Infectieuses et Tropicales, Bordeaux, France
| | - Sophie Matheron
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, AP-HP, Paris, France
| | - Diane Descamps
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Charlotte Charpentier
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
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12
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Ambike SS, Thakar MR, Patil AA, Gangakhedkar RR, Kurle SN. Partial pol Sequences from Drug Naive HIV-2 Infected Individuals from Maharashtra, India. AIDS Res Hum Retroviruses 2019; 35:505-508. [PMID: 30681008 DOI: 10.1089/aid.2018.0282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
HIV-2 is important due to its unique challenges in diagnosis, treatment, and drug resistance. The data on Indian HIV-2 pol gene as well as resistance to antiretroviral drugs are limited. Here we report sequence data of protease (PR) and reverse transcriptase (RT) genes from HIV-2 infected treatment naive individuals (N = 32) from Maharashtra, India. These sequences were found to be closely related to HIV-2 subtype A sequences from Guinea Bissau. We observed two unique residues at positions 14 and 70 in the PR region specific to Indian HIV-2. Mutations associated with resistance to RT and protease inhibitors were observed in 3 of 32 (9.37%) samples. To our knowledge, this is the first study from India to report drug resistance among treatment naive HIV-2 infected individuals. The results emphasize need for larger nationwide surveillance for HIV-2 drug resistance to better understand the primary drug resistance among HIV-2 infected individuals.
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Affiliation(s)
- Shubhankar S. Ambike
- HIV Drug Resistance Laboratory, ICMR-National AIDS Research Institute, Pune, India
| | - Madhuri R. Thakar
- Department of Immunology and Serology, National AIDS Research Institute, Pune, India
| | - Ajit A. Patil
- HIV Drug Resistance Laboratory, ICMR-National AIDS Research Institute, Pune, India
| | | | - Swarali N. Kurle
- HIV Drug Resistance Laboratory, ICMR-National AIDS Research Institute, Pune, India
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13
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90-90-90 for HIV-2? Ending the HIV-2 epidemic by enhancing care and clinical management of patients infected with HIV-2. Lancet HIV 2019; 5:e390-e399. [PMID: 30052509 DOI: 10.1016/s2352-3018(18)30094-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 12/23/2022]
Abstract
Distinct from HIV-1 and often neglected in the global campaign to end the AIDS epidemic, HIV-2 presents unique and underappreciated challenges in diagnosis, clinical care, antiretroviral therapy (ART), and HIV programmatic management. Here, we review the epidemiology and natural history of HIV-2, diagnostics and algorithms for accurately diagnosing and differentiating HIV-2 from HIV-1, the unique features of HIV-2 ART and drug resistance, and the clinical care and management of patients infected with HIV-2 in both developed and resource-limited settings. Ultimately, further research is needed to address the gaps in our knowledge of HIV-2 infection, increased resources are needed to specifically target HIV-2 as part of the UNAIDS/WHO 90-90-90 campaign to end AIDS, and increased determination is needed to better advocate for inclusion of people living with HIV-2 in global HIV/AIDS initiatives.
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14
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Cazals N, Le Hingrat Q, Abraham B, Da Silva P, Guindre L, Goffart S, Damond F, Visseaux B, Charpentier C, Ranger-Rogez S, Descamps D. HIV-2 Primary Infection in a French 69-Year-Old Bisexual Man. Open Forum Infect Dis 2018; 5:ofy223. [PMID: 30310823 PMCID: PMC6174253 DOI: 10.1093/ofid/ofy223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/10/2018] [Indexed: 11/20/2022] Open
Abstract
More than 1 million individuals, mainly in West Africa, are thought to be infected with HIV-2. Acute HIV-2 infection is rarely observed, only 2 primary infections have been described to date. We report a detailed case of HIV-2 primary infection in a 69-year-old French bisexual Caucasian man, thereby providing valuable insights into HIV-2 early infection.
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Affiliation(s)
- Nicolas Cazals
- Service de Médecine Interne, Maladies Infectieuses et Tropicales, Centre Hospitalier de Brive-la-Gaillarde, Brive-la-Gaillarde, France
| | - Quentin Le Hingrat
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Bruno Abraham
- Service de Médecine Interne, Maladies Infectieuses et Tropicales, Centre Hospitalier de Brive-la-Gaillarde, Brive-la-Gaillarde, France
| | - Patricia Da Silva
- Service de Médecine Interne, Maladies Infectieuses et Tropicales, Centre Hospitalier de Brive-la-Gaillarde, Brive-la-Gaillarde, France
| | - Laure Guindre
- Laboratoire de Microbiologie, Centre Hospitalier de Brive-la-Gaillarde, Brive-la-Gaillarde, France
| | - Sylvie Goffart
- Laboratoire de Microbiologie, Centre Hospitalier de Brive-la-Gaillarde, Brive-la-Gaillarde, France
| | - Florence Damond
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Benoît Visseaux
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Charlotte Charpentier
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Sylvie Ranger-Rogez
- Laboratoire de Virologie, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Diane Descamps
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
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15
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Requena S, Treviño A, Cabezas T, Garcia-Delgado R, Amengual MJ, Lozano AB, Peñaranda M, Fernández JM, Soriano V, de Mendoza C. Drug resistance mutations in HIV-2 patients failing raltegravir and influence on dolutegravir response. J Antimicrob Chemother 2018; 72:2083-2088. [PMID: 28369593 DOI: 10.1093/jac/dkx090] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/28/2017] [Indexed: 11/14/2022] Open
Abstract
Background A broader extent of amino acid substitutions in the integrase of HIV-2 compared with HIV-1 might enable greater cross-resistance between raltegravir and dolutegravir in HIV-2 infection. Few studies have examined the virological response to dolutegravir in HIV-2 patients that failed raltegravir. Methods All patients recorded in the HIV-2 Spanish cohort were examined. The integrase coding region was sequenced in viraemic patients. Changes associated with resistance to raltegravir and dolutegravir in HIV-1 were recorded. Results From 319 HIV-2-infected patients recorded in the HIV-2 Spanish cohort, 53 integrase sequences from 30 individuals were obtained (20 raltegravir naive and 10 raltegravir experienced). Only one secondary mutation (E138A) was found in one of the 20 raltegravir-naive HIV-2 patients. For raltegravir-experienced individuals, the resistance mutation profile in 9 of 10 viraemic patients was as follows: N155H + A153G/S (four); Y143G + A153S (two); Q148R + G140A/S (two); and Y143C + Q91R (one). Of note, all patients with Y143G and N155H developed a rare non-polymorphic mutation at codon 153. Rescue therapy with dolutegravir was given to 5 of these 10 patients. After >6 months on dolutegravir therapy, three patients with baseline N155H experienced viral rebound. In two of them N155H was replaced by Q148K/R and in another by G118R. Conclusions A wide repertoire of resistance mutations in the integrase gene occur in HIV-2-infected patients failing on raltegravir. Although dolutegravir may allow successful rescue in most HIV-2 raltegravir failures, we report and characterize three cases of dolutegravir resistance in HIV-2 patients, emerging variants Q148K and Q148R and a novel change G118R.
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Affiliation(s)
- Silvia Requena
- Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Ana Treviño
- Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | | | | | | | | | | | | | - Vicente Soriano
- La Paz University Hospital & Autonomous University, Madrid, Spain
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16
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Triki D, Billot T, Visseaux B, Descamps D, Flatters D, Camproux AC, Regad L. Exploration of the effect of sequence variations located inside the binding pocket of HIV-1 and HIV-2 proteases. Sci Rep 2018; 8:5789. [PMID: 29636521 PMCID: PMC5893546 DOI: 10.1038/s41598-018-24124-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/26/2018] [Indexed: 01/01/2023] Open
Abstract
HIV-2 protease (PR2) is naturally resistant to most FDA (Food and Drug Administration)-approved HIV-1 protease inhibitors (PIs), a major antiretroviral class. In this study, we compared the PR1 and PR2 binding pockets extracted from structures complexed with 12 ligands. The comparison of PR1 and PR2 pocket properties showed that bound PR2 pockets were more hydrophobic with more oxygen atoms and fewer nitrogen atoms than PR1 pockets. The structural comparison of PR1 and PR2 pockets highlighted structural changes induced by their sequence variations and that were consistent with these property changes. Specifically, substitutions at residues 31, 46, and 82 induced structural changes in their main-chain atoms that could affect PI binding in PR2. In addition, the modelling of PR1 mutant structures containing V32I and L76M substitutions revealed a cooperative mechanism leading to structural deformation of flap-residue 45 that could modify PR2 flexibility. Our results suggest that substitutions in the PR1 and PR2 pockets can modify PI binding and flap flexibility, which could underlie PR2 resistance against PIs. These results provide new insights concerning the structural changes induced by PR1 and PR2 pocket variation changes, improving the understanding of the atomic mechanism of PR2 resistance to PIs.
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Affiliation(s)
- Dhoha Triki
- Molécules thérapeutiques in silico (MTi), INSERM UMR-, S973, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Telli Billot
- Molécules thérapeutiques in silico (MTi), INSERM UMR-, S973, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Benoit Visseaux
- IAME, UMR 1137, INSERM, Laboratoire de Virologie, Hôpital Bichât, AP-HP, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Diane Descamps
- IAME, UMR 1137, INSERM, Laboratoire de Virologie, Hôpital Bichât, AP-HP, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Delphine Flatters
- Molécules thérapeutiques in silico (MTi), INSERM UMR-, S973, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Anne-Claude Camproux
- Molécules thérapeutiques in silico (MTi), INSERM UMR-, S973, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Leslie Regad
- Molécules thérapeutiques in silico (MTi), INSERM UMR-, S973, Paris, France. .,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
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17
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Mendoza CD, Requena S, Caballero E, Cabezas T, Peñaranda M, Amengual MJ, Sáez A, Lozano AB, Ramos JM, Soriano V. Antiretroviral treatment of HIV-2 infection. Future Virol 2017. [DOI: 10.2217/fvl-2017-0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
HIV-2 is a neglected virus despite estimates of 1–2 million people being infected worldwide. AIDS develops more slowly in HIV-2 than HIV-1. Outside endemic regions, HIV-2 is mostly found in immigrants from west Africa or their sex partners. There are four major caveats when treating HIV-2. First, some antiretrovirals are not or only partially active against HIV-2. Second, CD4 declines in HIV-2 occur slowly, but CD4 recovery is smaller with antiretroviral treatment. Third, both virological failure and rapid emergence of drug resistance occur more frequently in HIV-2 than HIV-1. Finally, misdiagnosis of HIV-2 in patients wrongly considered as infected with HIV-1 or in those dually infected may result in treatment failures with undetectable HIV-1 RNA. Integrase inhibitors, and especially dolutegravir, should be part of any preferred HIV-2 antiretroviral combination nowadays.
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Affiliation(s)
- Carmen de Mendoza
- Laboratory of Internal Medicine, Puerta de Hierro Research Institute, Majadahonda, Spain
| | - Silvia Requena
- Laboratory of Internal Medicine, Puerta de Hierro Research Institute, Majadahonda, Spain
| | | | | | - María Peñaranda
- Microbiology Unit, Son Espases Hospital, Palma de Mallorca, Spain
| | | | - Ana Sáez
- Microbiology Unit, Hospital Marqués de Valdecilla, Santander, Spain
| | | | - José M Ramos
- Infectious Diseases Unit, General Hospital, Alicante, Spain
| | - Vincent Soriano
- Infectious Diseases Unit, La Paz University Hospital & Autonomous University, Madrid, Spain
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MK-8591 (4'-Ethynyl-2-Fluoro-2'-Deoxyadenosine) Exhibits Potent Activity against HIV-2 Isolates and Drug-Resistant HIV-2 Mutants in Culture. Antimicrob Agents Chemother 2017; 61:AAC.00744-17. [PMID: 28559249 DOI: 10.1128/aac.00744-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/19/2017] [Indexed: 11/20/2022] Open
Abstract
There is a pressing need to identify more effective antiretroviral drugs for HIV-2 treatment. Here, we show that the investigational compound MK-8591 (4'-ethynyl-2-fluoro-2'-deoxyadenosine [EFdA]) is highly active against group A and B isolates of HIV-2; 50% effective concentrations [EC50] for HIV-2 were, on average, 4.8-fold lower than those observed for HIV-1. MK-8591 also retains potent activity against multinucleoside-resistant HIV-2 mutants (EC50 ≤ 11 nM). These data suggest that MK-8591 may have antiviral activity in HIV-2-infected individuals.
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de Mendoza C, Cabezas T, Caballero E, Requena S, Amengual MJ, Peñaranda M, Sáez A, Tellez R, Lozano AB, Treviño A, Ramos JM, Pérez JL, Barreiro P, Soriano V. HIV type 2 epidemic in Spain: challenges and missing opportunities. AIDS 2017; 31:1353-1364. [PMID: 28358736 DOI: 10.1097/qad.0000000000001485] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: HIV type 2 (HIV-2) is a neglected virus despite estimates of 1-2 million people infected worldwide. HIV-2 is less efficiently transmitted than HIV-1 by sex and from mother to child. Although AIDS may develop in HIV-2 carriers, it takes longer than in HIV-1-infected patients. In contrast with HIV-1 infection, there is no global pandemic caused by HIV-2, as the virus is largely confined to West Africa. In a less extent and due to socioeconomic ties and wars, HIV-2 is prevalent in Portugal and its former colonies in Brazil, India, Mozambique and Angola. Globally, HIV-2 infections are steadily declining over time. A total of 338 cases of HIV-2 infection had been reported at the Spanish HIV-2 registry until December 2016, of whom 63% were men. Overall 72% were sub-Saharan Africans, whereas 16% were native Spaniards. Dual HIV-1 and HIV-2 coinfection was found in 9% of patients. Heterosexual contact was the most likely route of HIV-2 acquisition in more than 90% of cases. Roughly one-third presented with CD4 cell counts less than 200 cells/μl and/or AIDS clinical events. Plasma HIV-2 RNA was undetectable at baseline in 40% of patients. To date, one-third of HIV-2 carriers have received antiretroviral therapy, using integrase inhibitors 32 individuals. New diagnoses of HIV-2 in Spain have remained stable since 2010 with an average of 15 cases yearly. Illegal immigration from Northwestern African borders accounts for over 75% of new HIV-2 diagnoses. Given the relatively large community of West Africans already living in Spain and the continuous flux of immigration from endemic regions, HIV-2 infection either alone or as coinfection with HIV-1 should be excluded once in all HIV-seroreactive persons, especially when showing atypical HIV serological profiles, immunovirological disconnect (CD4 cell count loss despite undetectable HIV-1 viremia) and/or high epidemiological risks (birth in or sex partners from endemic regions).
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Visseaux B, Damond F, Matheron S, Descamps D, Charpentier C. Hiv-2 molecular epidemiology. INFECTION GENETICS AND EVOLUTION 2016; 46:233-240. [PMID: 27530215 DOI: 10.1016/j.meegid.2016.08.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 12/13/2022]
Abstract
The Simian Immunodeficiency Virus of sooty mangabeys (SIVsmm) has been revealed to be at the origin of Human Immunodeficiency Virus type 2 (HIV-2) in humans, firstly detected from two Portuguese patients in 1986. HIV-2 is mainly restricted to West Africa where it infects up to 1 to 2 million people. HIV-2 is also present in Europe, mainly Portugal and France, India and United States of America. Two major HIV-2 groups, groups A and B, were generated by two independent transmission events involving infected sooty mangabeys from the Taï forest in Ivory Coast. Seven other HIV-2 groups have been described, but each has only been identified in one patient. To date, no subtypes have been formally described but some preliminary data suggest that HIV-2 group A may be divided in two distinct subtypes with distinct geographical origins. To date only two recombinant forms have been described: one circulating recombinant form (CRF01_AB) and one unique recombinant form. In this review, we focused mainly on molecular data available and their insights about HIV-2 origins, diversity, drug resistance and global epidemiology.
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Affiliation(s)
- Benoit Visseaux
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Virologie, F-75018 Paris, France.
| | - Florence Damond
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Virologie, F-75018 Paris, France
| | - Sophie Matheron
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Service de Maladies Infectieuses et Tropicales, F-75018 Paris, France
| | - Diane Descamps
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Virologie, F-75018 Paris, France
| | - Charlotte Charpentier
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Virologie, F-75018 Paris, France
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Abstract
Since the first antiviral drug, idoxuridine, was approved in 1963, 90 antiviral drugs categorized into 13 functional groups have been formally approved for the treatment of the following 9 human infectious diseases: (i) HIV infections (protease inhibitors, integrase inhibitors, entry inhibitors, nucleoside reverse transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors, and acyclic nucleoside phosphonate analogues), (ii) hepatitis B virus (HBV) infections (lamivudine, interferons, nucleoside analogues, and acyclic nucleoside phosphonate analogues), (iii) hepatitis C virus (HCV) infections (ribavirin, interferons, NS3/4A protease inhibitors, NS5A inhibitors, and NS5B polymerase inhibitors), (iv) herpesvirus infections (5-substituted 2'-deoxyuridine analogues, entry inhibitors, nucleoside analogues, pyrophosphate analogues, and acyclic guanosine analogues), (v) influenza virus infections (ribavirin, matrix 2 protein inhibitors, RNA polymerase inhibitors, and neuraminidase inhibitors), (vi) human cytomegalovirus infections (acyclic guanosine analogues, acyclic nucleoside phosphonate analogues, pyrophosphate analogues, and oligonucleotides), (vii) varicella-zoster virus infections (acyclic guanosine analogues, nucleoside analogues, 5-substituted 2'-deoxyuridine analogues, and antibodies), (viii) respiratory syncytial virus infections (ribavirin and antibodies), and (ix) external anogenital warts caused by human papillomavirus infections (imiquimod, sinecatechins, and podofilox). Here, we present for the first time a comprehensive overview of antiviral drugs approved over the past 50 years, shedding light on the development of effective antiviral treatments against current and emerging infectious diseases worldwide.
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Affiliation(s)
- Erik De Clercq
- KU Leuven-University of Leuven, Rega Institute for Medical Research, Department of Microbiology and Immunology, Leuven, Belgium
| | - Guangdi Li
- KU Leuven-University of Leuven, Rega Institute for Medical Research, Department of Microbiology and Immunology, Leuven, Belgium Department of Metabolism and Endocrinology, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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