HIV-2 Treatment and Care: What You Need to Know for Effective Management

Comprehensive Guide to Managing HIV-2: Treatment, Monitoring, and Key Strategies

While HIV-1 often dominates the conversation around HIV care, HIV-2 is an important strain to consider, especially in regions where it is more common. Though HIV-2 is less transmissible and progresses more slowly than HIV-1, it still requires careful attention to ensure proper management and to avoid complications.

What is HIV-2?

HIV-2 was first identified in 1986 in West Africa, and it is the second most common form of the virus that causes AIDS. It’s believed to have originated from Sooty mangabey monkeys, similar to how HIV-1 originated from chimpanzees.

Unlike HIV-1, which is prevalent globally, HIV-2 is much rarer and primarily found in West Africa. However, it has spread to other parts of the world due to migration and travel, including areas like Portugal, India, and France.

Key Differences Between HIV-1 and HIV-2:

Diagnosis of HIV-2

Diagnosing HIV-2 can be trickier than HIV-1. Standard HIV tests may not distinguish between the two types, so it’s crucial to use differentiation assays or nucleic acid testing (NAT) to confirm whether a patient is living with HIV-2.

Testing Steps:

• Initial screening: Fourth-generation HIV tests (which can detect both HIV-1 and HIV-2)
• Confirmatory testing: If the first test is positive, an HIV-1/HIV-2 differentiation test is needed.
• NAT or PCR: In some cases, HIV-2-specific viral load tests can be performed.

Note: HIV-2 is often not detected by standard rapid tests, so clinicians must be cautious, especially in regions where HIV-2 is more common.

HIV-2 Treatment: Key Strategies

HIV-2 requires tailored treatment, as it is resistant to certain drug classes, such as NNRTIs (non-nucleoside reverse transcriptase inhibitors) and fusion inhibitors. This means a careful selection of medications is necessary to manage the virus effectively.

Preferred HIV-2 Treatment Regimens

To ensure optimal suppression of the virus, the following regimens are recommended:

Integrase Strand Transfer Inhibitors (INSTIs):

• Dolutegravir
• Raltegravir
• Bictegravir (part of the Biktarvy combination, though more data on HIV-2 are needed)

Nucleoside Reverse Transcriptase Inhibitors (NRTIs):

• Tenofovir (TDF or TAF)
• Lamivudine (3TC)
• Emtricitabine (FTC)
• Abacavir (ABC) (requires HLA-B*5701 testing)

Protease Inhibitors (PIs):

• Darunavir/ritonavir
• Lopinavir/ritonavir

Avoid These Medications in HIV-2:

• NNRTIs (e.g., efavirenz, nevirapine, rilpivirine): These are ineffective for HIV-2 due to natural resistance.
• Fusion inhibitors (e.g., enfuvirtide): Have limited or inconsistent efficacy.
• CCR5 antagonists (e.g., maraviroc): Not well studied for HIV-2, so they are not recommended.

Example of a Treatment Regimen:

• Dolutegravir + Tenofovir + Emtricitabine
• Raltegravir + Lamivudine + Tenofovir

The goal of treatment is to reduce viral load and maintain a strong immune system, much like in HIV-1 management.

Monitoring HIV-2

Due to limited availability of viral load tests specific to HIV-2, CD4 counts and clinical signs are essential for monitoring treatment effectiveness.

Even without a reliable viral load test, clinical improvements such as increased energy and weight gain, along with stable or rising CD4 counts, can indicate successful treatment.

Managing Co-infections and Other Health Factors

Patients with HIV-2 are still at risk for opportunistic infections (like tuberculosis and hepatitis) and comorbidities such as mental health disorders, cardiovascular disease, and renal problems. Addressing these risks is an important part of comprehensive HIV care.

Preventive Measures:

• Vaccinations: Flu, Hepatitis B, Pneumococcus, and others are recommended to reduce the risk of infections.
• Mental Health: Regular screenings for depression, anxiety, and other issues should be incorporated into routine care.
• Screening for Comorbidities: Monitor cardiovascular health, liver function, and kidney function.

Key Takeaways

• HIV-2 is less transmissible and progresses more slowly than HIV-1, but it still requires careful management.
• Tailored ART is essential—avoid NNRTIs and fusion inhibitors, and use INSTIs, PIs, and NRTIs.
• Monitoring is crucial, even if HIV-2 viral load tests are not widely available. CD4 counts remain a key marker.
• Be aware of the risk of co-infections and comorbidities that can impact health.

Take Charge of Your Health

Managing HIV-2 doesn’t have to be complicated, but it does require attention to detail and a personalized approach. If you or someone you know is living with HIV-2, here are some steps to take today:

• Speak with your healthcare provider to develop a treatment plan that’s right for you.
• Stay informed—ask about the latest ART options and monitoring strategies.
• Join a community of others living with HIV-2 for support and empowerment.
• Get regular check-ups to track your health and stay on top of your treatment.

Stay proactive—don’t hesitate to reach out to PULSE CLINIC (Social Enterprise)

for second opinions or treatment advice.

Book an online appointment today to take one step closer to simplified HIV care.

Or contact us at pulseliving@pulse-clinic.com or via your preferred platform.

+66-84-226-2569   @pulserx    PulseClinic