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HIV-2 cases concentrated in northeastern US
Torian LV. MMWR. 2011;60(29):985-988.
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CDC surveillance indicate that HIV-2 infections are concentrated in the northeastern United States — primarily in New York City, and among those born in West Africa, according to recent findings published in a Morbidity and Mortality Weekly Report.
Officials recommend for suspected HIV-2 cases to be reported to state or local health departments for additional testing to avoid misclassification as HIV-1.
According to background information in the study, there is a need for surveillance case definition of HIV-infection to differentiate between HIV-1 and HIV-2. For this reason, Richard M. Selik, MD, of the CDC’s division of HIV/AIDS Prevention-Surveillance and Epidemiology, and colleagues set out to classify HIV-2 cases in the United States between 1987 and 2009. A working case definition required one or more of three criteria:
- HIV-1/HIV-2 type-differentiating antibody immunoassay.
- Positive HIV-2 nucleic acid test (DNA or RNA).
- Positive HIV-2 immunoblot and negative or indeterminate HIV-1 immunoblot.
Overall, 166 cases met the case definition criteria, of which 66% were reported from the Northeast. Specifically, 46% were from New York City and 81% of all cases were born in West Africa.
Although HIV-2 cases were rare, some HIV-2 cases may not have been recognized, as 60% of all HIV-2 cases also had positive HIV-1 immunoblot antibody test results, according to the researchers.
“Correct identification of HIV-2 is important because many drugs used to treat HIV-1 are not effective against HIV-2,” Selik told Infectious Disease News. “Health care providers and laboratories should consider specific testing for HIV-2 if tests for HIV-1 are inconsistent with one another, inconclusive or imply the absence of HIV infection despite clinical evidence suggesting its presence — particularly if the patient is from West Africa.”
In an accompanying editorial, CDC officials wrote: “Regional differences in the percentage of reported HIV cases caused by HIV-2 may be in part a result of the nonuniform geographic distribution of US residents born in West Africa. New York is a major gateway for African immigrants to the United States. However, regional differences in the percentage of HIV cases caused by HIV-2 also could be the result of variations in completeness of diagnosis and reporting of HIV-2 by laboratories and state HIV surveillance programs.”
Disclosure: Dr. Selik reports no relevant financial disclosures.
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