Long-term study shows that HIV-2 is deadlier than previously thought

November 8, 2018, Lund University
HIV infecting a human cell. Credit: NIH

A study published in The Lancet HIV shows that HIV-2 is more pathogenic than previously demonstrated. The new findings indicate that early treatment should be applied to all patients with HIV, not only to those with HIV-1.

"The study is unique in that we have followed cohort of study participants frequently over a long period, which enabled us to determine when the patients became infected by HIV, as well as to follow the development of the disease. Our data indicates that the majority of those infected with HIV-2 will develop and die of AIDS, something previous studies have not been able to determine," says Joakim Esbjörnsson, associate senior lecturer and researcher in medical microbiology at Lund University in Sweden.

The virus types HIV-1 and HIV-2 are closely related, but vary in their dissemination over the world. HIV-1 has spread globally whereas HIV-2, which is considered to be a milder variant of HIV, is mainly prevalent in West Africa.

The study is the first ever to present reliable estimates of the time between HIV infection and AIDS or HIV-related death for HIV-2. The researchers followed up on 4,900 individuals in a cohort study in Guinea-Bissau over 23 years, between 1990 and 2013, which involved annual examinations including blood tests. The study also compared individuals infected with HIV-1 with HIV-negative individuals in the same cohort. Data from the study shows that people with HIV-2 develop HIV-related infections and AIDS in an almost identical manner to those with HIV-1, although the process is slower over time.

Previous studies have indicated that a large proportion of those with HIV-2, even without antiretroviral , would have a normal life expectancy without any HIV-related complications, unlike those with HIV-1 for whom the absence of treatment led to the development of AIDS in more than 98 per cent of cases. Not even the WHO's treatment recommendations explicitly state that treatment should be offered to patients with HIV-2.

"There is a commonly held belief within research as well as in public healthcare about the various types of HIV: that HIV-2 does not lead to disease in the same way as HIV-1. We want to dismantle this belief and change the views on the international treatment recommendations," says Joakim Esbjörnsson.

A similar study has not been done previously, as the course of HIV disease is long, and it is unlikely that it will be possible to do something similar again. Joakim Esbjörnsson believes that the difficulty in studying HIV-2 over time is one of the reasons for the general uncertainty about how aggressive HIV-2 is, and also for the prevailing view of when treatment should be started.

Another specific problem with HIV-2 is that the majority of HIV-2-infected people do not have measurable virus levels in the blood, which has increased uncertainty as to when and whether treatment should be introduced, according to Hans Norrgren, associate professor of infectious diseases at Lund University and consultant physician at the infection clinic at Skåne University Hospital in Lund.

"Furthermore, HIV-2 mainly occurs in West Africa, which is the world's poorest region, characterised by low investment levels and frequent political instability. This not only makes research and development more difficult in the region, but has also contributed to the fact that commercial interest in the development of diagnostics and treatment of HIV-2 has not been equally strong," says Fredrik Månsson, researcher in clinical at Lund University and specialist physician at the infection clinic at Skåne University Hospital in Malmö.

The researchers would like to see more research in the field and on treatment for HIV, to better understand the differences between the two types. Among other things, a treatment study over time is needed to verify the usefulness of early treatment for patients with HIV-2.

Explore further: Aggressive HIV strain causes faster AIDS development

More information: Joakim Esbjörnsson et al, Long-term follow-up of HIV-2-related AIDS and mortality in Guinea-Bissau: a prospective open cohort study, The Lancet HIV (2018). DOI: 10.1016/S2352-3018(18)30254-6

Related Stories

Aggressive HIV strain causes faster AIDS development

November 27, 2013
A recently discovered HIV strain leads to significantly faster development of AIDS than currently prevalent forms, according to new research from Lund University in Sweden.

HIV-2 infection inhibits HIV-1 disease progression

July 19, 2012
(HealthDay) -- While many people don't know it, there's more than one kind of AIDS virus. Besides the HIV-1 strain that's common throughout the world, a type known as HIV-2 is found in some parts of Africa. Now, a new study ...

New method helps rule out heart valve infection

October 25, 2017
A risk assessment system developed by researchers at Lund University in Sweden shows which patients, with a certain type of streptococcal bacteria in the blood, need to be examined for a heart valve infection – a serious ...

Study finds increased survival and cure rates for patients with HIV and MDR-TB when infections treated concurrently

April 17, 2018
Patients co-infected with HIV and multidrug-resistant tuberculosis (MDR-TB) can achieve similar survival and tuberculosis cure rates to those infected with MDR-TB but not HIV when treated concurrently for both infections, ...

New strategy to cure chronic hepatitis B infection

May 18, 2018
Scientists from Karolinska Institutet and Hannover Medical School have published two studies that provide insights into how the immune system responds and helps to clear a hepatitis B infection after treatment interruption. ...

Recommended for you

Cellphone technology developed to detect HIV

November 9, 2018
The management of human immunodeficiency virus 1 (HIV), an autoimmune disorder that cripples the immune system by attacking healthy cells, remains a major global health challenge in developing countries that lack infrastructure ...

Long-term study shows that HIV-2 is deadlier than previously thought

November 8, 2018
A study published in The Lancet HIV shows that HIV-2 is more pathogenic than previously demonstrated. The new findings indicate that early treatment should be applied to all patients with HIV, not only to those with HIV-1.

Incarceration is likely to increase HIV and HCV transmission among people who inject drugs, new study finds

October 30, 2018
Injecting drug use, through the sharing of needles, syringes and other injecting equipment, is a primary route of transmission for both HIV and hepatitis C virus (HCV), blood-borne infections that cause considerable morbidity ...

Long-acting injectable implant shows promise for HIV treatment and prevention

October 9, 2018
A persistent challenge in HIV/AIDS treatment and prevention is medication adherence – getting patients to take their medication as required to get the best results.

Scientists develop rapid test for diagnosing tuberculosis in people with HIV

October 8, 2018
An international team that includes Rutgers scientists has made significant progress in developing a urine diagnostic test that can quickly, easily and inexpensively identify tuberculosis infection in people also infected ...

Researchers uncover new role of TIP60 protein in controlling tumour formation

October 8, 2018
Scientists from the Cancer Science Institute of Singapore (CSI Singapore) at the National University of Singapore (NUS) have discovered a new molecular pathway that controls colorectal cancer development, and their exciting ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.