Comparison of viro-immunological marker changes between HIV-1 and HIV-2-infected patients in France

INSERM, U875 Epidemiology and Biostatistics, Bordeaux F-33076, France.
AIDS (London, England) (Impact Factor: 5.55). 03/2008; 22(4):457-68. DOI: 10.1097/QAD.0b013e3282f4ddfc
Source: PubMed


HIV-2 is known to be less pathogenic than HIV-1, although the underlying mechanisms are still debated. We compared the changes over time in viro-immunological markers in HIV-1 and HIV-2-infected patients living in France during natural history and after initiation of the first combination antiretroviral therapy (CART).
Patients were included in the ANRS CO3 HIV-1 cohort (N = 6707) or the ANRS CO5 HIV-2 cohort (N = 572). HIV-1-infected patients were matched to HIV-2 patients according to sex, age, HIV transmission group and period of treatment initiation. Changes in markers were estimated using linear mixed models.
Analyses were performed for three groups of patients: those with estimated date of contamination (98 HIV-1 and 49 HIV-2-seroincident patients); untreated seroprevalent patients (320 HIV-1 and 160 HIV-2); and those initiating a first CART (59 HIV-1 and 63 HIV-2). In group 1, CD4 T-cell counts decreased less rapidly in HIV-2 than HIV-1 patients (-9 versus -49 cells/microl per year, P < 10(-4)). Results were similar in group 2. Baseline CD4 cell count at CART initiation was not different according to the type of infection. During the first 2 months of treatment, the CD4 cell count increased by +59 cells/microl per month (CI 34; 84) for HIV-1 and +24 (CI 6; 42) for HIV-2. The plasma viral load drop was threefold more important in HIV-1 patients: -1.56 log10/ml per month versus -0.62 among HIV-2 patients (P < 10(-4)).
Differences between the two infections during natural history are similar to those previously described in Africa. Once treatment is started, response is poorer in HIV-2 than in HIV-1 patients.

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    • "However in most of the reports reviewed, there seems to be a poorer CD4 cell count recovery after treatment initiation in HIV-2 infected patients compared to the HIV-1 infected ones [12]. This systematic review reveals that the median CD4 cell count at ART initiation was 165 cells/mm3 (IQR; 137–202), which is very close to the median CD4 count among HIV-1 infected patients in the same settings [12, 30]. "
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    • "Anti-HIV drugs are modelled mostly against HIV-1 subtype B. Although it is expected that other HIV variants should be sensitive to these therapies, it well established that this may not always be the case as not all known HIV genetic variants have similar sensitivities to available treatment regimens. HIV-1 group O and HIV-2 viruses are naturally resistant to the non-nucleoside reverse transcriptase inhibitors with poor treatment outcomes (Drylewicz et al., 2008). In like manner, the efficacy of protease inhibitors to HIV-2 is poor (Reynolds et al., 2007; Menéndez-Arias and Tözsér, 2008). "
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