HIV2 Flashcards

1
Q

How many lineages are there of HIV2?

A

9
Lettered a-I
Only a and b endemic

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2
Q

Testing for HIV2

A

Three CE marked serology tests performed in an ISO 15189 accredited lab - reactivity on 2 CE marked 4th gen tests for hiv1 and hiv2 then differention of hiv2 on a ce marked antibody only test

Not confirmed until second sample with consistent reactive results (poct can be first sample)

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3
Q

Hiv 2 window period

A

90 days from exposure because only an antibody test as p24 specific for hiv1

A negative test should be repeated at 6 weeks and 3/12 post exposure with parallel testing for hiv2 viral rna and if necessary proviral dna

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4
Q

What should you do with serology results that don’t fit into a clear pattern of confirmed lab diagnosis? Hiv2

A

Fully investigate for presence or abscence oh HIV2 - PCR for HIV2 proviral dna

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5
Q

When to measure viral load in PLW HIV2?

A

Baseline and appropriate intervals - 6 monthly for those not on treatment

Detectable pre treatment / 1,3,6 months then 6 monthly
Undetectable pre tx 1, 6 months then 6/12ly

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6
Q

How is HIV2 resistance testing performed?

A

Genotypic only method
Must have at least 500cp/ml

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7
Q

When to start ARV? HIV2

A

Minimal evidence for correlating viral load with treatment benefit but is evidence correlating cd4 cell count with treatment response.

Benefits of initiating treatment will outweigh risk in majority of people

Suggest all people with hiv2 start ARVs
Strong suggest if -
Dual hiv1/2 infection
Pregnancy
Coinfection with hep b
Diagnosis made during primary hiv2 injection
Detectable hiv2 viraemia
Cd4 <500
Advanced disease/opportunistic infection
Symptoms or an indicator condition of hiv 1 or 2 regardless of cd4 or VL

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8
Q

What ARV to use if uncertainty about whether there might be dual hiv 1 and 2 infection?

A

Something that is active against both viruses - resistance may be more
Likely to develop in HIV2

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9
Q

How to manage PHIV2?

A

Start ARV
From TEMPRANO/START/HPTN052 improved morbidity and mortality following ART initiation regardless of CD4 count
Reduces risk onward transmission
Possible limitation of viral reservoir

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10
Q

How to manage HBV/HIV2 coinfection?

A

As per HIV1 - tx with tdf containing ARV

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11
Q

How does VL differ in HIV2?

A

More elite controllers
Most people still go on to have disease progression and CD4 drops even if VL levels low

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12
Q

Does u=u apply in hiv2?

A

Yes but can only say this for those on treatment

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13
Q

What ARVs to start in HIV2?

A

TDF/FTC preferred backbone
TAF/FTC also suitable
ABC/3TC 2nd line - likely to be greater TDF activity in presence of viral resistance

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14
Q

What ARVs are not recommended in HIV2?

A

NNRTI no activity against HIV2

AZT, stavudine not recommended due to mitochondrial toxicity

atazanavir, fosamprenavir, tipranavir
No clinical experience of MVC in tx naive individuals

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15
Q

Which third agent to use in HIV2?

A

DTG BD or DRV/r Bd
unless consistently aviraemic before tx then can have OD

Alternatives if appropriate but minimal data
Bictegravir
Cobicistat as booster
RAL BD but more resistance emerging than with DTG
Elv/c

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16
Q

If needing to treat HIV 1/2 co infection prior to all results being back what ARV to give?

A

Bd dosing drv/r or dtg as safer

17
Q

Monitoring of HIV2 - not on treatment

A

Cd4 and VL every 6/12 if cd4 >500 as rate of decline slow

18
Q

Monitoring
If HIV2 on treatment

A

If pre tx VL detectable then VL and CD4 at 1, 3 and 6 months then 3-6 monthly
CD4 count response slower in hiv2 than hiv 1

If VL undetectable pre tx 1 and 6/12

If becomes detectable should have resistance testing

19
Q

HIV2 baby pep

A

Very low risk 2 weeks azt
Low risk 4 weeks azt
High risk azt/3TC/ral (lop/r second option for 3rd agent)

20
Q

Definition of treatment failure HIV2

A

Detection of HIV2 rna in 2 consecutive tests, decline in cd4, persistence or emergence of hiv/aids specific symptoms

21
Q

Management of virological rebound

A

Try and get resistance
Discuss adherence
?switch to more tolerable drugs if needed

22
Q

PEP/PREP use with HIV2

A

Same as HIV1 but longer follow up for PEPSE for serological tests (90 days)