Treatment of Acquired Immunodeficiency Syndrome in HIV-2 Mono-Infection or HIV-1/HIV-2 Coinfection

Managing AIDS in the setting of HIV-2 mono-infection or HIV-1/HIV-2 coinfection requires a distinct antiretroviral strategy. Because HIV-2 has different intrinsic resistance properties than HIV-1, regimen selection for ART-naive patients in this sub-population differs from standard HIV-1 management.

Clinical Scenario

This protocol addresses ART-naive patients with HIV-2 mono-infection or HIV-1/HIV-2 coinfection. The presence of HIV-2 directly shapes which drug classes can and cannot be used, and which class-based backbones are appropriate for initiating treatment.

Treatment Approach

The preferred first-line regimen is built around an integrase strand transfer inhibitor backbone. An alternative approach using a different class of antiretroviral is also specified for cases where the primary option is not suitable. Importantly, one entire drug class is excluded from use in this population due to intrinsic HIV-2 resistance — the structured protocol details which combinations qualify and under what circumstances.

Complete regimen selection, alternatives, and sequencing logic are available in the full protocol.

Treatment Goals

The primary clinical objectives for this population are:

Suppression of plasma HIV-2 RNA
Maintenance or increase of CD4 T lymphocyte cell count

Treatment response is assessed using HIV-2 RNA, CD4 cell counts, and clinical status.

Instant Access to Structured Evidence-Based Regimens

References

For ART-naive patients who have HIV-2 mono-infection or HIV-1/HIV-2 coinfection, antiretroviral (ARV) regimens should include an integrase strand transfer inhibitor (INSTI) plus two nucleoside reverse transcriptase inhibitors (NRTIs) (AII).
A regimen that contains one INSTI plus two NRTIs is the recommended initial ART for most individuals with HIV-2 (AII).
An alternative regimen is a boosted PI (DRV or LPV) that is active against HIV-2 plus two NRTIs (BII).
HIV-2 is intrinsically resistant to NNRTIs; therefore, NNRTI-based regimens, including long-acting injectable RPV (given with the INSTI CAB), are not recommended for treatment of HIV-2 (AIII).
HIV-2 RNA, CD4 T lymphocyte (CD4) cell counts, and clinical status should be used to assess treatment response (AII).

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