HIV-2 Experiences in Munich Josef Eberle Max von Pettenkofer - - PowerPoint PPT Presentation

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HIV-2 Experiences in Munich Josef Eberle Max von Pettenkofer - - PowerPoint PPT Presentation

Sep 12, 2022 641 likes •779 views

HIV-2 Experiences in Munich Josef Eberle Max von Pettenkofer Institute Ludwig-Maximilians-University Munich A case history male, 46 years old, West African origin, living in Austria blood was sent to us with the question of

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SLIDE 1

HIV-2 Experiences in Munich

Josef Eberle Max von Pettenkofer Institute Ludwig-Maximilians-University Munich

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SLIDE 2

A case history

  • male, 46 years old, West African origin, living in Austria
  • blood was sent to us with the question of missquantification (12/08)
  • since March 1998 HIV-1 infection documented by westernblot (New LAV blot I)

p24 +++, p31 ++, gp41Ø, p51+, p55 (+), p66 ++, gp120 (+), gp160 +

  • CD4-count was 100 per µL and HIV-1 VL 3,000 per mL

ART with AZT+ddI initiated in 04/1998

  • CD4-count was 60 and HIV-1 VL 700

ART switched in 12/1999 to d4T+3TC+Indinavir/r (later Saquinavir/r)

  • CD4-count increased to 760 and HIV-1 RNA became undetectable (5/2000)

Switch from boosted PI to NNRTI in 6/2003

  • CD4-count declined to 80 and could not be stabilized even after addition of ATV
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SLIDE 3

10 years of HIV treatment

HIV-1 RNA load and CD4+ T-cells

10 100 1000 10000 A pr 98 O k t 98 A pr 99 O k t 99 A pr 00 O k t 00 A pr 01 O k t 01 A pr 02 O k t 02 A pr 03 O k t 03 A pr 04 O k t 04 A pr 05 O k t 05 A pr 06 O k t 06 A pr 07 O k t 07 A pr 08 O k t 08 CD4+ cells per µL 100 200 300 400 500 600 700 800 HIV-1RNA viral load CD4+ T-cells per µL

start of boosted PI switch from PI to NNRTI switch back from NNRTI to ATV

H I V

  • 1

R N A c

  • p

i e s p e r m L

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SLIDE 4

+ control

  • control

V0836668 HIV-1 CR? V0836026 HIV-2 CR? V0820902 HIV-1 V0907312 HIV-2 V0910651 HIV-2 V0911622 dual infection V0907619 HIV-2 V0902269 HIV-2 CR? V0842701 dual infection

How clear is HIV-2 serology?

HIV-1 env

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SLIDE 5

+ control

  • control

V0836668 HIV-1 CR? V0836026 HIV-2 CR? V0820902 HIV-1 V0907312 HIV-2 V0910651 HIV-2 V0911622 dual infection V0907619 HIV-2 V0902269 HIV-2 CR? V0842701 dual infection

How clear is HIV-2 serology?

HIV-1/2 pol/gag

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SLIDE 6

How clear is HIV-2 serology?

HIV-2 env

+ control

  • control

V0836668 HIV-1 CR? V0836026 HIV-2 CR? V0820902 HIV-1 V0907312 HIV-2 V0910651 HIV-2 V0911622 dual infection V0907619 HIV-2 V0902269 HIV-2 CR? V0842701 dual infection

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SLIDE 7

How clear is HIV-2 serology?

+ control

  • control

V0836668 HIV-1 CR? - V0836026 HIV-2 - CR? V0820902 HIV-1 ? HIV-2 - V0907312 HIV-2 - V0910651 HIV-2 - V0911622 dual infection - V0907619 HIV-2 + V0902269 HIV-2 + CR? - V0842701 dual infection +/+

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SLIDE 8

HIV-2 cases in Germany

  • who many infected? dimension 100-1000

– about 60 requests for HIV-2 viral load tests in 30 months – 10 different clinical customers – 10 continuously monitored patients

  • who is infected?

– male vs. female (1 male, 2 ?, 7 females out of 10) – mostly West African origin – age distribution (mean 40.3 yrs, median 44, range 27-53)

  • who is under treatment?

– clearly less than 10 in our cohort – viral loads are increasing, CD4-counts dropping over time

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SLIDE 9

Nucleic acid tests for HIV-2

  • qualitative and quantitative PCR

– not standardized – different approaches (dilution PCR, real-time PCR) – absolute sensitivity? – subtype detection?

  • genotypic resistance test (PR, RT, IN)

– e.g. Primer 5‘ (2414-2431) Primer 3‘ (3779-3748) – further Primer pairs for nested PCR and sequencing – sequence interpretation

Martin Stürmer

1st round product 1386 bp

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SLIDE 10

German HIV-2 initiative

As numbers of patients with progressed disease will increase, we need:

  • Improvements in laboratory and clinical awareness

– learning from Portugal and France

  • Improvements in communication between lab and clinician
  • Improvements in lab tests

– sensitivity, standardization of viral load assays – performance and interpretation of genotypic resistance tests – comparison to phenotypic resistance tests

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SLIDE 11

The case ... continued

  • male, 46 years old, West African origin, living in Austria
  • blood was sent to us with the question of missquantification (12/08)
  • since March 1998 HIV-1 infection documented by western blot (New

LAV blot I) p24 +++, p31 ++, gp41Ø, p51+, p55 (+), p66 ++, gp120 (+), gp160 +

  • .....
  • .....
  • 1/2009 diagnosis of dual infection, set up of resistance test for HIV-2
  • as of 02-07-2009 ART switch to TNV+3TC+ Saquinavir/r+Raltegravir
  • CD4-count on 02-07-2009 was 120 per µL
  • CD4-count on 04-15-2009 was 170 per µL
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SLIDE 12

Thank you for attention

all other customers for their will to share data

and special acknowledgements

Wolfgang Prammer, Klinikum Wels-Grieskirchen, Austria (for the case)