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

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 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

10 years of HIV treatment HIV-1RNA viral load HIV-1 RNA load and CD4+ T-cells CD4+ T-cells per µL switch from PI start of to NNRTI boosted PI 10000 800 L 700 m CD4+ cells per µL 600 switch back r e 1000 p 500 from NNRTI to ATV s e 400 i p o 300 c 100 A 200 N R 100 1 10 0 - V I H 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

How clear is HIV-2 serology? + 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 HIV-1 env

How clear is HIV-2 serology? + 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 HIV-1/2 pol/gag

How clear is HIV-2 serology? + 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 HIV-2 env

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 +/+

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

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) 1st round product 1386 bp Primer 3‘ (3779-3748) – further Primer pairs for nested PCR and sequencing – sequence interpretation Martin Stürmer

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

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

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)