Treating HIV-2 Guidelines

posted: 04/11/2010

There are two main types of HIV, and HIV-2 is found mainly in West Africa and less so in parts of India, with very few migrants in the UK having this HIV type; most people in the UK have HIV-1.

The first treatment guidelines for HIV-2 have now been agreed by BHIVA (British HIV Association).
 

Under 150 people are diagnosed with HIV-2 in the UK and under 50 people have both HIV-1 and HIV-2, so these guidelines try to make sure the considerable differences between the two HIV types and the best treatments for HIV-2 are well understood.
Although HIV -1 and HIV-2 are closely related, there are some big differences in testing, monitoring viral load, in treatment.
 

Less transmission and health harm
HIV-2 is harder to pass on, because it is 5 – 10 times less infectious in heterosexual sex than HIV-1 is. Women are also less likely to pass on HIV to a baby: this is 20-30 times less likely with HIV-2. The assumption is that HIV-2 can also be passed on through sex between men and injecting drug use, like HIV-1.
 

HIV-2 is also less harmful than HIV-1. Death rates are far lower, people show no HIV symptoms for far longer (10 - 20 years without symptoms is not unknown) and some people may never develop AIDS. But HIV-2 also varies and some people will become ill as fast as they would have with HIV-1.
 

Testing
Standard HIV tests find people with HIV-2 but because dealing with HIV-2 is different to HIV-1, people with HIV-2 need to spotted during testing. Not all UK labs can test for HIV-2 but testing for HIV-2 needs to be done for people to be given proper treatment and care. There are special tests to identify people with HIV-2.
 

Measuring the viral load of people with HIV-2 is a problem. Different tests give different results. HIV-2 viral load is harder to find because it is about 30 times lower than with HIV-1: viral load is much more likely to be undetectable. There are no commercial HIV-2 viral load tests for sale.

Viral load is not detectable in half the people with a CD4 count of 300. The higher the CD4 count, the less likely it is that any HIV-2 viral load will be found. The CD4 counts and viral loads of people with HIV-2 have to be interpreted quite differently to people with HIV-1. There are four specialist labs in the country that can do this.
 

Treatment
Where HIV-2 viral load is undetectable the CD4 count may be the only guide to when to begin treatment. CD4 counts can remain stable for years. But CD4 can also fall as fast as with HIV-1, when a HIV-2 viral load is high. CD4 counts tend not to bounce back upwards as much after treatment as with HIV-1.
 

The BHIVA Guidelines for HIV-2 advise clinicians to refer all HIV-2 patients to someone expert in treating HIV-2. Most HIV doctors in the UK don’t have the necessary experience, and interpreting test results is a problem.
 

BHIVA’s treatment guidelines for HIV-2 describe how it responds to the various types of HIV drug. They suggest preferred first and second line treatment combinations for HIV-2 and the use of two NRTIs and one or more PIs. Second and third line options are limited. A good number of HIV drugs are not effective with HIV-2 and these must be avoided. Where people have both HIV-1 and HIV-2, treatment choices are limited and should be considered carefully.
 

When to treat
They suggest starting treatment before the CD4 count falls to between 350-500, and treating people whenever the VL is above 1000.
 

Source HIV Medicine (2010) 11, 611-619: the November issue and soon online

Psychologists and Confidentiality

posted: 08/03/2010

A 20 page booklet of guidance from the British Psychological Society advises psychologists working in the NHS how to deal with HIV confidentiality where people may be exposing their partners to HIV. The guidance – ‘Criminalisation of HIV Transmission – guidelines regarding confidentiality and exposure’ has best practice guidelines, sections on dealing with police enquires and on disclosing information to partners, and what the various codes of ethics and types of professional guidance say.

These guidelines on HIV confidentiality and disclosure were developed to help clinical psychologists where HIV-positive clients have not disclosed their status to their sexual partners and there is a significant risk for HIV transmission. They have also been developed to assist clinical psychologists when clients believe they have contracted HIV under these circumstances.

This 2009 booklet costs £4.70 to people who are not members of the British Psychological Association.