Antiretroviral Guidelines

US DHHS Guidelines with Australian commentary


HIV-2 Infection


Last Updated: April 8, 2015; Last Reviewed: April 8, 2015

Summary of HIV-2 Infection

AU comment: HIV-2 Infection

Summary of HIV-2 Infection


  • Compared to HIV-1 infection, the clinical course of HIV-2 infection is generally characterized by a longer asymptomatic stage, lower plasma HIV-2 RNA levels, and lower mortality; however, progression to AIDS does occur.
  • There have been no randomized trials addressing the question of when to start antiretroviral therapy (ART) or the choice of initial or second-line therapy for HIV-2 infection; thus, the optimal treatment strategy has not been defined.
  • Although the optimal CD4 T lymphocyte (CD4) cell count threshold for initiating ART in HIV-2 infection is unknown, therapy should be started before there is clinical progression.
  • HIV-2 is intrinsically resistant to non-nucleoside reverse transcriptase inhibitors and to enfuvirtide; thus, these drugs should not be included in an antiretroviral regimen for a patient living with HIV-2 infection.
  • Pending more definitive data on outcomes in an ART-naive patient who has HIV-2 mono-infection or HIV-1/HIV-2 dual infection and requires treatment, an initial antiretroviral therapy regimen for these patients should include two nucleoside reverse transcriptase inhibitors plus an HIV-2 active boosted protease inhibitor or integrase strand transfer inhibitors.
  • A few laboratories now offer quantitative plasma HIV-2 RNA testing for clinical care (see section text).
  • Monitoring of HIV-2 RNA levels, CD4 cell counts, and clinical improvements can be used to assess treatment response, as is recommended for HIV-1 infection.
  • Resistance-associated viral mutations to nucleoside reverse transcriptase inhibitors, protease inhibitors, and/or integrase strand transfer inhibitors may develop in patients with HIV-2 while on therapy. However, no validated HIV-2 genotypic or phenotypic antiretroviral resistance assays are available for clinical use.
  • In the event of virologic, immunologic, or clinical failure, second-line treatment should be instituted in consultation with an expert in HIV-2 management.
Rating of Recommendations:  A = Strong; B = Moderate; C = Optional
Rating of Evidence:  I = Data from randomized controlled trials; II = Data from well-designed nonrandomized trials or observational cohort studies with long-term clinical outcomes; III = Expert opinion