Clinical HIV-2 Viral Load Testing of a Large Population of HIV-2 Infected Individuals

Transcription

1 Clinical HIV-2 Viral Load Testing of a Large Population of HIV-2 Infected Individuals Linda M. Styer Wadsworth Center, NYSDOH ** The authors have no conflicts of interest to disclose **

2 HIV-2 viral load uses real time HIV-2 RT-PCR assay with standards and a No RT control. LYSIS.2 or.9 ml plasma 2ul internal control. DUPLEX REAL TIME PCR HIV-2 LTR-Repeat 7 IU IU No RT Control <% DNA, IU 2. EXTRACTION Total nucleic acid Nuclisens EasyMAG Internal Control (Mouse Hepatitis Virus), IU,, IU. REVERSE TRANSCRIPTION Random Hexamer Styer 2 JCV 58(s): e27-e LOD: 7 IU/ml (.9 ml), 2 IU/ml (.2 ml) LLOQ: IU/ml (.9mL), 85 IU/ml (.2mL)

3 Since 2, tested specimens from 8 HIV-2 infected patients 2 # viral load specimens cumulative # different viral load patients Number Year of Specimen Collection

4 Confirm HIV-2 infection with antibody & RNA testing Test Result # Patients Additional Results HIV-2 RNA HIV-2 RNA Detected 2 No sample left for Ab testing Multispot HIV-2 Positive n=7 HIV Undifferentiated HIV- RNA D, HIV-2 RNA D HIV-2 Positive w/ HIV- CR 7 HIV-2 Positive HIV Positive, Untypable HIV-2 VL: IU/ml Geenius HIV-2 Indeterminate (gp only) n=8 HIV-2 DNA detected HIV Indeterminate (gp, gp) HIV-2 Pos, months later Negative HIV-2 RNA Detected HIV- Positive (gp, gp, gp) HIV-2 VL: IU/ml Total 8

5 Case : HIV-2 viral load specimen, Geenius negative Date HIV-2 VL Geenius March 27 Not Detected Negative August 27 HIV-2 RNA Detected Negative HIV Ag/Ab Reactive,. Reactive, 8. October 27 Not Detected Negative Reactive,.5 October 28 2 IU/ml Negative Reactive,. Patient from Cape Verde. HIV-2 WB positive in 2 (CDC). On ARV treatment. No immune system abnormalities.

6 Case 2: HIV-2 viral load specimen, Geenius HIV- Pos Date HIV-2 VL Geenius HIV Ag/Ab HIV- RNA Oct 28 2 IU/ml HIV- Positive Reactive, 95 Not Detected HIV- Positive HIV-2 Positive w/ HIV- CR HIV- Positive Patient from Ivory Coast. Tested with HIV- viral load since 2 (undetectable). March 28 HIV Ag/Ab and Geenius HIV-2 Positive. Patient on ARV treatment.

7 Demographics of 8 HIV-2 Viral Load Patients Age # % -9 % 2-29 % -9 7 % -9 % % % 7-79 % >79 2 2% Mean Age = 55 years Sex # % Male 5 % Female 58 5% Residence # % New York City 7 2% Rest of New York State 5 5% Out-of-State (2 from contracted facility in MA) % Race/Ethnicity # % Black 87 8% Unknown % White/Hispanic % White/Unknown 2 2% Native American % Pacific Islander %

8 Most HIV-2 VL patients (7%) are from West Africa 8 7 Central Africa 2 East Africa 2 Mexico 2 India Pakistan Unknown 28

9 Summary of HIV-2 Viral Load Results by Specimen HIV-2 Viral Load (Log IU/ml) HIV-2 RNA Detected, Viral Load Obtained N = 8 (2%) Highest viral load 75, IU/ml Average viral load 2,52 IU/ml HIV-2 RNA Detected, Less than LLOQ N = 9 (22%) Reasons for Indeterminate samples with DNA >% samples with Inhibition HIV-2 RNA Not Detected N = 5 (%) Indeterminate N = (%)

10 HIV-2 Viral Load Patterns in 5 Patients with specimens HIV-2 Viral Load (Log IU/ml) RNA Detected <LLOQ 5 (28%) VL5 5 VL2 VL VL7 VL58 VL7 VL78 VL22 VL59 2 LLOQ VL VL8 VL VL LOD VL28 VL2 Sep- Jan- Jun- Oct-5 Mar-7 Jul-8 Dec-9 Collection Date HIV-2 Viral Load (Log IU/ml) 5 2 Successful (>.5 log drop) (25%) LLOQ LOD Sep- Jan- Jun- Oct-5 Mar-7 Jul-8 Dec-9 Collection Date VL7 VL9 VL52 VL85 VL8 VL VL VL5 VL87 VL8 VL82 VL9 VL9

11 HIV-2 Viral Load Patterns in 5 Patients with specimens Consistent Viral Load Values (9%) Fluctuating VL Values 7 (%) VL 5 5 VL2 HIV-2 Viral Load (Log IU/ml) 2 LLOQ VL9 VL VL VL2 VL2 VL VL7 VL2 VL79 VL2 HIV-2 Viral Load (Log IU/ml) 2 LLOQ LOD VL9 VL VL VL5 VL7 Sep- Jan- Jun- Oct-5 Mar-7 Jul-8 Dec-9 Collection Date Sep- Jan- Jun- Oct-5 Mar-7 Jul-8 Dec-9 Collection Date

12 HIV-2 Viral Load Patterns in 5 Patients with specimens (%) RNA not detected HIV-2 Viral Load (Log IU/ml) 5 2 Increasing VL Values (> Log) LLOQ 2 (%) VL8 VL8 LOD Sep- Jan- Jun- Oct-5 Mar-7 Jul-8 Dec-9 Collection Date

13 HIV-2 DNA in plasma Black male, 5- years On hemodialysis, kidney transplant in 25 Unusual HIV-2 Viral Load Cases HIV-2 Viral Load (Log IU/ml) 5 2 HIV-2 DNA repeatedly detected in No RT wells 25, IU/ml 75, IU/ml Sep- Jan- Jun- Oct-5 Mar-7 Jul-8 Dec-9 Collection Date VL7 VL9 VL High HIV-2 Viral Load ( 25, IU/ml). Black male, 5-9 years, poor response to treatment 2. Black female, -5 years, neurological symptoms, CSF VL = 72 IU/ml, excellent treatment response

14 Conclusions HIV-2 viral load testing is vital part of clinical care of HIV-2 infected patients Although HIV-2 viral loads are generally low, values above, IU/ml are not uncommon We have tested more than different HIV-2 infected patients

15 Acknowledgements Bloodborne Viruses Lab, Wadsworth Center Monica Parker Jean Stella, Robert Blum, Tom Miller Tim Sullivan, Phil Rivenburg, William Carmichael, Patty Dingman, Renee Hallack, Lea Ryman Dr. Lucia Torian, Bureau of HIV Prevention and Control, New York City Department of Health and Mental Hygiene