Epidemiologic Notes and Reports AIDS Due to HIV-2 Infection -
- New Jersey
The first reported case of AIDS caused by human
immunodeficiency
virus type 2 (HIV-2) in the United States was diagnosed in December
1987. The patient, a West African, came to the United States in
1987.
In December, the patient visited a physician because of a 3-year
history of weight loss and recent onset of neurologic symptoms. A
CAT
scan of the head revealed mass lesions that biopsy showed to be
caused
by Toxoplasma gondii. Biopsy of a lymph node revealed acid-fast
bacteria.
The patient did not give a history of sexual intercourse, use
of
nonsterile needles, or donation of blood while in the United
States.
All family members and household contacts, both in the United
States
and abroad, are reported to be well.
Because the diagnosis of cerebral toxoplasmosis without other
underlying cause of immunodeficiency fits the CDC surveillance
definition for AIDS, laboratory evidence of infection with HIV was
sought. Testing of the patient's serum revealed a negative enzyme
immunoassay (EIA) for antibody to HIV-1 with an indeterminate HIV-1
Western blot. However, EIA for antibodies to HIV-2 (Genetic Systems
Corporation, Seattle, Washington (research test kit)) was
repeatedly
reactive and HIV-2 Western blot revealed bands for antibodies to
gag
(p26), pol (p34), and env (gp140) proteins. DNA amplification by
the
polymerase chain reaction technique with HIV-1- specific and
HIV-2-specific DNA probes (1) revealed HIV-2 DNA but not HIV-1 DNA
in
the patient's lymphocytes and confirmed the diagnosis of HIV-2
infection.
Reported by: SH Weiss, MD, J Lombardo, MD, PhD, J Michaels, MD, LR
Sharer, MD, M Tayyarah, MD, J Leonard, MD, A Mangia, MD, P Kloser,
MD,
S Sathe, MD, R Kapila, MD, New Jersey Medical School, Univ of
Medicine
and Dentistry of New Jersey, Newark; NM Williams, MD, R Altman, MD,
MPH, J French, MA, WE Parkin, DVM, State Epidemiologist, New Jersey
State Dept of Health. Genetic Systems Corp, Seattle, Washington.
AIDS
Program, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: This patient represents the only documented case of
HIV-2 infection in the United States. HIV-2 is closely related to
HIV-1 and was first reported to be associated with AIDS in 1986 in
West Africa, where the virus is believed to be endemic (2-8).
Several
well-documented cases of HIV-2 infection have also been reported
among
Europeans and among West Africans residing in Europe (3,4,8). The
spectrum of disease and modes of transmission of HIV-2 are similar
to
those of HIV-1 (2-5). These modes of transmission include sexual
intercourse; however, infected persons present no risk to nonsexual
household contacts (9). The present case undoubtedly represents
infection acquired in West Africa since illness began before the
patients arrival in the United States. The patient has had no known
activities that would have exposed others in this country to HIV-2.
Because of the reports of HIV-2 infection in West Africa and
Europe, CDC and the Food and Drug Administration (FDA) initiated
surveillance for HIV-2 in the United States in January 1987. To
date,
CDC, FDA, and collaborating investigators have screened 22,699
serum
samples with anti-HIV-2 EIA (10). Of these specimens, 14,196 (63%)
were from individuals whose activities placed them at increased
risk
for HIV-1 infection and who would, therefore, potentially be at
risk
for HIV-2 infection. The remaining 8,503 were from asymptomatic
blood
donors randomly selected from three areas of the United States, two
of
which have reported large numbers of AIDS patients. Overall, 35
(0.2%)
of the serum samples were reactive by anti-HIV EIA using HIV-2
antigens but not by anti-HIV EIA using HIV-1 antigens. However,
none
of these EIAs could be confirmed when tested by HIV-2-specific
Western
blot. An additional 70 (0.3%) of the samples were reactive by
Western
blot with gag, pol, and env antigens of both HIV-1 and HIV-2. All
of
the dually reactive specimens were from individuals whose
activities
placed them at increased risk for HIV-1 infection. None were from
the
randomly selected blood donors. Sera from these dually reactive
subjects were studied for the presence of type-specific
neutralizing
antibody to HIV-1 or HIV-2, antibody to synthetic peptides specific
for HIV-1 or HIV-2 (Genetic Systems Corporation, Seattle,
Washington
(research test kit)), or HIV-1 and HIV-2 DNA by DNA amplification
(1).
Sixty of the subjects were shown to be infected with HIV-1 but not
HIV-2. Ten are still under investigation.
It is reassuring that HIV-2-specific tests on sera from 22,699
persons, including 8,503 randomly selected U.S. blood donors,
failed
to reveal HIV-2 infection. However, the occasional presence of this
virus in the United States, as in Europe, should be anticipated.
The
anti-HIV-1 EIA tests currently used for screening all U.S. blood
donors are estimated to detect 42% to 92% of HIV-2 infections
(4,11).
Surveillance for HIV-2 in the United States is being continued to
monitor the frequency of infection. Because the modes of
transmission
of HIV-1 and HIV-2 are similar, preventive measures for these
related
viruses are the same (12).
References
Ou C-Y, Kwok S, Mitchell SW, et al. DNA amplification for
direct
detection of HIV-1 in DNA of peripheral blood mononuclear
cells.
Science 1988;239:295-7.
Clavel F, Guetard D, Brun-V|$$|Aaezinet F, et al. Isolation of
a
new human retrovirus from West African patients with AIDS.
Science
1986;233:343-6.
Brun-Vezinet F, Rey MA, Katlama C, et al.
Lymphadenopathy-associated virus type 2 in AIDS and
AIDS-related
complex: clinical and virological features in four patients.
Lancet 1987;1:128-32.
Clavel F, Mansinho K, Chamaret S, et al. Human immunodeficiency
virus type 2 infection associated with AIDS in West Africa. N
Engl
J Med 1987;316:1180-5.
Brun-Vezinet F, Rey MA, Dazza MC, et al. LAV-2/HIV-2 infection:
clinical, epidemiological and virological features (Abstract
no.
THP.33). In: Abstracts of the third international conference on
acquired immunodeficiency syndrome (AIDS). Washington, DC: US
Department of Health and Human Services, Public Health Service,
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Antunes F, Odete Santos Ferreira M, Lourenco MH, Costa C, Pedro
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Katlama C, Harzic M, Kourouma K, Dazza MC, Brun-Vezinet F.
Seroepidemiological study of HIV1 and HIV2 infection in
Guinea-Conakry (Abstract no. THP.75). In: Abstracts of the
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Clavel F. HIV-2, the West African AIDS virus. AIDS 1987;
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Friedland GH, Saltzman BR, Rogers MF, et al. Lack of
transmission
of HTLV-III/LAV infection to household contacts of patients
with
AIDS or AIDS-related complex with oral candidiasis. N Engl J
Med
1986; 314:344-9.
Schochetman G, Schable CA, Goldstein LC, Epstein J, Zuck TF.
Screening of U.S. populations for the presence of LAV-II
(Abstract
no. THP.52). In: Abstracts of the third international
conference
on acquired immunodeficiency syndrome (AIDS). Washington, DC:
US
Department of Health and Human Services, Public Health Service,
World Health Organization, 1987:172.
Denis F, Leonard G, Mounier M, et al. Efficacy of five enzyme
immunoassays for antibody to HIV in detecting antibody to
HTLV-IV.
Lancet 1987; 1:324-5.
Public Health Service. Surgeon General's report on acquired
immune
deficiency syndrome. Washington, DC: US Department of Health
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Human Services, Public Health Service, 1986.
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