University of Washington-Dakar HIV-2 Study Group

A multidisciplinary collaboration of the UW & Universite Cheikh Anta Diop de Dakar, Senegal

Principal Investigators:

    Seattle: Geoffrey S. Gottlieb, MD PhD 

    Dakar: Moussa Seydi, MD               

Goals: A comprehensive understanding of HIV-2 infection

  • Natural history 
  • Epidemiology 
  • Antiretroviral therapy
  • Antiretroviral drug-resistance
  • Patient care and management
  • New HIV-2 specific technologies 

Mission Statement:

The overarching goals of our project are to develop an integrated program to further our ability to provide evidenced-based, potent antiretroviral therapy (ART) to patients with HIV-2 infection. Compared to HIV-1, HIV-2 infection is characterized by a longer asymptomatic stage, lower plasma viral loads, slower decline in CD4 count, decreased mortality rate due to AIDS, lower rates of mother to child transmission, and lower rates genital shedding and sexual transmission. In West Africa, where both HIV-1 and HIV-2 co-circulate, between 1-2 million individuals are infected with HIV-2 and a significant proportion  are co-infected with both HIV-1 and HIV-2. Despite the relatively attenuated disease course of HIV-2, a significant minority of untreated individuals will progress to clinical AIDS or death without ART and as will the majority of those dually infected with HIV-1 and HIV-2. Through local and global initiatives, antiretroviral therapy is becoming increasingly available inresource-limited West Africa.

Because HIV-2 is intrinsically resistant to non-nucleoside reverse transcriptase inhibitors and may have partial resistance to some protease inhibitors (PI), treating HIV-2 and HIV-1/HIV-2 dual infection presents distinct challenges. This is especially problematic in resource-limited settings where there is limited choice and availability of 1st line NRTI-PI based regimens as well as subsequent 2nd line and salvage regimens in those individuals with clinical progression, immuno-virologic failure or antiretroviral (ARV) toxicities. To date, we remain largely ignorant about the long-term outcomes of ART in HIV-2 infected people, we are in urgent need for assessment of new classes antiretrovirals for HIV-2 and we lack even rudimentary studies on ARV-
regimens to treat HIV-1/HIV-2 dual infection, or whether ARV treatment outcomes using NRTI-PI based regimens are different than HIV-2 single infection. 

This project has the following specific aims: 

AIM 1: Develop, implement and evaluate outcomes of a new HIV-2 viral load and ARV resistance-informed algorithm for 2nd-line ART in HIV-2 infected patients in the Initiative Sénégalaise d'Accès aux Antirétroviraux (ISAARV) program.

AIM 2: Determination of genotypic and phenotypic susceptibility, resistance mechanisms and pathways, of HIV-2 to novel and pipeline antiretroviral agents. 

AIM 3: Development and validation for clinical diagnostic use of a novel HIV-2 and HIV-1 total nucleic acid detection assay (HIV-1/2 tNAT).