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. 2013 Sep 24;27(15):2441-50.
doi: 10.1097/QAD.0b013e328362e856.

HIV-1 outcompetes HIV-2 in dually infected Senegalese individuals with low CD4⁺ cell counts

Dana N Raugi  1 , Geoffrey S Gottlieb, Papa S Sow, Macoumba Toure, Fatima Sall, Awa Gaye, Ibra N'doye, Nancy B Kiviat, Stephen E Hawes; University of Washington-Dakar HIV Study Group
Affiliations

HIV-1 outcompetes HIV-2 in dually infected Senegalese individuals with low CD4⁺ cell counts

Dana N Raugi et al. AIDS. .

Abstract

Objective: Dual infection with HIV-1 and HIV-2, which is not uncommon in West Africa, has implications for transmission, progression, and antiretroviral therapy (ART). Few studies have examined viral dynamics in this setting. Our objective was to directly compare HIV-1 and HIV-2 viral loads and to examine whether this relationship is associated with CD4⁺ cell count.

Study design: This is a retrospective analysis of data from observational cohort studies.

Methods: We compared HIV-1 and HIV-2 viral loads from 65 dually infected, ART-naive Senegalese individuals. Participants provided blood, oral fluid, and cervicovaginal lavage (CVL) or semen samples for virologic and immunologic testing. We assessed relationships between HIV-1 and HIV-2 levels using linear regression with generalized estimating equations to account for multiple study visits.

Results: After adjusting for CD4⁺ cell count, age, sex, and commercial sex work, HIV-1 RNA levels were significantly higher than HIV-2 levels in semen, CVL, and oral fluids. Despite similar peripheral blood mononuclear cell DNA levels among individuals with CD4⁺ cell counts above 500 cells/μl, individuals with CD4⁺ cell counts below 500 cells/μl had higher HIV-1 and lower HIV-2 DNA levels. Individuals with high CD4⁺ cell counts had higher mean HIV-1 plasma RNA viral loads than HIV-2, with HIV-1 levels significantly higher and HIV-2 levels trending toward lower mean viral loads among individuals with low CD4⁺ cell counts.

Conclusion: Our data are consistent with the hypothesis that with disease progression, HIV-1 outcompetes HIV-2 in dually infected individuals. This finding helps explain differences in prevalence and outcomes between HIV-1, HIV-2, and HIV-dual infection.

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Conflict of interest statement

Conflicts of interest

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1. HIV-1 and HIV-2 plasma RNA levels among HIV-1/2 dually infected individuals
Correlation between HIV-1 and HIV-2 is shown in panels a and c, respectively. Data points represent paired HIV-1 and HIV-2 viral loads. Filled markers indicate that both viral loads are from the same study visit, open markers indicate that one viral load is from a subsequent visit within 6 months. The linear regression line is also shown. Plasma RNA and PBMC DNA levels, stratified by CD4+ cell count, are shown in panels b and d, respectively. PMBC, peripheral blood mononuclear cell.
Fig. 2
Fig. 2. Correlation of HIV-1 and HIV-2 plasma RNA with peripheral blood mononuclear cell DNA levels in HIV-1/2 dually infected individuals
Data points represent HIV-1 (black diamonds) or HIV-2 (gray circles) plasma RNA/PBMC DNA pairs in dual HIV-1/2 infection. Filled markers indicate that plasma RNA and PBMC DNA levels are from the same study visit, open markers indicate that one level is from a subsequent visit within 6 months. Linear regression lines for the relationship between DNA and RNA are also shown, solid lines for individuals with CD4+ cell counts greater than or equal to 500 cells/µl or dashed lines for CD4+ cell counts less than 500 cells/ µl. PMBC, peripheral blood mononuclear cell.
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