Year: 2021
Type: article
Study design: Case Report
Abstract: referred back to us by the hematology team who had picked up a polyclonal hypergammaglobulinaemia secondary to HIV infection.In June 2014, a repeat HIV test was reported as: 'HIV 1+2 antibody and p24 antigen detected with the presence of both gp41 reactivity and gp36 peptide indicates that dual infection is likely, and DNA PCR is recommended.' It is unclear why an HIV 'DNA PCR' rather than an HIV RNA PCR was suggested but no further investigations on HIV-2 was carried out at this point.DB fully admitted to not wanting to engage with HIV care for 10 years but was ready to do so at that point.Her HIV-1 viral load came back as 27,000Copies/ml and her CD4 count had dropped to 190. DB had now developed natural immunity to hepatitis B with core Antibodies present with no surface Antigen.She had IgG antibodies to Toxoplasmosis and Cytomegalovirus and was negative for Hepatitis C and Syphilis.DB had hypertension and was on standard anti-hypertensive treatment for this.As she did night shifts and had HIV-1 wild type virus, she declined an Efavirenz based regimen and opted for Eviplera (Tenofovir Disoproxil Fumarate, Lamivudine and Rilpivirine) and remained on this regimen as her HIV-1 viral load dropped to less than 50copies/ml and her CD4 count rose to 590 in January 2020.When we realized that this lady was dual infected as a result of the BHIVA audit, she was recalled in February 2020 where an HIV-2 viral load was shown to be 2,300copies/ml.A subsequent HIV-2 resistance assay showed extensive nucleoside reverse transcriptase mutations (V21V, L21Q, K35KR, M184V, D195G, R200K, V201A, F214FL, Y227F, Q228R, V251T, K65R, N69ST, R104K and V111I) as well the K65R mutation which meant resistance to tenofovir.There was a natural resistance to NNRTIS with some PI mutations (G17D, N41D, S43V, E65K, 668N) which suggested natural resistance to Fosamprenavir and Tipranavir.Understandably, DB was quite upset and understood that the presence of dual HIV-1 and HIV-2 infection was rare.We discussed our U=U (Undetectable = Untransmissable)
Source: Journal of Clinical Case Studies
Language: English
Topic: HIV Research and Treatment
Subfield: Virology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: diamond
OpenAlex ID: W3136384377