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• W2018646875 abstract "To the Editor: In a recent report, McKellar et al1 found a high rate of false positive results for HIV-2 infection in a cohort of HIV-1 long-term nonprogressors (LTNP) (3/13) using a specific HIV-2 immunoblot test. The authors concluded that because of cross-reactivity with HIV-1, serologic testing for HIV-2 should only be used in patients with negative HIV-1 Western blot (WB) results, at least in HIV-2 nonendemic areas. Their recommendation would be to perform directly HIV-2 polymerase chain reaction (PCR) testing in subjects in whom this infection is suspected. We want to communicate our experience that is quite different from the one reported by McKellar et al.1 At our institution in Madrid, which includes a Tropical Medicine Unit, HIV-2 is screened in a routine basis in all HIV-seropositive individuals. Samples with reactivity in an HIV-1/2 enzyme immunoassay (EIA) are confirmed using an HIV-1 WB and a commercial line peptide assay (LIA) (Pepti-Lav; Bio-Rad, Marnes la Coquette, France). The latest is a synthetic peptide-based assay that contains both transmembrane proteins gp41 of HIV-1 and gp36 of HIV-2. Only in subjects with reactivity to both bands, HIV-2 WB and/or specific HIV-2 PCR are performed to definitively confirm HIV-2 infection. We retrospectively reviewed HIV testing results obtained from January 2005 to December 2007. A total of 563 subjects were found to be reactive in an HIV-1/2 EIA. Of them, 435 were Spaniards and 128 were immigrants, mainly from West Africa, where HIV-2 is endemic. The final report for this population of HIV-infected subjects was as follows: 497 HIV-1 positive, 4 HIV-2 positive, 1 dually infected by HIV-1 and HIV-2, and 61 HIV negative. HIV-2 was excluded or confirmed using a validated HIV-2 PCR test. Interestingly, of the 497 HIV-1-positive patients, only in 31 (6.2%) subjects the HIV-2 gp36 band in the LIA was reactive. However, in all these cases the gp36 band reactivity was weak. No relationship between the geographical origin of the patients and recognition of serological cross-reactivity was found. Finally, we investigated cross-reactivity using the LIA in a well-characterized cohort of HIV-1-infected LTNP, already described elsewhere.2 Of 20 individuals examined, none of them showed reactivity to the HIV-2 gp36 band. Our results support that serological cross-reactivity for HIV-2 infection using synthetic peptide-based assays in HIV-1-infected patients is uncommon. This is not surprising because the env genes in gp41 HIV-1 group M and gp36 for HIV-2 regions show up to a 50% divergence in their amino acid sequences. The findings of McKellar may be explained by the degree of cross-reactivity in some immunoblot assays, in which a recombinant HIV-2 protein is used.3 Synthetic peptides of specific antigenic regions may be more specific. Furthermore, the authors carried out the exam of a group of LTNP, who characteristically present a broader antibody response4 and therefore could have a higher tendency to cross-react. Using the synthetic peptide assay, we did not find any cross-reactivity in our cohort of LTNP. Finally, in agreement with McKellar et al,1 we found that reactivity to the gp36 band in the immunoblot is generally weak when present in HIV-1-infected persons. To exclude cross-reactivity, performance of serial dilutions using synthetic peptide-based assays can resolve the dual seroreactivity.5 Binding is stronger and only remains for specific either HIV-1 or HIV-2 antibodies. In summary, although HIV-2 infection is relatively uncommon outside endemic regions, international travel and immigration may support to implement diagnostic strategies to discharge HIV-2 infection. Synthetic peptide-based assays are commercially available, easy to perform and relatively cheap, and may be helpful to exclude HIV-2 in initially HIV-1/2 EIA-reactive samples. Aranzazu Amor* Ainhoa Simón† María Salgado† Berta Rodés† Vincent Soriano† Carlos Toro* *Service of Microbiology †Service of Infectious Diseases Hospital Carlos III Madrid, Spain" @default.
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• W2018646875 date "2009-03-01" @default.
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• W2018646875 title "Lack of Significant Cross-Reactivity for HIV-2 Immunoblots in HIV-1-Infected Patients" @default.
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• W2018646875 doi "https://doi.org/10.1097/qai.0b013e318193900d" @default.
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