HIV-2 Infection and HIV-1/HIV-2 Dual Reactivity in Patients With and Without AIDS-Related Symptoms in Gabon

Carol Tevi-Benissan,* Madeleine Okome,† Maria Makuwa,* Moise Ndong Nkoume,† Joseph Lansoud-Soukate,* Alain Georges,* Marie-Claude Georges-Courbot,* and Laurent Belec‡
*Centre International de Recherches Medicales, Franceville, Gabon; †Fondation Jeanne Ebori, Libreville, Gabon; and ‡Centre Hospitalo-Universitaire Broussais, Paris, France.

Emerg Infect Dis 1998 Jan-Mar:4(1);130-1

To the Editor: Between 1996 and 1997, we evaluated the incidence of HIV-2 infection at the Fondation Jeanne Ebori, the second largest hospital in Libreville, capital of Gabon; we found an unexpected high prevalence of HIV-2–infected or HIV-1/HIV-2–dually reactive patients.

During a 10-month period, 147 (14.3%) of 1,029 sera from inpatients and outpatients were found HIV-positive by the type III method recommended by the World Health Organization (two enzyme-linked immunosorbent assays are used to screen anti-HIV antibodies) (1). Further discrimination between HIV-1 and HIV-2 infections was assessed by using synthetic peptides specific for the gp41 and the gp120 of HIV-1 and the gp36 of HIV-2 (ImmunoComb II, PBS Orgenics, Illkirch, France). Of the 147 HIV-positive sera, 141 (96.0%) were exclusively HIV-1–positive; four were exclusively HIV-2–positive; and two were both HIV-1– and HIV-2–positive. Of the six sera with anti-gp36/HIV-2 reactivities, two (from patients A and B) were positive on HIV-2 Western blot, with marked anti-gag HIV-1 cross-reactivity and a discrimination assay positive only for HIV-2; two (from patients D and E) were positive on HIV-2 Western blot, with anti-gag and pol reactivities markedly lower than anti-env reactivities and a discrimination assay positive only for HIV-2; the two remaining sera (from patients C and F) showed typical dual reactivities for HIV-1 and HIV-2 infections, with positive patterns of HIV-1 and HIV-2 Western blots and a discrimination test positive for both viruses. As a whole, six (4.1%) of 147 HIV-positive sera showed either HIV-2 infection alone (n = 4) or dual reactivity. Of those, four were from Gabonese patients B, C, D, and E, and two were from immigrants from West Africa (patient A from Mali and patient F from Nigeria); two were female patients B and E. Among Gabonese patients, only one (patient E) had traveled to West Africa; the remaining three had never visited any neighboring country. However, one Gabonese man (patient C) lived in Port-Gentil, which has many West African immigrants. For all patients, the most likely risk factor for HIV was a heterosexual relationship with an unknown HIV-infected person. In three asymptomatic patients (A, B, and C) the HIV-2–serostatus was unexpected; in contrast, the three other patients had AIDS-related symptoms. Patients D and E had an HIV-2 Western blot pattern showing a marked decrease in anti-gag and pol reactivities compatible with their advanced stage of HIV-2 disease.

The case of a 55-year-old exclusively heterosexual asymptomatic woman (patient B) suggests the possibility of a specific variant of HIV-2 in Central Africa (2). The high frequency in primates in Gabon of natural infection with simian immunodeficiency retroviruses, which show a high degree of genetic relatedness to HIV-2 (3), could support such a hypothesis.

Two patients had typical dual reactivities to HIV-1 and HIV-2 antigens. To our knowledge, such dual reactivities have never been reported in Gabon (4). In the patient from Nigeria (patient F), the serologic pattern was typical of that usually observed in West Africa (5). Dual reactivity can result from genuine mixed infections and from serologic cross-reactivity in HIV-1 and HIV-2 infection alone; theoretically, it could also represent infection with a different, cross-reacting recombinant strain (5).

HIV-2 infection in Gabon is epidemiologically related to West Africa, because of cultural and, above all, economic ties. However, HIV-2 is not limited to immigrant populations from West Africa or to Gabonese citizens traveling in this area; it has also reached the indigenous Gabonese population. The possibility of rare cases of HIV-1 and HIV-2 coinfections, recombinant HIV-1 and HIV-2 strains, and also peculiar HIV-2 variants from Central Africa, should be considered in Gabon. A possible entry of HIV-2 infection into Central Africa from Gabon in the near future could have major public health implications.

Acknowledgments

We thank Dr. Jean Wickings for reviewing the manuscript. CIRMF is funded by the Gabonese government, ELF Gabon, and the French Ministry of Cooperation.

References

1. World Health Organization. Global programme on AIDS. Recommendations for the selection and use of HIV antibody tests. Wkly Epidemiol Rec. 1992 May 15; 67(20): 145-9.
2. Belec L, Martin PMV, Georges-Courbot MC, Brogan T, Gresenguet G, Mathiot CC, et al. Dementia as the primary manifestation of HIV-2 infection in a Central African patient. Ann Inst Pasteur Virol. 1988 Jul-Sep; 139(3): 291-4.
3. Georges-Courbot MC, Moisson P, Leroy E, Pingard AM, Nerrienet E, Dubreuil G, et al. Occurrence and frequency of transmission of naturally occurring simian retroviral infections (SIV, STLV, and SRV) at the CIRMF Primate Center, Gabon. J Med Primatol. 1996 Oct; 25(5): 313-26.
4. Delaporte E, Janssens W, Peeters M, Buve A, Dibanga G, Perret J-L, et al. Epidemiological and molecular characteristics of HIV infection in Gabon, 1986-1994. AIDS. 1996 Jul; 10(8): 903-10.
5. Peeters M, Gershy-Damet G-M, Fransen K, Koffi K, Coulibaly M, Delaporte E, et al. Virological and polymerase chain reactions studies of HIV-1/HIV-2 dual infection in Côte d'Ivoire. Lancet. 1992 Aug 8; 340(8815): 339-40.

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