Raltegravir in the Treatment of HIV–2 Infection: A Report of Eight Cases

Background: Although endemic in West Africa, HIV-2 infection dissemination is limited to about 1.2 million people worldwide. However, the prevalence of HIV-2 infection is in Portugal disproportionately high, similarly to other countries with strong socioeconomic ties with West African former colonies. Due to HIV-2 intrinsic resistance to non-nucleoside reverse transcriptase inhibitors (non-NRTIs) and enfuvirtide, along with reduced susceptibility to several of the protease inhibitors (PI), antiretroviral therapy (ART) relies on a regimen containing two NRTIs and a selected boosted PI. The integrase inhibitor raltegravir (RAL) showed, in vitro, activity against HIV-2 infection, and small case series published report RAL efficacy in the treatment of HIV-2 infection.
Methods: We report eight HIV-2 ART-experienced patients treated with a RAL-containing regimen.
Results: In this small series of eight patients, medium time of known HIV-2 infection before RAL introduction was 9.4 years; all had previous exposition to ART, some with more than 3 past therapeutic regimens. The majority had low CD4+T cell count. Despite these clinical aspects, the majority showed undetectable viral load (75%) and improvement or stability of the CD4+ T cell count (63%).
Conclusion: Despite limitations inherent to this small case series, RAL proved to be useful in the treatment of HIV-2 infected patients, with beneficial effect in virus control and CD4+T cell preservation. In the presence of extensive resistance to other antiretrovirals, the benefit of RAL seems to be decreased. Accordingly to other emergent data, RAL may represent a novel therapeutic possibility for HIV-2 infected patients.