title: An unexpected diagnosis of human immunodeficiency virus-2 infection in an overseas visitor: a case report.
abstract: BACKGROUND
  Human immunodeficiency virus 2 infection is endemic in West Africa but is also found in parts of Europe, North and South America, and India where it is thought to have been introduced secondary to migration and commercial trade ties. It is less common than Human immunodeficiency virus 1, with differences in pathogenicity, lower rates of transmission, longer asymptomatic period and slower progression to acquired immunodeficiency syndrome. Human immunodeficiency virus 2 is also associated with diagnostic challenges given the lack of commercially available diagnostic tests, and management challenges given intrinsic resistance to many anti-retroviral therapies.
  
  
  METHODS
  We describe a case of a 65 year old South Indian female, visiting her family in Australia, who presented with weight loss, pancytopaenia and generalised lymphadenopathy on a background of newly diagnosed congestive cardiac failure. Multiple investigations were performed to elucidate the cause of her presentation, with the eventual unexpected diagnosis of human immunodeficiency virus 2. She was commenced on anti-retroviral treatment and made a remarkable recovery.
  
  
  CONCLUSIONS
  We describe the challenges associated with diagnosis of human immunodeficiency virus 2 due to lack of commercially available diagnostics, as well as the treatment and management challenges including the fact that human immunodeficiency virus 2 is intrinsically resistant to non-nucleoside reverse transcriptase inhibitors. Human immunodeficiency virus 2 infection should be considered in patients who present with symptoms and signs that do not point towards a clear diagnosis, such as unexplained pancytopaenia or lymphadenopathy, and who have risk factors such as being from an endemic area or having had blood transfusions, especially prior to the commencement of blood-borne virus screening of blood donors.
authors.affiliation: Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg, VIC, Australia. asohail1@hotmail.com.
authors.forename: Asma
authors.identifier: http://orcid.org/0000-0002-1716-8518
authors.initials: A
authors.lastname: Sohail
authors.affiliation: Department of General Medicine, Austin Health, Heidelberg, VIC, Australia.
authors.forename: Lyndal
authors.initials: L
authors.lastname: Van Leer
authors.affiliation: Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg, VIC, Australia.|Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Natasha
authors.initials: N
authors.lastname: Holmes
mesh_terms: D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001315:Australia; D001803:Blood Transfusion; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000628:therapy; D015498:HIV-2; D006801:Humans; D007194:India; D012307:Risk Factors; D014195:Travel; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents
keywords: Antiretroviral therapy; Diagnostic testing; HIV-2; Human immunodeficiency virus-2