title: HIV type 2 epidemic in Spain: challenges and missing opportunities.
abstract: : HIV type 2 (HIV-2) is a neglected virus despite estimates of 1-2 million people infected worldwide. HIV-2 is less efficiently transmitted than HIV-1 by sex and from mother to child. Although AIDS may develop in HIV-2 carriers, it takes longer than in HIV-1-infected patients. In contrast with HIV-1 infection, there is no global pandemic caused by HIV-2, as the virus is largely confined to West Africa. In a less extent and due to socioeconomic ties and wars, HIV-2 is prevalent in Portugal and its former colonies in Brazil, India, Mozambique and Angola. Globally, HIV-2 infections are steadily declining over time. A total of 338 cases of HIV-2 infection had been reported at the Spanish HIV-2 registry until December 2016, of whom 63% were men. Overall 72% were sub-Saharan Africans, whereas 16% were native Spaniards. Dual HIV-1 and HIV-2 coinfection was found in 9% of patients. Heterosexual contact was the most likely route of HIV-2 acquisition in more than 90% of cases. Roughly one-third presented with CD4 cell counts less than 200 cells/μl and/or AIDS clinical events. Plasma HIV-2 RNA was undetectable at baseline in 40% of patients. To date, one-third of HIV-2 carriers have received antiretroviral therapy, using integrase inhibitors 32 individuals. New diagnoses of HIV-2 in Spain have remained stable since 2010 with an average of 15 cases yearly. Illegal immigration from Northwestern African borders accounts for over 75% of new HIV-2 diagnoses. Given the relatively large community of West Africans already living in Spain and the continuous flux of immigration from endemic regions, HIV-2 infection either alone or as coinfection with HIV-1 should be excluded once in all HIV-seroreactive persons, especially when showing atypical HIV serological profiles, immunovirological disconnect (CD4 cell count loss despite undetectable HIV-1 viremia) and/or high epidemiological risks (birth in or sex partners from endemic regions).
authors.affiliation: aPuerta de Hierro Research Institute, Madrid bHospital de Poniente, Almeria cHospital Vall d'Hebrón, Barcelona dCorporación Sanitaria Parc Taulí, Sabadell eSon Espases Hospital, Palma de Mallorca fHospital Marqués de Valdecilla, Santander gFundación Jiménez Díaz, Madrid hGeneral Hospital, Alicante iLa Paz University Hospital & Autonomous University, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: de Mendoza
authors.forename: Teresa
authors.initials: T
authors.lastname: Cabezas
authors.forename: Estrella
authors.initials: E
authors.lastname: Caballero
authors.forename: Silvia
authors.initials: S
authors.lastname: Requena
authors.forename: María J
authors.initials: MJ
authors.lastname: Amengual
authors.forename: María
authors.initials: M
authors.lastname: Peñaranda
authors.forename: Ana
authors.initials: A
authors.lastname: Sáez
authors.forename: Raquel
authors.initials: R
authors.lastname: Tellez
authors.forename: Ana B
authors.initials: AB
authors.lastname: Lozano
authors.forename: Ana
authors.initials: A
authors.lastname: Treviño
authors.forename: José M
authors.initials: JM
authors.lastname: Ramos
authors.forename: José L
authors.initials: JL
authors.lastname: Pérez
authors.forename: Pablo
authors.initials: P
authors.lastname: Barreiro
authors.forename: Vicente
authors.initials: V
authors.lastname: Soriano
mesh_terms: D054242:Emigrants and Immigrants; D058872:Epidemics; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology*; D015498:HIV-2 / Q000302:isolation & purification*; D006801:Humans; D011174:Portugal; D013030:Spain / Q000453:epidemiology