In Reply: Although misdiagnosis of HIV-2 as HIV-1 might account for the rare LTNP in some cohorts, as suggested by Dr Gottlieb and colleagues, this should be limited to relatively high HIV-2 prevalence areas, with an HIV-1 immunoblot that cross-reacts with HIV-2. However, the prevalence of HIV-2 infection is declining worldwide and remains extremely low in the United States.1 Additionally, many centers use immunoblots specific for HIV-1. At the National Institute of Allergy and Infectious Diseases, HIV testing occurs with the screening HIVAB HIV-1/HIV-2 (rDNA) EIA (Abbott Laboratories, Abbott Park, Illinois) and the confirmatory Cambridge Biotech HIV-1 Western blot (Maxim Biomedical, Inc, Rockville, Maryland). True HIV-2 infection would result in a positive EIA with a negative or indeterminate Western blot.1 In contrast, all of our LTNP patients have had unequivocally positive HIV-1 Western blots.
Migueles SA, Connors M. Long-term Nonprogressive Disease Among Individuals With Untreated HIV Infection—Reply. JAMA. 2010;304(16):1784-1786. doi:10.1001/jama.2010.1477