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October 27, 2010

Long-term Nonprogressive Disease Among Individuals With Untreated HIV Infection

JAMA. 2010;304(16):1784-1786. doi:10.1001/jama.2010.1475

To the Editor: In their overview of long-term nonprogressive (LTNP) disease among individuals with untreated human immunodeficiency virus (HIV) infection, Drs Migueles and Connors1 overlooked misdiagnosed HIV type 2 (HIV-2) infection as a potential reason for apparent elite HIV-1 viral control and LTNP. HIV-2 is endemic in West Africa, with limited spread to other locales. Compared with HIV-1, the natural history of HIV-2 infection is characterized by a much longer asymptomatic stage, lower plasma viral loads, slower decline in CD4 counts, decreased mortality rate due to AIDS, and lower frequencies of mother-to-child and sexual transmission.2,3