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Project Topic
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Human immunodeficiency virus type 2 (HIV-2) is a retrovirus responsible for an AIDS epidemic localized in West Africa, were the circulation of both HIV-1 and HIV-2 leads to co-infections with both viruses (HIV-1&2). The HIV-2 infection is characterized by a longer asymptomatic phase and a slower disease progression than HIV-1 infection, as well as the intrinsic resistance of HIV-2 to non-nucleoside reverse transcriptase inhibitors (NNRTIs). It is mandatory to differentiate HIV-1 from HIV-2 infection before initiating antiretroviral therapy (ART), but the diagnosis is still challenging, especially for the HIV-1 and HIV-2 dually infected individuals. It is then critical to explore new diagnosis algorithm based on routinely used HIV rapid tests, to ensure the peripheral diagnosis of patients dually infected in West Africa. Another challenge is the difficulty to describe the epidemiology of HIV-2 and dual infection in West Africa. The conflicting report on the epidemic trend of HIV-2 infection and the lack of updated data lead to low consideration for HIV-2 infected patients in the WHO guidelines for antiretroviral therapy. In the context of challenging access to integrase inhibitors in Africa, generating updated data on the epidemiology of HIV-2 infection is critical to enhance the advocacy and improve the holistic care of people living with HIV-2. Furthermore, the important mortality reported among HIV-2 infected individuals may be the consequence of immune activation and persistence of soluble biomarkers as demonstrated in HIV-1 infection. However, the role and mechanism of immunologic and inflammatory biomarkers on disease progression and prognosis of HIV-2 infected patients are still poorly understood. Thus, providing a better understanding of morbidity, disease progression and the role of soluble biomarkers in the prognosis of HIV-2 infected individuals could improve the holistic care of these patients. This research project will rely on the West African HIV-2 cohort, and the related biobank to (i) evaluate new diagnosis algorithm for HIV-1&2 dual infection, (ii) produce more accurate and updated epidemiologic data on HIV- 2 infection and (iii) explore disease progression and prognostic role of immunologic and inflammatory markers in HIV-2 infection. A mix-method approach including longitudinal analysis, demographic survey sampling and geospatial modelling, as well as specific biological testing on biobank samples, will be developed during threeyears research project. The accurate epidemiologic data, the improved diagnosis of HIV-2 patients and the better understanding of dynamics and correlates of disease progression that will arise from this project, will help inform specific guidelines for HIV-2 infection. This project is organized in three different axes, allowing the exploration of the main questions regarding HIV-2 infection. This configuration allow the recruitment of graduate students in epidemiology, immunology and biostatistics, who will be trained and have the opportunity to develop skill in research under the supervision of the fellow. Finally, the results and the scientific production expected from this grant will be essential for the career development of the fellow who will then established as senior researcher in his field.
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