First HIV-2 infection in a child in Turkey

Dear Editor, Human immunodeficiency virus (HIV) infection has become an important cause of secondary immunodeficiency syndromes and opportunistic infections since its discovery in 1985. Human immunodeficiency virus type 1 (HIV-1) infection is a major cause of the AIDS pandemic while HIV type 2 (HIV-2) is the leading cause of disease in some regions of the world [1,2]. This is important when considering the diagnosis of HIV-2 infection, which has different important features compared to HIV-1. In Turkey, no pediatric HIV-2 case has been reported to date. Herein, we present the case of a girl of 10 years of age with HIV-2 infection due to maternal transmission. Her father was a sailor in a commercial shipping company working for West African countries. She had been treated based on a HIV-1/AIDS diagnosis before referral to our hospital. During the follow up, her CD4(+)-T lymphocyte count decreased despite appropriate anti-retroviral treatment initiated according to molecular drug-resistance test results. Interestingly, her CD-4(+)-T lymphocyte count had increased when her mother died. Her legal guardians warned the health-care workers about the fact that the mother was never compliant with her daughter's treatment and forced her daughter to say she took her medicine as suggested. Poor adherence to therapy should always be kept in mind in patients with decreasing lymphocyte count despite appropriate drug therapy. Diagnosis of HIV-2 infection is considerably more difficult than HIV-1 infection because of technical insufficiencies all over the World, as well as in Turkey. HIV-2 was first described in West Africa but after a while spread to other regions of Africa, Europe, India, and America [1]. The increase of migration from countries where HIV-2 is endemic to industrialized countries has facilitated the spread of the virus. In Turkey, the first patient with AIDS was diagnosed in 1985. According to official health records in Turkey there have been 7,041 HIV (+) people and 1,197 patients with AIDS diagnosis between 1985 and 2015, [3]. But, no pediatric HIV-2 case was reported to date. Compared to HIV-1 infection, the clinical course of HIV-2 infection is generally characterized by a longer asymptomatic stage, lower plasma HIV-2 RNA levels, and lower mortality; however, progression to AIDS does occur [1,4].