Test Catalog

Test ID: HIV2L    
HIV-2 Antibody Confirmation, Serum

Useful For Suggests clinical disorders or settings where the test may be helpful

Confirmation of the presence of HIV-2 antibodies in patients with repeatedly reactive combined HIV-1 and HIV-2 antibody or HIV-2 antibody-only screening test results


Diagnosis of HIV-2 infection

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Human immunodeficiency virus type 2 (HIV-2) is a lentivirus, a retrovirus in the same genus (Lentiviridae) as HIV-1. It was first isolated in 1986 in West Africa, where it is currently endemic. As of June 2010, CDC has reported a total of 166 cases that met the CDC case definition of HIV-2 infection in the United States. Most of these cases were found in the northeastern United States, and the majority had a West African origin or connection.


Compared to HIV-1 infection, HIV-2 infection is associated with slower rate of progression, low viral load (which may not be reliably measured with current methods), slower rates of decline in CD4 cell count, and lower rates of transmission (sexually or vertically). Up to 95% of HIV-2-infected individuals are long-term nonprogressors, and individuals with undetectable HIV-2 viral load have similar survival rates as that of the uninfected population. However, HIV-2 does cause immunosuppression as well as AIDS with the same signs, symptoms, and opportunistic infections seen in HIV-1. Due to the rarity of HIV-2, there are scant data from controlled trials to inform management decisions.


Although there are several FDA-approved screening assays to detect combined HIV-1 and HIV-2 antibodies or HIV-2 antibodies alone, currently there is only one FDA-approved supplemental (confirmatory) HIV-2 serologic assay for clinical use in the United States.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.


Interpretation Provides information to assist in interpretation of the test results

Negative results for HIV-2 antibodies usually indicate the absence of HIV-2 infection. However, in patients with reactive initial combined HIV-1/-2 antigen and antibody test results, such negative results do not rule-out acute or early HIV-2 infection. If acute or early HIV-2 infection is suspected, detection of HIV-2 DNA/RNA (FHV2Q / HIV-2 DNA/RNA Qualitative Real-Time PCR) is recommended, based on the patient's clinical and epidemiologic exposure history.


Positive HIV-2 antibody results indicate the presence of HIV-2 infection. Additional testing with a new whole blood specimen for HIV-2 DNA/RNA (FHV2Q / HIV-2 DNA/RNA Qualitative Real-Time PCR) is recommended to verify and confirm the diagnosis of HIV-2 infection prior to initiating antiretroviral treatment.


Indeterminate HIV-2 antibody results may be due to acute HIV-1 infection or very early HIV-2 infection (in individuals with risk factors). If acute HIV-1 infection or early HIV-2 infection is suspected, detection of HIV-1 RNA (HIVQN / HIV-1 RNA Detection and Quantification, Plasma) and/or HIV-2 DNA/RNA (FHV2Q / HIV-2 HIV-2 DNA/RNA Qualitative Real-Time PCR) is recommended, depending on the epidemiologic exposure history.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

A negative HIV-2 antibody supplemental (confirmatory) test result does not exclude the possibility of acute or early (<60 days from time of exposure) HIV-2 infection. Individuals suspected of having acute or early HIV-2 infection should be tested for qualitative HIV-2 DNA/RNA (FHV2Q / HIV-2 DNA/RNA Qualitative Real-Time PCR) or quantitative HIV-2 RNA.


The US Association of Public Health Laboratories recommends verification of all first-time positive supplemental test results for the definitive diagnosis of HIV infection. A second serum specimen should be obtained from the patient and submitted for repeat testing to verify all first-time positive test results.


Although a positive HIV-2 antibody supplemental test result indicates HIV-2 infection, a diagnosis of AIDS can only be made based on the case definition established by the CDC. In many US states, positive HIV-2 antibody supplemental test results are required to be reported to the state department of health.


Individuals at risk for HIV-2 infection with indeterminate or negative HIV-2 antibody supplemental test results should be retested in 2 to 4 weeks or have qualitative HIV-2 DNA/RNA (FHV2Q) testing performed.


Assay performance characteristics have not been established for the following specimen characteristics:

-Heat-inactivated specimens

-Cadaveric specimens

-Presence of particulate matter

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Campbell-Yesufu OT, Gandhi RT: Update on human immunodeficiency virus (HIV)-2 infection. 2011 Mar 15;52(6):780-787

2. Centers for Disease Control and Prevention and Association of Public Health Laboratories. Laboratory testing for the diagnosis of HIV infection: Updated recommendations. June 27, 2014. Accessed June 15, 2020. Available at https://stacks.cdc.gov/view/cdc/23447

3. Malloch L, Kadivar K, Putz J, et al: Comparative evaluation of the Bio-Rad Geenius HIV-1/2 confirmatory assay and the Bio-Rad Multispot HIV-1/2 rapid test as an alternative differentiation assay for CLSI M53 algorithm-I. J Clin Virol. 2013 Dec;58(Suppl. 1):e85-e91

4. Montesinos I, Eykmans J, Delforge ML: Evaluation of the Bio-Rad Geenius HIV-1/2 test as confirmatory assay. J Clin Virol. 2014 Aug;60(4):399-401

5. Mor O, Milequir F, Michaeli M, Levy I, Mendelson E: Evaluation of the Bio-Rad Geenius HIV 1/2 assay as an alternative to the INNO-LIA HIV 1/2 assay for confirmation of HIV infection. J Clin Microbiol. 2014 Jul;52(7):2677-2679

6. Abbate I, Pergola C, Pisciotta M, et al: Evaluation in a clinical setting of the performances of a new rapid confirmatory assay for HIV-1/2 serodiagnosis. J Clin Virol. 2014 Sep;61(1):166-169

Special Instructions Library of PDFs including pertinent information and forms related to the test