Martell Randolph, a Los Angeles activist, spends hours surroundedby other HIVers. But she often feels as alone as PWAs did in the earlyyears when no one knew what the hell had hit them. The soft-spokenRandolph has HIV 2, the strain common in West Africa but rare in theU.S.—and tricky to treat (see “A Different Duck,”below.) “The mostfrustrating thing,” she says, “is that I’ve never met another personwith HIV 2.” In fact, the feds report a mere 132 U.S. cases, althoughsome experts fear that there are many more undiagnosed—not least amongthe estimated 300,000 HIVers who have never been tested.

Randolph,now 42, fell ill in 1999. She’d had a monogamous relationship with anAfrican man in Rome in 1990, but “didn’t suspect anything amiss.” Aftertwo inconclusive HIV tests, Randolph “started to freak out.” A coworkerat New York City’s GMHC sent her to Manuel Revuelta, MD—one of ahandful of HIV 2–savvy U.S. docs—who solved the mystery. Hospitalizedwith PCP pneumonia and 13 T cells, Randolph felt “life was closing inon me.”

Slowly, she climbed out of the hole. On solo Kaletra(reasonable for HIV 2, which moves slower than HIV 1), her T cells hit900—“the most miraculous turnaround I’d seen,” Revuelta says. But she’snow resistant to Kaletra and is awaiting tipranavir—in trials for HIV 1and reputedly effective against HIV 2.
“I have to educate the peopletaking care of me,” Randolph says—like teaching lab techs that HIV 1viral-load tests won’t measure HIV 2. She adds, “I hope this story willhelp others with HIV 2 find me.” And diagnosis. 

A Different Duck
How HIV 2 differs from HIV 1:
Testing: Western blot, but not ELISA and OraSure, can tell HIV 2 from HIV 1.

Treatment:Non-nukes and some protease inhibitors (PIs) don’t quash HIV 2. MartinSchutten, MD, of the Netherlands’ Erasmus Medical Center, likes twonukes plus a boosted PI (Crixivan or Kaletra, not Lexiva or Viracept).HIV 2 enters cells differently from 1, so entry inhibitors like Fuzeonare iffy.
Experimental PI tipranavir has worked in trials.

Monitoring: HIV 2 requires its own PCR and resistance tests—but CD4 cells register similarly for both strains.

Reaching Out: