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WITHIN the past year, the US Food and Drug Administration (FDA) has licensed two combined human immunodeficiency virus type 1 (HIV-1)/human immunodeficiency virus type 2 (HIV-2) enzyme immunoassays (EIAs) for screening donated blood and plasma. The FDA has also mandated that by June 1, 1992, US blood centers must implement testing for antibodies to HIV-2 in addition to testing for antibodies to HIV-1. Implementation of this policy and reports of HIV-2—infected US residents have raised important public health and clinical questions about HIV-2 infection in the United States. This article summarizes current information regarding the epidemiology and diagnosis of HIV-2 infection and discusses public health considerations that arise from the presence of HIV-2 in the United States. BACKGROUND: WORLDWIDE DISTRIBUTION, TRANSMISSION, AND NATURAL HISTORY Infection with HIV-2 is endemic in many countries in West Africa, but generally much rarer elsewhere in the world. 1,2 The highest prevalence of HIV-2 infection

A national, population-based survey was initiated in 1988 to measure the prevalence of human immunodeficiency virus (HIV) infection in women giving birth to infants in the United States. Following standardized procedures, residual dried-blood specimens collected on filter paper for newborn metabolic screening were tested anonymously in state public health laboratories for maternal antibody to HIV. As of September 1990, annual survey data were available from 38 states and the District of Columbia. The highest HIV seroprevalence rates were observed in New York (5.8 per 1000), the District of Columbia (5.5 per 1000), New Jersey (4.9 per 1000), and Florida (4.5 per 1000). Nationwide, an estimated 1.5 per 1000 women giving birth to infants in 1989 were infected with HIV. Assuming a perinatal transmission rate of 30%, we estimate that approximately 1800 newborns acquired HIV infection during one 12-month period. Preventing transmission of HIV infection to women and infants is an urgent public health priority. (JAMA. 1991;265:1704-1708)