"The ESRB has issued an initial rating of AO (Adults Only) for Manhunt 2" according to an emailed statement from Rockstar Interactive to several media outlets.
"We believe the process of rating videogames is to help people make informed entertainment choices and not to limit them", the statement continues. "Manhunt 2 was created for mature audiences and we strongly believe it should receive an M (Mature) rating, aligning it with similar content created in other forms of media. We are exploring our options with regard to the rating of Manhunt 2."
An AO rating doesn't seem as bad as Manhunt 2 UK ban, but - in essence - they are the same. An AO rating means that most USA retail chains, such as Best Buy, GameStop, or Wal-Mart won't sell the game, effectively narrowing sales to less than 10% (analysts' estimation). According to several activists, there are no clear boundaries between M-rated violence - which would sell everywhere - and AO Violence.
The American AO rating is certainly not affected by the British ban, since ESRB has already communicated Manhunt 2's rating to Rockstar several days ago. Rockstar now has the option of either appealing the rating or to adjust the content of the game to elude the AO categorization.
According to the ESRB site, only 23 games have ever earned an AO rating, of those, only GTA:SA Hot Coffee version was released for console briefly.