Clinical Outcomes and Disease Progression among Patients Coinfected with HIV and Human T Lymphotropic Virus Types 1 and 2

Abstract

The goal of this study was to investigate clinical outcomes and survival probabilities among persons coinfected with human immunodeficiency virus (HIV) and human T lymphotropic viruses types 1 and 2 (HTLV-I/II). A nonconcurrent cohort study of 1033 HIV-infected individuals was also conducted. Sixty-two patients were coinfected with HTLV-I, and 141 patients were coinfected with HTLV-II. HTLV-I/II coinfection was highly associated with African-American race/ethnicity, age of >36 years, higher CD4(+) T cell count at baseline and over time, and history of injection drug use. Coinfected patients were more likely to have neurologic complications, thrombocytopenia, respiratory and urinary tract infections, and hepatitis C. Despite having higher CD4(+) T cell counts over time, there was no difference in the incidence of opportunistic infections. Progression to both acquired immunodeficiency syndrome (AIDS; adjusted hazard ratio [aHR], 0.50; 95% confidence interval [CI], 0.25-0.98) and death (aHR, 0.57, 95% CI, 0.37-0.89) were slower among HTLV-II-coinfected patients, compared with time-entry- and CD4(+) T cell count-matched control subjects. In conclusion, HIV-HTLV-I/II coinfection may result in improved survival and delayed progression to AIDS, but this happens at the expense of an increased frequency of other of clinical complications.

HTLV- I infection is not associated with a higher risk of death in peruvian HIV-infected patients

“…The number of deaths and AIDS-defining conditions did not show significant differences (Table 2). Although the numbers are small, this finding is consistent with the report by BEILKE et al 4 and with our observation for the complete population.…”

“…Most of them suggested that HIV/HTLV-I co-infection shortens the survival of these patients 6,12,16,18,22 . In contrast, a recent longitudinal retrospective study showed that the HTLV-I infection in persons with HIV was not associated with a shorter survival 4 .…”

“…Several retrospective studies have evaluated the effect of HTLV-I infection on survival of HIV patients 4,6,12,16,18,22 . Most of them suggested that HIV/HTLV-I co-infection shortens the survival of these patients 6,12,16,18,22 .…”

“…In contrast, BESSINGER et al 5 did not find an association between HIV/HTLV-I co-infection and high CD4+ T cell counts. Moreover, a recent large longitudinal study 4 showed that there were no significant differences in the presence of opportunistic infections, progression to AIDS or death between HIV/ HTLV-I co-infected and HIV infected patients.…”

Onset of opportunistic infections in patients co-infected by HTLV-1 and HIV-1, with high CD4+ cells count

“…However, other studies have shown that immunosupression per se should be related to expression of such conditions without a rise in HTLV viral load [5][6][7].…”