Early and Successful Combination Antiretroviral Therapy Normalizes Survival Time in Patients Coinfected With Human Immunodeficiency Virus and Human T-cell Lymphotrophic Virus Type 1

Abstract

Background Coinfection with human T-cell lymphotrophic virus type 1 (HTLV-1) is associated with shorter survival for adults and children infected with human immunodeficiency virus (HIV), although the reasons remain a matter of debate. We evaluated the factors associated with survival time in a large cohort of HIV/HTLV-1–coinfected and HIV-monoinfected individuals on combination antiretroviral therapy (cART). Methods In a nested, retrospective case-control study (1:1), we reviewed medical records of people with HIV infection on cART in a referral AIDS center in Salvador, Brazil. We matched 149 patients coinfected with HTLV-1 (cases) by age at HIV diagnosis and sex, to an equal number of HTLV-uninfected persons (controls). Death rates, survival time, baseline and current CD4 cell count, last HIV-1 RNA plasma viral load (pVL), and causes of death were compared between groups. Results The overall mortality rate was 2.1 person-years (76 deaths, 53 among coinfected patients). Survival time for cases (16.7 ± 0.7 years) was significantly shorter than for controls (18.1 ± 0.4 years; P = .001). Among patients with pVL >50 copies/mL, coinfected patients had a shorter survival time (8.4 ± 0.8 years) than monoinfected ones (12.9 ± 1.4 years; P = .02), regardless of pVL magnitude. However, survival time did not differ for HIV-monoinfected (19.0 ± 0.4 years) or coinfected patients (20.2 ± 0.6 years) presenting with pVL <50 copies/mL (P = .5). Deceased coinfected patients had higher initial CD4 count (417 ± 219 cells) than monoinfected ones with the same outcome (177 ± 160 cells; P = .004), while survivors had similar CD4 cell count at baseline, regardless of HTLV status. Conclusions Successful cART is able to normalize survival for coinfected patients and should be introduced for all coinfected patients, regardless of CD4 cell count. HIV/human T-cell lymphotrophic virus type 1 coinfection is believed to decrease survival of coinfected patients. In this case-control study, we demonstrate that successful combination antiretroviral therapy (last HIV viral load <50 copies/mL) is able to improve survival of coinfected patients to levels observed for those monoinfected.

Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil

“…HTLV-1/HIV coinfected individuals in our cohort displayed fourfold higher mortality rates (2.6 per 100 person-years) as compared to recent data from an HIV cohort also located in metropolitan Sao Paulo (0.6 per 100 person-years) [36]. These mortality rates are strikingly similar to a recent publication comparing HTLV-1/HIV-1 coinfected patients (3.0 per 100 person-years) with HIV monoinfected patients (1.3 per 100 person-years) in Salvador-Bahia, Northeast Brazil [13]. However, Brites et al demonstrated that the decreased survival observed in HTLV-1/HIV-1 coinfected patients was normalized in those with early and successful ART [13].…”

“…The incidence of ATLL and HAM/TSP varies from 0.5% to 10% among HTLV-1 infected subjects, increasing morbidity and mortality rates [9] Additionally, treatment of coinfections, such as HIV and HCV, can be delayed due to HTLV-1 promoting an inefficacious increase in CD4+ cells, leading to a delay in antiretroviral therapy (ART) initiation and, possibly, inefficacious HCV clearance [10][11][12][13]. In endemic countries, parasitic coinfection with Strongyloides stercoralis also increases morbidity and mortality [12].…”

Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil

“…These mortality rates are strikingly similar to a recent publication comparing HTLV-1/HIV co-infected patients (3.0 per 100 person-years) with HIV monoinfected patients (1.3 per 100 person-years) in Salvador-Bahia, Northeast Brazil [17]. However, Brites et al demonstrated that the decreased survival observed in HTLV-1/HIV co-infected patients was normalized in those with early and successful ART [17].…”

“…HTLV-1/HIV co-infected individuals in our cohort displayed fourfold higher mortality rates (2.6 per 100 person-years) as compared to recent data from an HIV cohort also located in metropolitan Sao Paulo (0.6 per 100 person-years [40]. These mortality rates are strikingly similar to a recent publication comparing HTLV-1/HIV co-infected patients (3.0 per 100 person-years) with HIV monoinfected patients (1.3 per 100 person-years) in Salvador-Bahia, Northeast Brazil [17]. However, Brites et al demonstrated that the decreased survival observed in HTLV-1/HIV co-infected patients was normalized in those with early and successful ART [17].…”

“…The incidence of ATLL and HAM/TSP varies from 0.5% to 10% among HTLV-1 infected subjects, increasing morbidity and mortality rates [10][11][12][13]. Also, treatment of co-infections, such as HIV and HCV, can be delayed due to HTLV-1 promoting an inefficacious increase in TCD4+ cells, leading to a delay in antiretroviral therapy (ART) initiation and, possibly, inefficacious HCV clearance [14][15][16][17]. In endemic countries, parasitic co-infection with Strongyloides stercoralis also increases morbidity and mortality [16].…”