Tropical Spastic Paraparesis/Human T Leukemia Virus Type 1--Associated Myelopathy in HIV Type 1--Coinfected Patients

Tulane University Health Sciences Center, New Orleans, Louisiana 70112, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 09/2005; 41(6):e57-63. DOI: 10.1086/432890
Source: PubMed


Tropical spastic paraparesis/human T leukemia virus type 1 (HTLV-1)-associated myelopathy (TSP/HAM) is rarely reported in the United States. The causative agents of TSP/HAM are HTLV-1 and, possibly, its cosmopolitan variant, human T leukemia virus type 2 (HTLV-2). Among HTLV-1- or HTLV-2-monoinfected individuals, the estimated lifetime risk for development of TSP/HAM is <2%. However, it has been suggested that HIV/HTLV coinfection may increase the risk for development of TSP/HAM.
A total of 2239 human immunodeficiency virus (HIV)-infected patients were tested for HTLV-1 and HTLV-2 infection at the New Orleans Outpatient Clinic (Louisiana) during the period 1991-1998. HTLV-1-infected patients with suspected myelopathy were referred for additional evaluation.
Four cases of TSP/HAM (9.7%) were identified among 41 individuals with Western blot-confirmed HTLV-1 infection. The diagnosis was confirmed with use of molecular diagnostic assays and viral isolation. No TSP/HAM cases were identified among 65 patients with HIV-HTLV-2 coinfection. An additional patient with HIV-HTLV-1 coinfection also received a diagnosis of TSP/HAM at the New Orleans Veteran's Affairs HIV Outpatient Clinic (Louisiana). All patients had normal CD4+ T cell counts at the time of diagnosis.
Given the high rates of HIV-HTLV coinfection in the United States, a heightened suspicion for TSP/HAM should be considered in HIV-infected patients who present with normal CD4+ T cell counts and myelopathy in the absence of other acquired immunodeficiency syndrome-defining conditions.

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    • "The obvious outcome of HTLV-I or HTLV-II and HIV co-infection is an increased CD4+ cells count without any immune benefit for patients (26-27). Furthermore, some studies have reported that the risk of developing HAM/TSP in HIV–HTLV-I co-infected patients is higher than in HTLV-I-infected individuals and it may be due to the higher HTLV proviral load in co-infected patients (18, 22, 28-29). Understanding the effect of HTLV-I virus on HIV viral replication and vice versa, will help for better monitoring and following up of HIV and HTLV-I–associated diseases in this endemic area. "
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    ABSTRACT: Objective(s): HTLV-I and HIV virus quantification is an important marker for assessment of virus activities. Since there is a direct relationship between the number of virus and disease progression, HTLV-I and HIV co-infection might have an influence on the development of viral associated diseases, thus, viral replication of these viruses and co-infection were evaluated. Materials and Methods: In this study, 40 subjects were selected; 14 HIV infected, 20 HTLV-I infected and 6 HTLV-I/HIV co-infected subjects. The amount of viruses was measured using qPCR TaqMan method and CD4 and CD8 lymphocytes were assessed by flow cytometry. Results: The mean viral load of HIV infected subjects and HTLV-I infected individuals were 134626.07±60031.07 copies/ml and 373.6±143.3 copies/104 cells, respectively. The mean HIV viral load in co-infected group was 158947±78203.59 copies/ml which is higher than HIV infected group. The mean proviral load of HTLV-I in co-infected group was 222.33±82.56 copies/ml which is lower than HTLV-I infected group (P<0.05). Also, the mean white blood cell count was higher in co-infected group (5666.67±1146.49 cells/μl). However, the differences between these subjects did not reach to a statistical significance within 95% confidence interval level (P =0.1). No significant differences were observed regarding CD4 and CD8 positive lymphocytes between these groups. Conclusion: HTLV-I/HIV co-infection might promote HIV replication and could reduce the HTLV-I proviral load, in infected cells. Considering the presence of both viruses in Khorasan provinces, it encourages researchers and health administrators to have a better understanding of co-infection outcome.
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    ABSTRACT: Human T lymphotropic virus type 1 is associated with some neurologic diseases, mainly human T lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis. Human T lymphotropic virus type 2 has also been associated with similar cases of human T lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis, but evidences for a definitive relationship are less clear. On the other hand, neurologic manifestations of HIV infection are quite common, affecting more than one third of patients in HIV clinics. Seroepidemiologic studies show that HIV-infected individuals are at an increased risk for human T lymphotropic virus infection and vice versa in comparison with the general population. Furthermore, HIV/human T lymphotropic virus coinfection has been associated with distinctive immunophenotypes and an increased risk for development of neurodegenerative conditions. Thus, studies on HIV/human T lymphotropic virus coinfection have a practice clinical importance. In this review, we aim to discuss clinical and laboratorial data focusing on neurologic diseases in HIV/human T lymphotropic virus coinfection.
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