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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