Coinfection with human T-cell lymphotropic virus type I and HIV in Brazil. Impact on markers of HIV disease progression
Schechter, M.; Harrison, L.H.; Halsey, N.A.; Trade, G.; Santino, M.; Moulton, L.H.; Quinn, T.C.
JAMA 271(5): 353-357
1994
ISSN/ISBN: 0098-7484 PMID: 7904317 Document Number: 277373
Objectives.-To study the effect of human T-cell lymphotropic virus type I (HTLV-I) on markers of human immunodeficiency virus (HIV) disease progression. Design.-A retrospective, nested case-control study. Setting.-A university hospital outpatient HIV clinic in Rio de Janeiro, Brazil. Participants.-Human immunodeficiency virus-seropositive adults participating in a prospective HIV cohort study. Main Outcome Measures.-The HIV clinical stage, CD4+ lymphocyte counts, and other laboratory parameters in 27 individuals infected with HIV and HTLV-I (coinfection) and 99 age-matched, HIV-seropositive, HTLV-seronegative controls (single infection). Results.-Variables independently associated with coinfection included higher CD4+ lymphocyte count (odds ratio (OR), 2.3; 95% confidence limits (CL), 1.3,4.1), higher CD4+ percentage (OR, 2.0; 95% CL, 1.3, 3.2), beta-2-Microglobulin level of 254 nmol/L or more (OR, 6.8; 95% CL, 1.3, 35.4), World Health Organization stages 3 and 4 (OR, 4.4; 95% CL, 1.1, 18.0), and reporting a parenteral risk factor (OR, 7.4; 95% CL, 1.4, 38.9). When stratified by p24 antigenemia, coinfection was associated with an estimated 82% higher CD4+ lymphocyte count (P lt .05). Conclusion.-Coinfection was associated with higher CD4+ lymphocyte counts, more advanced clinical disease, and higher beta-2-Microglobulin levels than HIV infection alone. The higher mean CD4+ lymphocyte count does not appear to offer immunologic benefit. Caution should be exercised when using CD4+ lymphocytes as a surrogate marker in studies of HIV infection in populations where HTLV-I is prevalent. Further studies are needed to address whether current CD4+ lymphocyte values for the initiation of antiretroviral therapy and chemoprophylaxis against opportunistic infections in HIV infection are appropriate in coinfection.