Progressive spastic myelopathy in a patient co-infected with HIV-1 and HTLV-II: autoantibodies to the human homologue of rig in blood and cerebrospinal fluid.
OBJECTIVE
Human T-cell leukemia virus types I (HTLV-I) and II (HTLV-II) are closely related human retroviruses. HTLV-I has been implicated in a chronic progressive myelopathy, known as tropical spastic paraparesis (TSP) or HTLV-I-associated myelopathy (HAM). We sought to determine whether autoantibodies to brain antigens were present in the cerebrospinal fluid (CSF) of a patient with chronic progressive spastic myelopathy with evidence of both HIV-1 infection and HTLV-I/II seropositivity.


METHODS
A 54-year-old bisexual man with clinical features of HAM/TSP of over 20 years' duration was followed.


METHODS
We applied discriminatory DNA amplification (polymerase chain reaction) to distinguish HTLV-I from HTLV-II and to verify co-infection with HIV-1. The patient's CSF was used to screen a human brain cDNA expression library to identify antibodies directed against brain antigens. Autoreactive bacteriophage clones were isolated and sequenced.


RESULTS
The patient was found to be co-infected with both HIV-1 and HTLV-II, but not with HTLV-I. HTLV-II proviral levels in the peripheral blood remained relatively constant, despite therapy with zidovudine. Prominent oligoclonal banding of immunoglobulins was present in the patient's CSF. A single repeatedly reactive cDNA clone was identified, by screening with CSF antibody, sequenced, and found to be the human homologue of the rat insulinoma gene, rig.


CONCLUSIONS
HTLV-II infection may predispose to development of a HAM/TSP-like illness. Autoimmune mechanisms, such as autoantibody formation, may play a role in pathogenesis.
Rosenblatt
J D
JD
Department of Medicine, UCLA School of Medicine.
Tomkins
P
P
Rosenthal
M
M
Kacena
A
A
Chan
G
G
Valderama
R
R
Harrington
W
W
Saxton
E
E
Diagne
A
A
Zhao
J Q
JQ
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000276:immunology*; D000595:Amino Acid Sequence; D001323:Autoantibodies; D001923:Brain Chemistry / Q000276:immunology; D003001:Cloning, Molecular; D015491:HTLV-II Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D008875:Middle Aged; D008969:Molecular Sequence Data; D009687:Nuclear Proteins / Q000235:genetics / Q000276:immunology*; D015493:Paraparesis, Tropical Spastic / Q000150:complications / Q000276:immunology*; D011533:Proviruses / Q000302:isolation & purification; D015215:Zidovudine / Q000627:therapeutic use
D001323:Autoantibodies; D009687:Nuclear Proteins; D015215:Zidovudine