A polyclonal CD4+ and CD8+ lymphocytosis in a patient doubly infected with HTLV-I and HIV-1: a clinical and molecular analysis.
HTLV-I is associated with adult T-cell leukemia/lymphoma (ATL) characterized by monoclonal expansions of CD4+ T-lymphocytes. In this report we describe a histologically benign, polyclonal HTLV-I infection in a patient exhibiting both an absolute CD4+ and CD8+ lymphocytosis. Three T-cell lines containing integrated HTLV-I proviral copies established from this patient were initially polyclonal, but with time all grew out the same two clones as determined by analysis of their T-cell antigen receptor beta chain gene rearrangements. The patient subsequently developed pulmonary and nasopharyngeal nodules containing HTLV-I infected cells. Restriction analysis of the patient's HTLV-I provirus revealed no differences from prototype HTLV-I and the tax gene was normally expressed in vivo and in vitro. The patient's T-lymphocytosis and HTLV-I+ pulmonary tract nodules were put into a complete clinical remission by treatment with alkylating agents and steroids. Subsequently, the patient developed a severe immunodeficiency state and expired. Retrospective serologic and gene amplification assays for HIV-1 demonstrated that he had been doubly infected from the time of presentation. Postmortem analysis by polymerase chain reaction revealed the presence of both HTLV-I and HIV-1 in lymphatic tissues and the testes; HIV-1 was also detected in brain tissue.
Ehrlich
G D
GD
Department of Medicine, State University of New York Health Science Center, Syracuse 13210.
Davey
F R
FR
Kirshner
J J
JJ
Sninsky
J J
JJ
Kwok
S
S
Slamon
D J
DJ
Kalish
R
R
Poiesz
B J
BJ
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000276:immunology*; D000328:Adult; D000945:Antigens, Differentiation, T-Lymphocyte / Q000032:analysis*; D015139:Blotting, Southern; D016827:CD8 Antigens; D002460:Cell Line; D015342:DNA Probes; D004797:Enzyme-Linked Immunosorbent Assay; D005784:Gene Amplification; D015490:HTLV-I Infections / Q000150:complications / Q000276:immunology*; D006801:Humans; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000150:complications / Q000276:immunology*; D008218:Lymphocytosis / Q000209:etiology / Q000276:immunology*; D008297:Male; D013601:T-Lymphocytes / Q000276:immunology*
D000945:Antigens, Differentiation, T-Lymphocyte; D016827:CD8 Antigens; D015342:DNA Probes