title: Coinfection with human T-cell lymphotropic virus type I and HIV in Brazil. Impact on markers of HIV disease progression.
abstract: OBJECTIVE
  To study the effect of human T-cell lymph-tropic virus type I (HTLV-I) on markers of human immunodeficiency virus (HIV) disease progression.
  
  
  METHODS
  A retrospective, nested case-control study.
  
  
  METHODS
  A university hospital outpatient HIV clinic in Rio de Janeiro, Brazil.
  
  
  METHODS
  Human immunodeficiency virus-seropositive adults participating in a prospective HIV cohort study.
  
  
  METHODS
  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 < .05).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Preventive Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Schechter
authors.forename: L H
authors.initials: LH
authors.lastname: Harrison
authors.forename: N A
authors.initials: NA
authors.lastname: Halsey
authors.forename: G
authors.initials: G
authors.lastname: Trade
authors.forename: M
authors.initials: M
authors.lastname: Santino
authors.forename: L H
authors.initials: LH
authors.lastname: Moulton
authors.forename: T C
authors.initials: TC
authors.lastname: Quinn
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001938:Brazil; D016516:CD4-CD8 Ratio; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D016022:Case-Control Studies; D005260:Female; D016655:HIV Core Protein p24 / Q000097:blood; D015658:HIV Infections / Q000150:complications* / Q000276:immunology* / Q000503:physiopathology; D015490:HTLV-I Infections / Q000150:complications* / Q000276:immunology; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D012189:Retrospective Studies; D016176:T-Lymphocyte Subsets / Q000276:immunology*; D001613:beta 2-Microglobulin / Q000032:analysis
chemical_list: D015415:Biomarkers; D016655:HIV Core Protein p24; D001613:beta 2-Microglobulin