title: Presence of tropical spastic paraparesis/human T-cell lymphotropic virus type 1-associated myelopathy (TSP/HAM)-like among HIV-1-infected patients.
abstract: Human immunodeficiency virus type 1 (HIV-1) and human T-cell lymphotropic virus types 1 and 2 (HTLV-1 and -2) are retroviruses that share similar routes of transmission and some individuals may have a dual infection. These co-infected subjects may be at increased risk for tropical spastic paraparesis/HTLV-1-associated myelopathy (TSP/HAM)-like. To study the prevalence of tropical spastic paraparesis/HTLV-1-associated myelopathy (TSP/HAM) among co-infected HIV-1/HTLV-1 subjects. Since July 1997, our group has been following a cohort to study the interaction of HTLV with HIV and/or hepatitis C virus (HCV), as well as HTLV-1-only infected asymptomatic carriers or those already presenting with TSP/HAM. During these 9 years, 296 HTLV-1-infected individuals were identified from a total of 538 patients who were referred to our clinic at the Institute of Infectious Diseases "Emílio Ribas," in São Paulo, Brazil. All subjects were evaluated by two neurologists, blinded to the HTLV status. TSP/HAM diagnosis was based on Kagoshima diagnostic criteria.
  
  
  RESULTS
  A total of 38 HIV-1/HTLV-1 co-infected subjects were identified in this cohort: Twenty-six had already been diagnosed with AIDS and 12 remained asymptomatic. Six of 38 co-infected subjects (18%) were diagnosed as having TSP/HAM and also AIDS, and for 5 of them TSP/HAM was their first illness. One additional incident case was diagnosed after 2 years of follow-up. No modifications on HIV-1 viral load was seen. In contrast, the co-infected with TSP/HAM-like group showed higher HTLV-1 proviral load (505 +/- 380 vs. 97 +/- 149 copies/10(4) PBMC, P = 0.012) than asymptomatic co-infected subjects, respectively. The incidence of myelopathy among HIV-1/HTLV-1 co-infected subjects is probably higher than among patients infected only with HTLV-1, and related to a higher HTLV-1 proviral load. Thus, HTLV-1/2 screening should be done for all HIV-1-infected patients in areas where HTLV-1 infection is endemic.
authors.affiliation: HTLV Service, Institute of Infectious Diseases Emílio Ribas, São Paulo, Brazil. jorge_casseb@yahoo.com.br
authors.forename: Jorge
authors.initials: J
authors.lastname: Casseb
authors.forename: Augusto César Penalva
authors.initials: AC
authors.lastname: de Oliveira
authors.forename: Maria Paulina Posada
authors.initials: MP
authors.lastname: Vergara
authors.forename: Patricia
authors.initials: P
authors.lastname: Montanheiro
authors.forename: Francisco
authors.initials: F
authors.lastname: Bonasser
authors.forename: Claudio
authors.initials: C
authors.lastname: Meilman Ferreira
authors.forename: Jerusa
authors.initials: J
authors.lastname: Smid
authors.forename: Alberto José da Silva
authors.initials: AJ
authors.lastname: Duarte
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003937:Diagnosis, Differential; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D015368:Human T-lymphotropic virus 1 / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D015493:Paraparesis, Tropical Spastic / Q000150:complications* / Q000175:diagnosis / Q000821:virology; D013118:Spinal Cord Diseases / Q000150:complications* / Q000175:diagnosis / Q000821:virology
chemical_list: D019380:Anti-HIV Agents