title: Higher mortality in HIV-2/HTLV-1 co-infected patients with pulmonary tuberculosis in Guinea-Bissau, West Africa, compared to HIV-2-positive HTLV-1-negative patients.
abstract: OBJECTIVE
  To investigate the effect of human T-lymphotropic virus type 1 (HTLV-1) on CD4 counts and mortality in tuberculosis (TB) patients with or without human immunodeficiency virus (HIV).
  
  
  METHODS
  A prospective study on 280 hospitalized patients with pulmonary TB was performed in Guinea-Bissau, 1994-1997, including HIV, CD4 counts and clinical outcome. We compared the CD4 count levels at the time of inclusion between HIV-negative and HIV-positive patients, with or without HTLV-1. Mortality was determined while patients were on treatment for TB.
  
  
  RESULTS
  Median CD4% was significantly higher in HIV-positive subjects co-infected with HTLV-1 compared to HTLV-1-negative patients. Two hundred thirty-three individuals were included in the analysis of mortality, and among HIV-negative subjects the mortality was 18.6/100 person-years . In HIV-2-positive HTLV-1-negative subjects the mortality was 39.5/100 person-years and in HIV-2/HTLV-1 co-infected patients it was 113.6/100 person-years (adjusted mortality rate ratio 4.7, 95% CI 1.5-14.4; p < 0.01). When all HIV-positive patients were analyzed together, corresponding mortality rates were 53.5/100 person-years and 104.8/100 person-years , respectively (not significant).
  
  
  CONCLUSIONS
  HIV/HTLV-1 co-infected patients hospitalized for pulmonary TB had a high mortality and had significantly higher CD4% compared to only HIV-positive subjects. This may imply that HTLV-1 has an adverse effect on the immune system in HIV-infected subjects, independently of the CD4 count, that makes co-infected subjects more vulnerable to TB.
authors.affiliation: Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden. Hans.Norrgren@med.lu.se
authors.forename: Hans
authors.initials: H
authors.lastname: Norrgren
authors.forename: Sana
authors.initials: S
authors.lastname: Bamba
authors.forename: Zacarias J
authors.initials: ZJ
authors.lastname: Da Silva
authors.forename: Tuija
authors.initials: T
authors.lastname: Koivula
authors.forename: Sören
authors.initials: S
authors.lastname: Andersson
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000276:immunology / Q000401:mortality*; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D005260:Female; D006169:Guinea-Bissau / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000401:mortality*; D015497:HIV-1; D015498:HIV-2; D015490:HTLV-I Infections / Q000150:complications* / Q000276:immunology / Q000401:mortality*; D006801:Humans; D008297:Male; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000276:immunology / Q000401:mortality*