title: Comparison of HTLV-associated myelopathy (HAM) in HIV-positive and HIV-negative patients at a tertiary South African hospital.
abstract: BACKGROUND
  HTLV-1 associated myelopathy (HAM), or tropical spastic paraparesis, is caused by a retrovirus, the human T-cell lymphotropic virus (HTLV). Although patients with HAM and HIV infection have been described, to our knowledge no direct comparison has been made between patients who are HIV positive and suffering from HAM (HHAM) v. those who are HIV negative and suffering from HAM.
  
  
  OBJECTIVE
  We aimed to compare clinical and radiological findings in HIV-positive and -negative patients with HAM.
  
  
  METHODS
  Adult patients who presented to the Neurology Unit at the Steve Biko Academic Hospital from May 2005 to June 2012 with a progressive myelopathy and HTLV seropositivity were retrospectively identified and their clinical and radiological data were collected and reviewed.
  
  
  RESULTS
  21 patients with HAM were identified, of whom 9 were HIV-positive and 11 HIV-negative. One patient, whose HIV status had not been established, was not included in the study. Although the trend did not reach statistical significance, co-infected patients tended to present at an earlier age (HHAM 6/9 (66%) <40 years old; HAM 2/11 (18%) <40 years old) and presented to hospital earlier (HHAM 6/9 (66%) < 3 years symptomatic; HAM 7/11 (63%) > 3 years symptomatic). Cord atrophy occurred in 7/8 dually infected patients and 8/10 HIV-negative patients.
  
  
  CONCLUSIONS
  Although the study is limited by the small number of patients, co-infected patients tended to have a younger age of onset and to present to hospital sooner, and thoracic cord atrophy was very common.
authors.affiliation: Department of Neurology, Steve Biko Academic Hospital, Pretoria, South Africa. cschutte@meic.up.ac.za
authors.forename: C -M
authors.initials: C-
authors.lastname: Schutte
authors.forename: T
authors.initials: T
authors.lastname: Townsend
authors.forename: R
authors.initials: R
authors.lastname: Van Coller
authors.forename: S
authors.initials: S
authors.lastname: Olorunju
mesh_terms: D000328:Adult; D005260:Female; D006678:HIV / Q000276:immunology*; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015493:Paraparesis, Tropical Spastic / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*