Increased Risk of Developing Peripheral Neuropathy in Patients Coinfected With HIV-1 and HTLV-2

Abstract

One thousand one hundred fifty-two HIV-1-positive patients were screened for HTLV-2 infection, and the AIDS-free coinfected individuals were consecutively included in a longitudinal study with the aim of investigating the role of HTLV-2 in the progression to AIDS and the development of specific neurologic diseases. Two matched HIV-1-positive/HTLV-2-negative controls for each coinfected individual were also enrolled in the study. HTLV-2 infection was found in 95 (8.2%) of the HIV-1-positive patients, 30 of whom were followed up for a median of 28.5 months. No significant differences were observed between them and the patients infected with HIV-1 alone in terms of the rate of decline in CD4 cell counts, progression to AIDS, or AIDS mortality, but they had an increased risk of developing peripheral neuropathy (hazard ratio, 3.3; 95% confidence interval, 1.3-8.0; p =.009). One coinfected patient developed myelopathy during the follow-up. In the second part of the study, aimed at preliminarily assessing the effect of highly active antiretroviral therapy (HAART) on the incidence of peripheral neuropathy, we extended our observations to two groups of coinfected and singly infected individuals receiving HAART. An 80% decrease in incidence of peripheral neuropathy was observed among both groups without any significant difference between them. These results support the hypothesis that HTLV-2 plays a role in the development of neurologic abnormalities in HIV-1-infected patients and suggest that the immune reconstitution due to HAART may limit the activity of HTLV-2 as an opportunistic agent.

Clinical and epidemiological aspects of HTLV-II infection in São Paulo, Brazil: presence of Tropical Spastic Paraparesis/HTLV-Associated Myelopathy (TSP/HAM) simile diagnosis in HIV-1-co-infected subjects

“…On basis of the clinical findings, some HTLV-II-infected subjects showed peripheral neuropathy during the co-infection and urinary tract infection either in HIV-1/HTLV-II-infected subjects as well in solely infected with HTLV-II. These findings have been shown by other investigators 2,23 , but its pathogenesis remain to be better studied.…”

Neurologic abnormalities in HTLV-I– and HTLV-II–infected individuals without overt myelopathy

“…Although a limited number of studies have shown that HTLV-II-infected individuals are more likely than uninfected individuals to develop neurologic disability, 20 peripheral neuropathy, 21,22 and progressive myelopathy, 23 the role of HIV and/or drugrelated factors could not be excluded. In this study, subjects were seronegative for HIV and only a small percentage reported injection drug use, which we adjusted for in our analysis.…”

“…Although less research has focused on HTLV-II, sensory neuropathy has been observed with HTLV-II alone 20 and with HIV coinfection. [20][21][22][23] A spinocerebellar syndrome has also been documented in a few case reports of HTLV-I-and -IIinfected patients. 24 A better understanding of the neurologic abnormalities associated with HTLV infection is important for the clinical care of infected patients.…”

Human T-Lymphotropic Viruses (HTLV)

“…In addition, increased incidence of sensory neuropathy has been reported in IDU infected with HTLV-2 (Dooneief et al, 1996). This association was more pronounced in patients co-infected with HIV-1, whose risk of developing peripheral neuropathy was shown to be three times higher compared with patients infected only with HIV-1 (Zehender et al, 2002). In summary, HTLV-2 has been considered less pathogenic than HTLV-1.…”