Progressive HIV infection in the presence of a raised CD4+ count: HIV/HTLV-1 co-infection

Abstract

There are a number of pathophysiological causes for a normal or raised CD4 count in the context of progressive HIV infection. These include various co-infections, previous splenectomy, and lymphoproliferative disorders. Such circumstances can both confound HIV diagnosis and delay initiation of chemoprophylaxis and highly active antiretroviral therapy (HAART). We describe the case of a patient co-infected with HIV and human T-cell lymphotropic virus type 1 (HTLV-1) who, prior to HAART initiation, was found to have progressive immune deficiency associated with a raised CD4 count. S Afr J HIV Med 2013;14(2):92-94.

Molecular Detection and Clinical Implications of HTLV-1 Infections among Antiretroviral Therapy-Naïve HIV-1-Infected Individuals in Abuja, Nigeria

“…Human T-cell lymphotrophic virus type-1 (HTLV-1) was the first human retrovirus to be identified, and it is structurally related to other viruses of the Retroviridae family. 1 Since its discovery in 1979, three additional deltaretroviruses (ie, HTLV-2, HTLV-3, and HTLV-4) were subsequently discovered, but only HTLV-1 and HTLV-2 have been associated with human diseases. 1…”

“…1 Since its discovery in 1979, three additional deltaretroviruses (ie, HTLV-2, HTLV-3, and HTLV-4) were subsequently discovered, but only HTLV-1 and HTLV-2 have been associated with human diseases. 1…”

“…It was once asserted that a CD4+ lymphocyte count cannot always be considered to be a reliable marker of immunological competence in HIV-infected people, especially in patients coinfected with HTLV-1. 1,16 Normal or high CD4+ cell counts in such persons can be on account of reactive or clonal expansion of T-lymphocytes and can confound HIV diagnosis and delay initiation of chemoprophylaxis and highly active antiretroviral therapy (HAART). 1,16 Conversely, high CD4 count could be attributable to increased macrophage population especially in early HIV infection since HIV bind, enter, and infect host cells via CCR5 and CD4 cells on macrophages.…”

Recommendations for the medical evaluation of children prior to adoption in South Africa

“…Although regions of SA are known to be endemic for HTLV-1, [29] the lifetime risk of HTLV-1-associated disease is considered to be only 10%. [30] Until data on the local incidence of mother-to-child transmission become available, informed recommendations are not possible.…”