Journal Article

Tropical Spastic Paraparesis/Human T Leukemia Virus Type 1—Associated Myelopathy in HIV Type 1—Coinfected Patients

Mark A. Beilke, Shanker Japa, Christiane Moeller-Hadi and Sheryl Martin-Schild

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 41, issue 6, pages e57-e63
Published in print September 2005 | ISSN: 1058-4838
Published online September 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/432890
Tropical Spastic Paraparesis/Human T Leukemia Virus Type 1—Associated Myelopathy in HIV Type 1—Coinfected Patients

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Background. Tropical spastic paraparesis/human T leukemia virus type 1 (HTLV-1)—associated myelopathy (TSP/HAM) is rarely reported in the United States. The causative agents of TSP/HAM are HTLV-1 and, possibly, its cosmopolitan variant, human T leukemia virus type 2 (HTLV-2). Among HTLV-1– or HTLV-2—monoinfected individuals, the estimated lifetime risk for development of TSP/HAM is <2%. However, it has been suggested that HIV/HTLV coinfection may increase the risk for development of TSP/HAM.

Methods. A total of 2239 human immunodeficiency virus (HIV)—infected patients were tested for HTLV-1 and HTLV-2 infection at the New Orleans Outpatient Clinic (Louisiana) during the period 1991–1998. HTLV-1—infected patients with suspected myelopathy were referred for additional evaluation.

Results. Four cases of TSP/HAM (9.7%) were identified among 41 individuals with Western blot—confirmed HTLV-1 infection. The diagnosis was confirmed with use of molecular diagnostic assays and viral isolation. No TSP/HAM cases were identified among 65 patients with HIV—HTLV-2 coinfection. An additional patient with HIV—HTLV-1 coinfection also received a diagnosis of TSP/HAM at the New Orleans Veteran's Affairs HIV Outpatient Clinic (Louisiana). All patients had normal CD4+ T cell counts at the time of diagnosis.

Conclusions. Given the high rates of HIV-HTLV coinfection in the United States, a heightened suspicion for TSP/HAM should be considered in HIV-infected patients who present with normal CD4+ T cell counts and myelopathy in the absence of other acquired immunodeficiency syndrome—defining conditions.

Journal Article.  4308 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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