Loss of correlation between HIV viral load and CD4+ T-cell counts in HIV/HTLV-1 co-infection in treatment naive Mozambican patients

• Published in: International journal of STD & AIDS Vol. 20; no. 12; p. 863
• Main Authors: Bhatt, N B, Gudo, E S, Semá, C, Bila, D, Di Mattei, P, Augusto, O, Garsia, R, Jani, I V
• Format: Journal Article
• Language: English
• Published: England 01-12-2009
• Subjects: Adult; CD4 Lymphocyte Count; CD4-CD8 Ratio; Female; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - virology; HIV-1 - immunology; HIV-1 - physiology; HIV-2 - immunology; HIV-2 - physiology; HTLV-I Antibodies - blood; HTLV-I Infections - complications; HTLV-I Infections - epidemiology; HTLV-I Infections - immunology; HTLV-I Infections - virology; Human T-lymphotropic virus 1 - immunology; Humans; Lymphocyte Activation - immunology; Lymphocytosis; Male; Middle Aged; Mozambique - epidemiology; Prevalence; Viral Load; Mozambique
• ISSN: 0956-4624
• DOI: 10.1258/ijsa.2008.008401

Seven hundred and four HIV-1/2-positive, antiretroviral therapy (ART) naïve patients were screened for HTLV-1 infection. Antibodies to HTLV-1 were found in 32/704 (4.5%) of the patients. Each co-infected individual was matched with two HIV mono-infected patients according to World Health Organization clinical stage, age +/-5 years and gender. Key clinical and laboratory characteristics were compared between the two groups. Mono-infected and co-infected patients displayed similar clinical characteristics. However, co-infected patients had higher absolute CD4+ T-cell counts (P = 0.001), higher percentage CD4+ T-cell counts (P < 0.001) and higher CD4/CD8 ratios (P < 0.001). Although HIV plasma RNA viral loads were inversely correlated with CD4+ T-cell-counts in mono-infected patients (P < 0.0001), a correlation was not found in co-infected individuals (P = 0.11). Patients with untreated HIV and HTLV-1 co-infection show a dissociation between immunological and HIV virological markers. Current recommendations for initiating ART and chemoprophylaxis against opportunistic infections in resource-poor settings rely on more readily available CD4+ T-cell counts without viral load parameters. These guidelines are not appropriate for co-infected individuals in whom high CD4+ T-cell counts persist despite high HIV viral load states. Thus, for co-infected patients, even in resource-poor settings, HIV viral loads are likely to contribute information crucial for the appropriate timing of ART introduction.