Bhatt N B, Gudo E S, Semá C, Bila D, Di Mattei P, Augusto O, Garsia R, Jani I V
Department of Immunology, Instituto Nacional de Saúde, Maputo, Mozambique.
Int J STD AIDS. 2009 Dec;20(12):863-8. 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.
对704例未接受过抗逆转录病毒治疗（ART）的HIV-1/2阳性患者进行了HTLV-1感染筛查。在32/704（4.5%）的患者中发现了抗HTLV-1抗体。根据世界卫生组织临床分期、年龄±5岁和性别，将每例合并感染患者与两名HIV单感染患者进行匹配。比较了两组患者的关键临床和实验室特征。单感染和合并感染患者表现出相似的临床特征。然而，合并感染患者的CD4+T细胞绝对计数更高（P = 0.001）、CD4+T细胞计数百分比更高（P < 0.001）以及CD4/CD8比值更高（P < 0.001）。虽然HIV血浆RNA病毒载量在单感染患者中与CD4+T细胞计数呈负相关（P < 0.0001），但在合并感染个体中未发现相关性（P = 0.11）。未治疗的HIV和HTLV-1合并感染患者的免疫和HIV病毒学标志物之间存在分离。目前在资源匮乏地区启动ART和针对机会性感染进行化学预防的建议依赖于更容易获得的CD4+T细胞计数，而不考虑病毒载量参数。这些指南不适用于合并感染个体，在这些个体中，尽管HIV病毒载量很高，但CD4+T细胞计数仍持续较高。因此，对于合并感染患者，即使在资源匮乏地区，HIV病毒载量也可能为适时引入ART提供关键信息。
