Harrison L H, Vaz B, Taveira D M, Quinn T C, Gibbs C J, de Souza S H, McArthur J C, Schechter M
Department of International Health, Johns Hopkins University School of Hygiene, Baltimore, MD, USA. LHARRISO+@PITT.EDU
Neurology. 1997 Jan;48(1):13-8. doi: 10.1212/wnl.48.1.13.
To determine whether subjects coinfected with HTLV-I and HIV have a higher frequency of myelopathy than subjects singly infected with HIV.
A prospective, nested case-control study of HTLV-I and HIV coinfected (cases) and HIV singly infected adults (controls) participating in a prospective HIV cohort study at a university hospital outpatient HIV clinic in Rio de Janeiro, Brazil.
Subjects were evaluated for evidence of myelopathy by a neurologist unaware of their HTLV serologic status. Patients with at least two pyramidal signs, such as paresis, hypertonicity or spasticity, hyperreflexia, clonus, diminished or absent superficial reflexes, or the presence of pathologic reflexes (e.g., Babinski or Hoffmann), were defined as having myelopathy. Myelopathy severity was quantified using the Kurtzke Functional Disability Scale (FDS); patients with FDS scores > or = 4 were considered to have significant myelopathy. Selected patients with myelopathy underwent lumbar puncture for the evaluation of intrathecal synthesis of HTLV-I antibodies.
Of 15 coinfected subjects, 11 (73%) had evidence of myelopathy versus 10 of 62 subjects (16%) with HIV single infection (adjusted odds ratio [OR] = 13.0, p = 0.00002). When only myelopathy patients with FDS scores of > or = 2 or > or = 4 were included, the association between coinfection and the presence of myelopathy remained (OR = 7.3, p = 0.0003 for scores > or = 2; and OR = 8.9 for scores > or = 4, p = 0.04). In addition, a higher proportion of coinfected subjects had peripheral neuropathy (40%) than controls (16%) (OR = 3.5, p = 0.07).
Coinfection with HTLV-I was strongly associated with myelopathy among subjects infected with HIV. The relative contribution of HTLV-I versus HIV in the pathogenesis of coinfection-associated myelopathy is not known. Coinfection may also be associated with peripheral neuropathy. Further studies are needed to elucidate the mechanisms of coinfection-associated neurologic conditions.
确定同时感染人类嗜T淋巴细胞病毒I型（HTLV-I）和人类免疫缺陷病毒（HIV）的受试者发生脊髓病的频率是否高于单纯感染HIV的受试者。
在巴西里约热内卢一家大学医院门诊HIV诊所，对参与一项前瞻性HIV队列研究的同时感染HTLV-I和HIV的受试者（病例组）以及单纯感染HIV的成年人（对照组）进行一项前瞻性巢式病例对照研究。
由一名不知道受试者HTLV血清学状态的神经科医生对受试者进行脊髓病证据评估。至少有两种锥体束征的患者，如轻瘫、张力亢进或痉挛、反射亢进、阵挛、浅反射减弱或消失，或存在病理反射（如巴宾斯基征或霍夫曼征），被定义为患有脊髓病。使用库尔茨克功能障碍量表（FDS）对脊髓病严重程度进行量化；FDS评分≥4的患者被认为患有严重脊髓病。选定的脊髓病患者接受腰椎穿刺以评估鞘内HTLV-I抗体的合成情况。
在15名同时感染的受试者中，11名（73%）有脊髓病证据，而在62名单纯感染HIV的受试者中有10名（16%）有脊髓病证据（调整后的优势比[OR]=13.0，p=0.00002）。当仅纳入FDS评分≥2或≥4的脊髓病患者时，同时感染与脊髓病存在之间的关联仍然存在（FDS评分≥2时，OR=7.3，p=0.0003；FDS评分≥4时，OR=8.9，p=0.04）。此外，同时感染的受试者发生周围神经病变的比例（40%）高于对照组（16%）（OR=3.5，p=0.07）。
在感染HIV的受试者中，HTLV-I合并感染与脊髓病密切相关。HTLV-I与HIV在合并感染相关脊髓病发病机制中的相对作用尚不清楚。合并感染也可能与周围神经病变有关。需要进一步研究以阐明合并感染相关神经系统疾病机制。
