RETROVIRAL CO-INFECTIONS IN NEW ORLEANS.

Abstract

P191 HIV/HTLV-I and HIV/HTLV-II co-infections are recognized with increasing frequency in many urban areas. To characterize the clinical, immunologic and virologic features associated with retroviral co-infections, a longitudinal study of HIV/HTLV co-infections was initiated in 1992 through the present at the Charity Hospital HIV Outpatient Clinic in New Orleans, Louisiana. 172 HTLV-I/II infections have been diagnosed in 2,339 HIV-infected patients (7.3%). From this group, we studied 1271 individuals with HIV only (group 1), 41 individuals with HIV/HTLV-I co-infection (group 2) and 65 individuals with HIV/HTLV-II coinfection (group 3). In bivariate analysis, age at time of HTLV-I/II test, African American race, and history of IVDA were highly associated with HIV/HTLV-I as well as HIV/HTLV-II co-infections (p<0.001). After adjusting for these factors, we determined the adjusted odds ratios (95% CI) for having a CD4>500 as follows: Group 1 (OR 1.00), Group 2 (OR 2.22, 1.02-4.84), Group 3 (OR 2.07, 1.07-4.02). For CD8>800: Group 1 (OR 1.00), Group 2 (OR 2.52, 1.28-4.95), Group 3 (1.88, 1.05-3.12). One case of ATLL was seen in Group 2. Also, patients in group 2 were more likely to have a diagnosis of myelopathy than group 1 (n=4 or 9.7%, p<0.01). All four patients had HAM/TSP-like features as well as elevated creatine phosphokinase levels. One also had extensive white matter lesions in the brain. All four had CD4 and CD8 > 1,000 at time of diagnosis, and had detectable HTLV-I tax/rex mRNA in uncultured peripheral blood mononuclear cells by reverse transcription polymerase chain reaction. These results confirm that retroviral co-infections are associated with higher CD4 and CD8 counts even after adjusting for unique demographic parameters. Also, HAM/TSP during HIV/HTLV-I co-infection is associated with high CD4 and CD8 counts and HTLV-I virus expression is increased.