International Journal of STD & AIDS > Volume 20, Number 12 > Pp. 863-868

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Original research articles

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

N B Bhatt MD MMED ^* , E S Gudo MD ^*, C Semá BSc ^*, D Bila MSc ^*, P Di Mattei MD DTM&H , O Augusto ^*, R Garsia PhD FRCPA   and I V Jani MD PhD ^*

^* Department of Immunology, Instituto Nacional de Saúde, Maputo, Mozambique; HIV Outpatient Clinic, Alto Maé Health Centre, Médecins Sans Frontières-Switzerland (MSF-CH), Maputo, Mozambique; Department of Medicine, University of Sydney, New South Wales, Australia; Department of Clinical Immunology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

Correspondence to: Dr N B Bhatt, Department of Immunology, Instituto Nacional de Saúde, PO Box 264, Maputo, Mozambique Email: nbhatt.mz{at}gmail.com

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.

Key Words: HIV • HTLV-1 • CD4+ T lymphocytes • lymphocytosis • Mozambique

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