Original Research

A comparative study of human T-cell lymphotropic virus-associated myelopathy in HIV-positive and HIV-negative patients in KwaZulu-Natal

Hoosain F. Paruk, Ahmed I. Bhigjee, Suzaan Marais
Southern African Journal of HIV Medicine | Vol 18, No 1 | a746 | DOI: https://doi.org/10.4102/sajhivmed.v18i1.746 | © 2017 Hoosain F. Paruk, Ahmed I. Bhigjee, Suzaan Marais | This work is licensed under CC Attribution 4.0
Submitted: 06 March 2017 | Published: 06 December 2017

About the author(s)

Hoosain F. Paruk, Department of Neurology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
Ahmed I. Bhigjee, Department of Neurology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
Suzaan Marais, Department of Neurology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa


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Abstract

Background: KwaZulu-Natal is an endemic area for HIV and human T-cell lymphotropic virus (HTLV) infection. The main neurological manifestation of HTLV is HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The effect of HIV co-infection in patients with HAM/TSP is not well documented.

Aims: To determine the prevalence of HIV seropositivity in patients with HAM/TSP and compare the clinical, laboratory and radiological features of patients mono-infected with HTLV and those dually infected with HTLV and HIV.

Methods: Adult patients referred to the Neurology Department at Inkosi Albert Luthuli Central Hospital in KwaZulu-Natal, South Africa, for the period 01 January 2004 to 31 December 2015 with a positive HTLV serology were identified from the National Health Laboratory Service database. A retrospective chart review was conducted to identify all patients who had a diagnosis of HAM/TSP and to record their HIV status. Clinical, laboratory and radiological data were compared for HIV-positive and HIV-negative patients.

Results: A total of 52 patients with HAM/TSP were identified. HIV results were available in 44 patients of whom 23 (52%) patients were HIV co-infected. Patients who were HIV-positive had a younger age of presentation compared to HIV-negative patients (median: 31 vs 50 years, p = 0.002). HIV-positive patients had a median duration of symptoms at presentation of 12 months compared to 16 months for HIV-negative patients, but the difference did not reach statistical significance (p = 0.082). The CD4 cell counts of HIV-positive patients were well preserved with a median count of 781 cells/µL.

Conclusions: HIV co-infection is commonly seen in the setting of HAM/TSP in KwaZulu-Natal. An interaction between the viruses may accelerate the development of HAM/TSP, leading to a younger age of presentation. Co-infection may have treatment implications because of CD4 counts being preserved in these patients.


Keywords

HTLV; HIV; myelopathy; tropical spastic paraparesis

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