Early and Successful Combination Antiretroviral Therapy Normalizes Survival Time in Patients Coinfected With Human Immunodeficiency Virus and Human T-cell Lymphotrophic Virus Type 1.

Background: Coinfection with human T-cell lymphotrophic virus type 1 (HTLV-1) is associated with shorter survival for adults and children infected with human immunodeficiency virus (HIV), although the reasons remain a matter of debate. We evaluated the factors associated with survival time in a large cohort of HIV/HTLV-1-coinfected and HIV-monoinfected individuals on combination antiretroviral therapy (cART).

Methods: In a nested, retrospective case-control study (1:1), we reviewed medical records of people with HIV infection on cART in a referral AIDS center in Salvador, Brazil. We matched 149 patients coinfected with HTLV-1 (cases) by age at HIV diagnosis and sex, to an equal number of HTLV-uninfected persons (controls). Death rates, survival time, baseline and current CD4 cell count, last HIV-1 RNA plasma viral load (pVL), and causes of death were compared between groups.

Results: The overall mortality rate was 2.1 person-years (76 deaths, 53 among coinfected patients). Survival time for cases (16.7 ± 0.7 years) was significantly shorter than for controls (18.1 ± 0.4 years; P = .001). Among patients with pVL >50 copies/mL, coinfected patients had a shorter survival time (8.4 ± 0.8 years) than monoinfected ones (12.9 ± 1.4 years; P = .02), regardless of pVL magnitude. However, survival time did not differ for HIV-monoinfected (19.0 ± 0.4 years) or coinfected patients (20.2 ± 0.6 years) presenting with pVL <50 copies/mL (P = .5). Deceased coinfected patients had higher initial CD4 count (417 ± 219 cells) than monoinfected ones with the same outcome (177 ± 160 cells; P = .004), while survivors had similar CD4 cell count at baseline, regardless of HTLV status.

Conclusions: Successful cART is able to normalize survival for coinfected patients and should be introduced for all coinfected patients, regardless of CD4 cell count.HIV/human T-cell lymphotrophic virus type 1 coinfection is believed to decrease survival of coinfected patients. In this case-control study, we demonstrate that successful combination antiretroviral therapy (last HIV viral load <50 copies/mL) is able to improve survival of coinfected patients to levels observed for those monoinfected.