Higher risk for myelopathy development among HTLV-I / HIV-I coinfected subjects

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1 HIV Infection and the Central Nervous System: Developed and Resource Limited Settings Higher risk for myelopathy development among HTLV-I / HIV-I coinfected subjects Claudio Meilman Ferreira Clinical Research Unit on Human Retrovirology, University of Campinas, São Paulo, Brazil 2005

2 Overview Previous knowledge on HIV and HTLV coinfection Epidemiological data Brazilian statistics Characteristics of our cohort Prevalence of myelopathy

3 HIV-I X HTLV-I HIV-I Origin: ~100 years Infectivity: High Mutation Rate: High 10 subtypes Recombination: Yes Replication: High Evolution: 90% in y Apoptosis: High IL-2: Low HTLV-I ~ years Low Low 5 subtypes No Low <5% em y Low IL-2: High

4 PREVALENCE OF HTLV-I/II AND HIV COINFECTION IN THE WORLD Location HTLV-I (%) HTLV-II (%) Ref. London Cooke et al Buenos Aires 8.1 ND Scapellato et al Milan Zehender et al New Orleans 6 13 Beilke et al Buenos Aires 5* - de los Angeles Pando, 2004 Switzerland 1/1620 5/1620 Boni et al Accra, Ghana 11.3 ND Adjei et al Kingston,Jamaica 5 ND Smikle et al., 2003 Brescia ND 12 Quiros-Roldan et al. 2003

5 Coinfection HIV-I + HTLV-I/II Coinfection was associated to higher CD4+ cells counts, higher CD4+ cells counts did not correlate with better immune status (Fantry et al., CID 1995, Nadler et al., CID 1996) More advanced HIV related disease (Batholomew et al., Lancet 1997, Page et al., Lancet 1990, Brites et al., AIDS 2001) Non-specific, non-functional CD4+ cells related to HTLV- 1 infection (Schechter et al., Neurology 1994)

6 SURVIVAL OF HIV/HTLV COINFECTED Brites C et al. 2001

7 Coinfection HIV-I + HTLV-I/II Higher CD4+ cells counts at the beggining and during follow-up IDU No difference on survival or progression to AIDS in the group coinfected with HTLV-I Lower progression to AIDS in the group coinfected with HTLV-II Higher association with neurological disease, thrombocytopenia, UTI, airway infections and Hep C Beilke et al. CID, 2004, Hershow et al., JID 1996, Harrison et al, AIDS and STDs, 1998

8 COINFECTION IN BRAZIL Incidence of myelopathy was higher in the coinfection group: 73% vs 16%, as well as of peripheral neuropathy (Harrison et al. 1997) In Santos, SP, coinfection was a surrogate predictor of lower survival (Etzel et al. 2004, Bangkok) Coinfection had lower survival rates when compared to controls (1849 vs 2430 days, P = 0.001), despite genre or CD4 at baseline (Brites et al. 2001)

9 HIV AND AIDS NUMBERS IN BRAZIL Cumulative AIDS Cases (Dec/2002): 257,780 Cumulative AIDS Deaths (Dec/2002): 113,840 Estimated Number of HIV+ Individuals (2000): 597,000 Incidence Rate of AIDS (2000): 12,4 / Prevalence Rate of HIV (2000): 0,65%

10 HTLV I/II IN BRAZIL LOCATION PREVALENCE AUTHOR Belém 1,61% Saraiva et al, 1989 Manaus 0,08% Galvão et al, 1994 Fortaleza 0,40% Castro-Costa et al, 1995 Recife 0,82% Loureiro et al, 1995 Salvador 1,80% Moreira et al, 1993 Belo Horizonte 0,32% Proietti et al, 1994 Rio de Janeiro 0,45% Araújo et al, ,35% Galvão et al, 1994 São Paulo 0,41% Wendel et al, ,40% Gabbai et al, ,18% Ferreira et al, 1995 Florianópolis 0,08% Galvão et al, 1994 Porto Alegre 0,42% Menna-Marreto et al, 1995

11 HTLV I/II IN BRAZIL 0,08% 0,5% 1,21% 0,7% 1,4% 0,5% 0,4% 0,4% 0,08% 0,5%

12 PREVALENCE OF HTLV-I/II AND HIV COINFECTION IN BRAZIL Location HTLV-I (%) HTLV-II (%) Ref. Rio de Janeiro 13 ND Cortes et al São Paulo 0 0 Covas et al São Paulo 9 ND Gabbai et al São Paulo Caterino et al Fortaleza Broutet N et al Belém 3 5 Vallinoto et al Salvador 23 ND Moreira et al. 199 Belo Horizonte 1.6 ND Catalan-Soares, 2000 Santos 6 7 Etzel et al. 2001, 2004

13 THE QUESTION What would it be the attack rate of mielopathy among coinfected patients in our setting? 3.2% Beilke et al % Harrison et al. 1997

14 Material and Methods Cohort from an out-patient HTLV clinic HTLV I or II infection diagnosed by EIA Confirmed and typed by WB and PCR Neurologists blinded to serological status (FDS, DSS, Osame ) TSP/HAM diagnosis was based on Kagoshima diagnostic guidelines

15 Material and Methods Other myelopathies excluded (syphilis, B12 deficiency, compression) CDC criteria to classify HIV-I infected subjects

16 Results 210 HTLV-I infected individuals 27 coinfected with HIV-I (12%) 8 with myelopathy among coinfected (30%)

17 Results HIV-I+/HTLV-I Coinfection Myelopathy No myelopathy Group A Group B N Men/women 7/1 15/4 Mean age (y) SD Mean CD4 cell count (cells/ml) ** 228 (54-603) 522 ( ) * Clinical classification in accordance to CDC, ** First initial CD4 cell count, or for the first visit at the HTLV out-clinic. Results shown in mean and standard deviation 25%-75% percentile variation in parenthesis *** TSP/HAM diagnosis in accordance to WHO Classification criteria.

18 CONCLUSIONS HIV-1/HTLV-I coinfection is related to a ~ 20 times higher myelopathy attack rate; HIV-infected Individuals should be tested for the other retrovirus; Coinfected subjects should be aware of higher risk of developing neurological syndromes

19 AMBULATÓRIO DE HTLV - INSTITUTO DE INFECTOLOGIA EMÍLIO RIBAS IIER Jorge Casseb Augusto C. Penalva de Oliveira M. Paulina Posada Francisco Bonasser Laboratory of Allergy and Clinical and Experimental Immunology Patrícia Montanheiro Alberto Duarte Suporte: Fapesp, CNPq, LIM56/FFM

Prevalence of anxiety, depression and quality of life in HTLV-1 infected patients

ORIGINAL ARTICLE Prevalence of anxiety, depression and quality of life in HTLV-1 infected patients Authors Maria Rita Polo Gascón 1 Claudio Garcia Capitão 2 Jorge Casseb 3 Maria Cezira Fantini Nogueira-Martins