Early and Successful cART Normalizes Survival Time in HIV-HTLV-1 Coinfected Patients

BACKGROUND: coinfection by HTLV-1 is associated with shorter survival for adults and children infected by HIV, although the reasons remain a matter of debate. We evaluated the factors associated to survival time in a large cohort of HIV-HTLV-1 co-infected and HIV mono-infected patients on cART. METHODS: in a nested, retrospective case-control study (1:1) we reviewed medical records of HIV-infected patients on cART in a referral AIDS center in Salvador, Brazil. We matched 149 patients co-infected by HTLV-1 (cases) by age at HIV diagnosis and gender to equal number of HTLV-negative patients (controls). Death rates, survival time, baseline and current CD4 count, last HIV-1 RNA plasma viral load (VL) and causes of death were compared between groups. RESULTS: The overall mortality rate was 2.1 persons-year (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=0.001). Among patients with VL >50 copies-mL, coinfected patients had a shorter survival time (8.4 ± 0.8 years) than singly-infected ones (12.9 ± 1.4 years, p=0.02), regardless VL magnitude. However, survival time did not differ for HIV-singly (19.0 ± 0.4 years) or coinfected patients (20.2 ± 0.6 years) presenting VL<50 copies-ml (p=0.5). Deceased coinfected patients had higher initial CD4 count (417±219 cells) than singly-infected ones with same outcome (177±160 cells, p=0.004), while survivors had similar CD4 count at baseline, regardless HTLV status. CONCLUSIONS: successful cART is able to normalize survival for coinfected patients and should be introduced for all coinfected patients, regardless CD4 count.