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Published on: June 14, 2024
HTLV-1, ATLL, severe hypercalcaemia and HIV-1 co-infection: an overview
Abdullah Ebrahim Laher1, Osman Ebrahim2
1Department of Emergency Medicine and Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, 5 Jubilee Road, Parktown, Johannesburg, 2193, South Africa.
Insights
Human T-lymphotropic Virus type 1 (HTLV-1) co-infection with HIV-1 is often overlooked. Investigating HTLV-1 in HIV-1 positive individuals is crucial due to its potential to worsen HIV disease and cause adult T-cell lymphoma/leukemia.
Area of Science:
- Virology
- Immunology
- Oncology
Background:
- Human T-lymphotropic Virus type 1 (HTLV-1) and Human Immunodeficiency Virus type 1 (HIV-1) are human retroviruses that can co-infect individuals.
- HTLV-1 co-infection can accelerate HIV-1 disease progression and increase the risk of adult T-cell lymphoma/leukemia (ATLL).
- Despite these risks, HTLV-1 is infrequently investigated in HIV-1 positive patients.
Purpose of the Study:
- To highlight the clinical significance of HTLV-1 co-infection in individuals with HIV-1.
- To emphasize the diagnostic and therapeutic implications of considering HTLV-1 in the management of HIV-1 positive patients.
Main Methods:
- Literature review and synthesis of existing research on HTLV-1 and HIV-1 co-infection.
- Analysis of clinical presentations and outcomes associated with HTLV-1/HIV-1 co-infection.
Main Results:
- Severe hypercalcemia, often refractory to treatment, complicates up to 70% of ATLL cases.
- Both HTLV-1 and ATLL are linked to increased dysfunctional CD4 lymphocytes.
- This immune dysfunction can create a false impression of immune competence in co-infected individuals.
Conclusions:
- HTLV-1 co-infection poses significant risks for HIV-1 positive individuals, including accelerated disease and ATLL development.
- The immune dysregulation caused by HTLV-1/ATLL may mask the true extent of immune compromise in HIV-1 infection.
- Routine screening for HTLV-1 in HIV-1 positive populations should be considered to improve patient management and outcomes.
Abstract:
HIV and HTLV (Human T-ymphotropic Virus) are the only known retroviruses responsible for causing infection in humans. HTLV-1 and HIV-1 are frequent co-pathogens, however, despite its potential for accelerated progression of HIV disease and the risk of developing adult T-cell lymphoma/leukemia (ATLL), HTLV-1 is seldom considered for investigation in the HIV-1 positive individual. Severe/refractory hypercalcaemia, unresponsive to conventional calcium lowering therapy may complicate up to 70% of cases of ATLL. In addition, HTLV-1 and ATLL have both been associated with a rise in dysfunctional CD4 lymphocytes, thereby conveying a false sense of immune competence in the HIV-1 infected individual.
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