HIV-HTLV-1 coinfection is associated with higher rates of mother-to-child-transmission, and a shorter survival time in children in Bahia, Brazil
C. Pedroso1, N. Weyll2, C. Brites1
1Federal University of Bahia, Virology Research Laboratory, Salvador, Brazil, 2CEDAP, Salvador, Brazil
Background: HIV-HTLV-1 coinfection has been associated with shorten survival time, in adults, but this question is still controversial. There is no published data on clinical characteristics and impact of coinfection in children.
Methods: We reviewed all cases of coinfected children diagnosed in the AIDS Clinic of Federal University of Bahia Hospital, from 1992 to 2008, in Salvador, Brazil. Vertical transmission, mean CD4+ cells count, and mortality rate/survival time were calculated.
Results: A total of 96 children were born from 95 HIV-HTLV coinfected mothers. In 12 already dead mothers HTLV serology was not performed, but their children had no other identifiable source of infection. We detected a significantly higher transmission rate (37/96, 38,5%) of coinfection, compared to that observed for HIV-1 (12/96, 12,5%) or HTLV-1 alone (9/96, 9,3%, OR=13,02, 95% CI: 4,46 - 39,46, P< 0,00001). Taken together, the overall vertical transmission rate was alarmingly high (60,3%). Surprisingly, the frequency of breastfeeding was significantly lower for coinfected (58%), than for HIV-1 singly-infected children (85%, p=0.02, Fisher exact test). Mean initial CD4+ cells count was higher (1502 ± 618 cells/mm3) for coinfected than for singly-infected children (810 ± 532 cels/mm3, p< 0,001). Mortality rate was also higher for coinfected (36%) compared with singly-infected (6%) children (OR=3,6, IC 95%: 1,02 - 12,92, p=0,005, Fisher exact test), while survival time was shorter (9,5 ± 3,1 vs. 12,1± 4,5 years, for coinfected and singly-infected, repectively, p=0,01). Initial mean CD4+ cells count did not differ for those that died compared with survivors.
Conclusions: HIV and HTLV vertical transmission was enhanced when these agents coinfect pregnant women. Children coinfected by HIV and HTLV have higher CD4+ cells count / higher mortality rate. The shorter survival time for coinfected children may be due to a delay in starting antiretroviral therapy, in consequence of higher CD4+ cells count.
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