Socio-Demographic, Clinical, and Mortality Differences between HIV-Infected and HIV/HTLV-1 Co-Infected Patients in Peru
Background and aims: In Peru, the estimated prevalence of human immunodeficiency virus (HIV) and human T-lymphotropic virus-1 (HTLV-1) co-infection has been reported to be as high as 18%. Despite the endemicity of HTLV-1 in Peru, few studies have assessed the impact of HIV/HTLV-1 co-infection. Our s...
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MDPI AG
2023-06-01
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| Series: | Pathogens |
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| Online Access: | https://www.mdpi.com/2076-0817/12/7/869 |
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| author | Maria Pia Amanzo-Vargas Tessy Arellano-Veintemilla Elsa González-Lagos Juan Echevarría Fernando Mejía Ana Graña Eduardo Gotuzzo |
| author_facet | Maria Pia Amanzo-Vargas Tessy Arellano-Veintemilla Elsa González-Lagos Juan Echevarría Fernando Mejía Ana Graña Eduardo Gotuzzo |
| author_sort | Maria Pia Amanzo-Vargas |
| collection | DOAJ |
| description | Background and aims: In Peru, the estimated prevalence of human immunodeficiency virus (HIV) and human T-lymphotropic virus-1 (HTLV-1) co-infection has been reported to be as high as 18%. Despite the endemicity of HTLV-1 in Peru, few studies have assessed the impact of HIV/HTLV-1 co-infection. Our study compared socio-demographic and clinical characteristics, and mortality rates between HIV-infected and HIV/HTLV-1 co-infected patients. Methods: We reviewed the medical records of patients aged 18 years and older belonging to the HIV and HTLV-1 cohorts in Lima during a 30-year period: 1989–2019. Each HIV/HTLV-1 co-infected patient was randomly matched with two HIV-infected patients with similar characteristics (same sex, age ± 5 years, and same year of HIV diagnosis). Allegedly co-infected patients without a confirmatory diagnosis of HIV and HTLV-1 were excluded. Most of the patients in the HIV-infected group did not have a negative test result for HTLV-1 infection, so we used two probabilistic sensitivity analysis models to correct for potential HTLV-1 exposure misclassification bias in the group of HIV-infected patients. Results: Of 162 patients enrolled, 54 were HIV/HTLV-1 co-infected and 108 were HIV-infected. The median age was 42 years (IQR = 34–51 years) and the majority were male (61.1%), single (44.4%), heterosexual (71%), born in Lima (58%), educated at the secondary school level (55.6%), and receiving antiretroviral treatment (91.4%). HIV/HTLV-1 co-infection was associated with an increased risk of death (HR: 11.8; 95% CI: 1.55–89.00; <i>p</i> = 0.017) while antiretroviral treatment was associated with a decreased risk of death (HR: 0.03; 95% CI: 0.003–0.25; <i>p</i> = 0.001). The overall mortality rate was 13.6 per 100 persons and the survival time for co-infected patients (median = 14.19 years) was significantly shorter than that of HIV-infected patients (median = 23.83 years) (<i>p</i> < 0.001). Conclusions: HIV/HTLV-1 co-infected patients had a significantly shorter survival time compared to HIV-infected patients, suggesting that the immune alterations caused by HTLV-1 in CD4 cell count may have contributed to late initiation of antiretroviral treatment and prophylaxis against opportunistic infections over the decades, and thus reducing their benefits in these patients. |
| first_indexed | 2024-03-11T00:45:29Z |
| format | Article |
| id | doaj.art-eabd834f81334f28b4db9e104f1daa3d |
| institution | Directory Open Access Journal |
| issn | 2076-0817 |
| language | English |
| last_indexed | 2024-03-11T00:45:29Z |
| publishDate | 2023-06-01 |
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| spelling | doaj.art-eabd834f81334f28b4db9e104f1daa3d2023-11-18T20:50:08ZengMDPI AGPathogens2076-08172023-06-0112786910.3390/pathogens12070869Socio-Demographic, Clinical, and Mortality Differences between HIV-Infected and HIV/HTLV-1 Co-Infected Patients in PeruMaria Pia Amanzo-Vargas0Tessy Arellano-Veintemilla1Elsa González-Lagos2Juan Echevarría3Fernando Mejía4Ana Graña5Eduardo Gotuzzo6Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima 15102, PeruFacultad de Medicina, Universidad Peruana Cayetano Heredia, Lima 15102, PeruFacultad de Medicina, Universidad Peruana Cayetano Heredia, Lima 15102, PeruFacultad de Medicina, Universidad Peruana Cayetano Heredia, Lima 15102, PeruFacultad de Medicina, Universidad Peruana Cayetano Heredia, Lima 15102, PeruInstituto de Medicina Tropical “Alexander von Humboldt”, Universidad Peruana Cayetano Heredia, Lima 15102, PeruFacultad de Medicina, Universidad Peruana Cayetano Heredia, Lima 15102, PeruBackground and aims: In Peru, the estimated prevalence of human immunodeficiency virus (HIV) and human T-lymphotropic virus-1 (HTLV-1) co-infection has been reported to be as high as 18%. Despite the endemicity of HTLV-1 in Peru, few studies have assessed the impact of HIV/HTLV-1 co-infection. Our study compared socio-demographic and clinical characteristics, and mortality rates between HIV-infected and HIV/HTLV-1 co-infected patients. Methods: We reviewed the medical records of patients aged 18 years and older belonging to the HIV and HTLV-1 cohorts in Lima during a 30-year period: 1989–2019. Each HIV/HTLV-1 co-infected patient was randomly matched with two HIV-infected patients with similar characteristics (same sex, age ± 5 years, and same year of HIV diagnosis). Allegedly co-infected patients without a confirmatory diagnosis of HIV and HTLV-1 were excluded. Most of the patients in the HIV-infected group did not have a negative test result for HTLV-1 infection, so we used two probabilistic sensitivity analysis models to correct for potential HTLV-1 exposure misclassification bias in the group of HIV-infected patients. Results: Of 162 patients enrolled, 54 were HIV/HTLV-1 co-infected and 108 were HIV-infected. The median age was 42 years (IQR = 34–51 years) and the majority were male (61.1%), single (44.4%), heterosexual (71%), born in Lima (58%), educated at the secondary school level (55.6%), and receiving antiretroviral treatment (91.4%). HIV/HTLV-1 co-infection was associated with an increased risk of death (HR: 11.8; 95% CI: 1.55–89.00; <i>p</i> = 0.017) while antiretroviral treatment was associated with a decreased risk of death (HR: 0.03; 95% CI: 0.003–0.25; <i>p</i> = 0.001). The overall mortality rate was 13.6 per 100 persons and the survival time for co-infected patients (median = 14.19 years) was significantly shorter than that of HIV-infected patients (median = 23.83 years) (<i>p</i> < 0.001). Conclusions: HIV/HTLV-1 co-infected patients had a significantly shorter survival time compared to HIV-infected patients, suggesting that the immune alterations caused by HTLV-1 in CD4 cell count may have contributed to late initiation of antiretroviral treatment and prophylaxis against opportunistic infections over the decades, and thus reducing their benefits in these patients.https://www.mdpi.com/2076-0817/12/7/869HIVHTLV-1co-infectionmortalitysurvivalantiretroviral therapy |
| spellingShingle | Maria Pia Amanzo-Vargas Tessy Arellano-Veintemilla Elsa González-Lagos Juan Echevarría Fernando Mejía Ana Graña Eduardo Gotuzzo Socio-Demographic, Clinical, and Mortality Differences between HIV-Infected and HIV/HTLV-1 Co-Infected Patients in Peru Pathogens HIV HTLV-1 co-infection mortality survival antiretroviral therapy |
| title | Socio-Demographic, Clinical, and Mortality Differences between HIV-Infected and HIV/HTLV-1 Co-Infected Patients in Peru |
| title_full | Socio-Demographic, Clinical, and Mortality Differences between HIV-Infected and HIV/HTLV-1 Co-Infected Patients in Peru |
| title_fullStr | Socio-Demographic, Clinical, and Mortality Differences between HIV-Infected and HIV/HTLV-1 Co-Infected Patients in Peru |
| title_full_unstemmed | Socio-Demographic, Clinical, and Mortality Differences between HIV-Infected and HIV/HTLV-1 Co-Infected Patients in Peru |
| title_short | Socio-Demographic, Clinical, and Mortality Differences between HIV-Infected and HIV/HTLV-1 Co-Infected Patients in Peru |
| title_sort | socio demographic clinical and mortality differences between hiv infected and hiv htlv 1 co infected patients in peru |
| topic | HIV HTLV-1 co-infection mortality survival antiretroviral therapy |
| url | https://www.mdpi.com/2076-0817/12/7/869 |
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