OBJECTIVE: To follow prospectively the clinical course of patients dually infected with HIV-1 and HTLV-I or HTLV-II. METHODS: Seven patients have been identified who are dually infected with HIV-1 and HTLV-I/II. HTLV-I and HTLV-II were distinguished using a Coulter System recombinant ELISA. Physical examination, complete blood counts, T cell counts and HTLV-I/II virus isolation studies were done every 4 months. Quantitative HIV-1 DNA PCR was performed on the peripheral blood mononuclear cells (PBMNCS) using SK 38/39 primers. RESULTS: There are four males co-infected with HIV-1 and HTLV-I. None have developed AIDS, but two of these patients have tropical spastic paraparesis as well as polymyositis. These two patients have high CD4 counts. Cultures established from the PBMNCS of these two patients express HTLV-I antigens. A transformed lymphoid cell line obtained from one of these patients produces mature virions. There are three patients co-infected with HIV-1 and HTLV-II; one of these patients developed AIDS and died, while the remaining two have CD4 counts < 500 but do not have AIDS. Quantitative PCR on these seven patients reveals approximately one copy of proviral DNA per 25,000 PBMNCS. CONCLUSION: (1) HTLV-I, but not HTLV-II, co-infection with HIV-1 seems to be associated with normalization or even elevation of CD4 counts (2) Two patients with HIV/HTLV-I have tropical spastic paraparesis, polymyositis and positive lymphocyte cultures for HTLV-I, suggesting that HIV-1 is permissive for expression of HTLV-I-associated disease.

*HIV Infections/COMPLICATIONS *HIV-1/GENETICS *HIV-1/ISOLATION & PURIF *HTLV-I Infections/COMPLICATIONS *HTLV-II Infections/COMPLICATIONS

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