Abstract:
BACKGROUND. HTLV-1 associated myelopathy (HAM), or tropical spastic paraparesis, is caused by a retrovirus, the human T-cell
lymphotropic virus (HTLV). Although patients with HAM and HIV infection have been described, to our knowledge no direct comparison
has been made between patients who are HIV positive and suffering from HAM (HHAM) v. those who are HIV negative and suffering
from HAM.
AIM. We aimed to compare clinical and radiological findings in HIV-positive and -negative patients with HAM.
METHODS. Adult patients who presented to the Neurology Unit at the Steve Biko Academic Hospital from May 2005 to June 2012 with a
progressive myelopathy and HTLV seropositivity were retrospectively identified and their clinical and radiological data were collected and
reviewed.
RESULTS. 21 patients with HAM were identified, of whom 9 were HIV-positive and 11 HIV-negative. One patient, whose HIV status had
not been established, was not included in the study. Although the trend did not reach statistical significance, co-infected patients tended to
present at an earlier age (HHAM 6/9 (66%) <40 years old; HAM 2/11 (18%) <40 years old) and presented to hospital earlier (HHAM 6/9
(66%) < 3 years symptomatic; HAM 7/11 (63%) > 3 years symptomatic). Cord atrophy occurred in 7/8 dually infected patients and 8/10
HIV-negative patients.
CONCLUSION. Although the study is limited by the small number of patients, co-infected patients tended to have a younger age of onset and
to present to hospital sooner, and thoracic cord atrophy was very common.
