Does Human T-Cell Lymphotropic Virus Type I and Human Immunodeficiency Virus Type 1 Coinfection Accelerate Acquired Immunodeficiency Syndrome?

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Abstract
In this issue of the Archives, Gotuzzo et al1 provide evidence that human immunodeficiency virus type 1 (HIV-1) and human T-cell lymphotropic virus type I (HTLV-I) coinfection is associated with a more severe clinical course with shortened survival for acquired immunodeficiency syndrome (AIDS). The teleological attraction of epidemiologic findings such as this, as with prior population studies of coinfected persons,2-4 is that in vitro molecular and biochemical studies suggest that other viruses can enhance the replication and expression of HIV-1. Viruses for which this effect has been demonstrated include HTLV-I,5 HTLV type II (HTLV-II),6 cytomegalovirus,7 human herpes virus type 6,8 herpes simplex virus,9 and Epstein-Barr virus.10 For example, the envelope peptides of both HTLV-I and HTLV-II have been reported to activate T cells, resulting in enhanced HIV-1 expression.6 In addition, the tax gene product of HTLV-I (the regulatory element of HTLV-I