A polyclonal CD4+ and CD8+ lymphocytosis in a patient doubly infected with HTLV‐I and HIV‐1: A clinical and molecular analysis

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Abstract
HTLV‐I is associated with adult T‐cell leukemia/ lymphoma (ATL) characterized by monoclonal expansions of CD4+ T‐lymphocytes. In this report we describe a histologically benign, polyclonal HTLV‐I infection in a patient exhibiting both an absolute CD4+ and CD8+ lymphocytosis. Three T‐cell lines containing integrated HTLV‐I proviral copies established from this patient were initially polyclonal, but with time all grew out the same two clones as determined by analysis of their T‐cell antigen receptor beta chain gene rearrangements. The patient subsequently developed pulmonary and nasopharyngeal nodules containing HTLV‐I infected cells. Restriction analysis of the patient's HTLV‐I provirus revealed no differences from prototype HTLV‐I and the tax gene was normally expressed in vivo and in vitro. The patient's T‐lymphocytosis and HTLV‐I+ pulmonary tract nodules were put into a complete clinical remission by treatment with alkylating agents and steroids. Subsequently, the patient developed a severe immunodeficiency state and expired. Retrospective serologic and gene amplification assays for HIV‐1 demonstrated that he had been doubly infected from the time of presentation. Postmortem analysis by polymerase chain reaction revealed the presence of both HTLV‐I and HIV‐1 in lymphatic tissues and the testes; HIV‐1 was also detected in brain tissue.