Treatment of strongyloidiasis in HTLV-1 and Strongyloides stercoralis coinfected patients is associated with increased TNFα and decreased soluble IL2 receptor levels

Abstract

Background: Human T cell lymphotropic virus type 1 (HTLV-1) infection has been associated with recurrent and disseminated strongyloidiasis and adult T cell leukemia/lymphoma (ATLL).

Methods: We compared immunological aspects and markers for ATLL in HTLV-1 patients with or without strongyloidiasis, and evaluated the influence of Strongyloides stercoralis treatment on the immune response and clinical outcomes of HTLV-1 infection.

Results: Levels of TNFα and IFNγ were lower in patients coinfected with HTLV-1 and S. stercoralis than in patients with HTLV-1 only (p < 0.05), and there was an increase in TNFα levels after anthelmintic treatment. Levels of sIL-2R were higher in patients with HTLV-1 coinfected with S. stercoralis and anthelmintic treatment decreased sIL-2R levels (p < 0.05). The one patient who developed ATLL was coinfected with S. stercoralis.

Conclusion: These data show that helminthic infection has a modulatory role in HTLV-1 infection and that S. stercoralis may be a cofactor in the development of ATLL.

Keywords: ATLL; HTLV-1; Interleukin-2 receptor; Leukemia; Strongyloides stercoralis; sIL-2R.

Figure 1.

Cytokine profile and sIL-2R levels in patients with human T cell lymphotropic virus type 1 (HTLV-1) with or without strongyloidiasis before and after treatment for strongyloidiasis. (A) The levels (median; range) of IFNγ and TNFα were higher in the 60 HTLV-1 patients without strongyloidiasis (1144 pg/ml; 0–6025 pg/ml and 485 pg/ml; 0–4686 pg/ml, respectively) than in the 26 HTLV-1 patients with strongyloidiasis (744 pg/ml; 0–4538 pg/ml and 113 pg/ml; 0–1157 pg/ml, respectively) (p < 0.05; Mann-Whitney U test). (B) There was an increase in TNFα levels after strongyloidiasis treatment (885 pg/ml; 0–1642 pg/ml) compared with levels before treatment (109 pg/ml; 0–4145 pg/ml) (p < 0.05; Wilcoxon Signed-Rank Test). (C) The levels of sIL-2R in the serum of 22 patients with HTLV-1 and strongyloidiasis (1255 pg/ml; 0–2483 pg/ml) were higher than in the 55 patients with HTLV-1 without strongyloidiasis (452 pg/ml; 0–2094 pg/ml) (p < 0.05; Mann-Whitney U test). (D) Higher levels of sIL-2R were noted before anthelmintic treatment (1532 pg/ml; 0–2438 pg/ml) than after it (527 pg/ml; 0–3419) (p < 0.05; Wilcoxon Signed-Rank test).