The influence of human T lymphotropic virus type I infection on the outcome of cardiovascular surgery

Objective: Human T lymphotropic virus type I infects CD4(+) T cells and aff ects cell-mediated immunity. Cardiopulmonary bypass transiently alters lymp hocyte subsets, resulting in a reduction in CD4(+) T cells and an increase in CD8(+) T cells. We proposed that cardiovascular operations and human T l ymphotropic virus type I infection may act synergistically, resulting in se rious damage to cell-mediated immunity. Methods: A total of 517 consecutive patients who were preoperatively screen ed for anti-human T lymphotropic virus type I antibody and underwent cardio vascular operations with cardiopulmonary bypass were enrolled in this study . Of the 517 patients, 82 (16%) had positive test results for antihuman T l ymphotropic virus type I antibody. The surgical outcome of patients with po sitive and negative results for anti-human T lymphotropic virus type I anti body was analyzed retrospectively. Results: There was no difference between the 2 groups with respect to early mortality. Distribution of survival curve was also not significantly diffe rent (P =.5; mean follow-up duration, 2.4 +/- 1.8 years [range, 0-9.4 years ] and 3.2 rt 2.8 years [range, 0-9.8 years]) in the groups with positive an d negative antibody results, respectively). In particular, long-term follow -up did not reveal adult T-cell leukemia or human T lymphotropic virus type I-associated myelopathy, and occurrence of neoplasm did not differ between groups. Early infectious complication was, however, significantly higher i n the group with positive antibody results than in the group with negative results (P =.02). Logistic regression analysis revealed human T lymphotropi c virus type I infection as a significant risk for this complication (P =.0 4; odds ratio, 2.5; 95% confidence interval, 1.0-5.8). Conclusion: A combination of human T lymphotropic virus type I infection an d cardiovascular operation is believed to increase the potential risk of in fectious complications shortly after the operation. However, this synergist ic effect seems to be transient and has little influence on long-term progn osis.