High Rate of Co-Infection with Human T-Cell Lymphotropic Virus-2 in Patients with HIV in the Peruvian Amazon

HTLV-1/2 coinfection in people with HIV (PWH) has been little studied in the Peruvian Amazon, an endemic area for both viruses. We aimed to estimate its prevalence and describe the main clinical and epidemiological features of co-infected individuals. We conducted a prospective, cross-sectional study (October–December 2023) at the Divi-sion of Infectious Diseases and Tropical Medicine from the Regional Hospital of Loreto, in Iquitos. We performed a screening test (recombinant HTLV I+II ELISA) and confirm the results with INNO-LIA. Among 293 PWH analyzed, 14 (4.1%) were HTLV positive: 1 was HTLV-1 (0.3%; 95% CI: 0.06-0.9), 11 were HTLV-2 (3.8%; 95% CI: 2.1-6.8) and 2 were non-typeable (0.7%; 95% CI: 0.1-2.7). Compared with HIV-monoinfected indi-viduals, coinfected patients were older (55 vs. 39 years; p=0.001) and more often had low education (35.7% vs. 15.4%; p=0.05). In conclusion, HIV–HTLV-2 coinfection is relatively common (~4%) in the Peruvian Amazon, particularly among older, ru-ral-born individuals, underscoring the need for targeted screening and prevention strategies in endemic areas.