CD4 and tropical spastic paraparesis: These interactions may influence HIV progression and outcomes, underscoring the importance of HTLV testing in HIV-positive patients—particularly those with compatible ethnic backgrounds and unexpectedly high CD4 counts—and the need for vigilance regarding HTLV-associated conditions such as HAM/TSP, adult T-cell leukemia/lymphoma, and Strongyloides hyperinfection [10,11].