Global epidemiology of HTLV-I infection and associated diseases.

Epidemiologic aspects of human T-lymphotropic virus type I (HTLV-I) infection have been thoroughly studied over the course of approximately 25 years since its first description. The geographic distribution of the virus has been defined, with Japan, Africa, Caribbean islands and South America emerging as the areas of highest prevalence. The reasons for HTLV-I clustering, such as the high ubiquity in southwestern Japan but low prevalence in neighboring regions of Korea, China and eastern Russia are still unknown. The major modes of transmission are well understood, although better quantitative data on the incidence of transmission, and on promoting/inhibiting factors, are needed. Epidemiologic proof has been obtained for HTLV-I's causative role in major disease associations: adult T-cell leukemia (ATL), HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP), HTLV-associated uveitis and infective dermatitis. However, more and better studies are needed for other apparent disease outcomes such as rheumatologic, psychiatric and infectious diseases. Since curative treatment of ATL and HAM/TSP is lacking and a vaccine is unavailable, the social and financial cost for the individual, his/her family and the health system is immense. For this reason, public health interventions aimed at counseling and educating high-risk individuals and populations are of paramount importance

Doença falciforme e qualidade de vida: um estudo da percepção subjetiva dos pacientes da Fundação Hemominas, Minas Gerais, Brasil Sickle cell disease and quality of life: a study on the subjective perception of patients from the Fundação Hemominas, Minas Gerais, Brazil

Na presente investigação, buscou-se pesquisar se o conceito de qualidade de vida, preconizado pela Organização Mundial de Saúde (OMS) poderia ser utilizado para pacientes com doença falciforme (DF), uma vez que se apresenta como um problema de saúde pública no país. Utilizou-se uma abordagem qualitativa com a seguinte questão norteadora na entrevista: "Para você o que é QV?". De acordo com o relato dos pacientes, procurou-se identificar a presença dos domínios físico, psicológico, nível de independência, relações sociais, meio ambiente e espiritualidade/crenças pessoais na representação da QV. Participaram do estudo 25 pacientes, dos quais 80% eram portadores da hemoglobina SS (HbSS) e 20% com hemoglobina SC (HbSC). A média da idade encontrada foi de 33,3 anos, 56% eram do sexo feminino e 44% eram casados(as). Em relação à escolaridade, 44% atingiram até 11 anos de estudo e 56% até 8 anos. A DF representou, para 72%, impedimento para o trabalho, o que revela seu impacto negativo no desenvolvimento das habilidades laborais. Todos os domínios de QV preconizados pela OMS foram detectados no relato dos participantes: domínio físico em 84%, psicológico e relações sociais em 76%, nível de independência em 60%, meio ambiente em 52% e espiritualidade/crenças pessoais em 4% deles. Os aspectos referentes à multidimensionalidade e à subjetividade, apresentados no conceito de QV preconizado pela OMS, e representados pelos seus domínios, podem ser tomados como norteadores de estudos que envolvam o conceito de QV em pacientes com DF.<br>This study aimed at investigating whether the concept of quality of life advocated by the World Health Organization can be applied to sickle cell patients, as this disease is an important public health problem in the country. A qualitative approach was utilized with the following guide question in the interview: "What is quality of life for you?" According to the patients' replies, the following domains were identified: physical, psychological, level of independence, social relationships, environment and spirituality/personal beliefs. Twenty-five patients took part in the study, 80% had hemoglobin SS and 20% hemoglobin SC. The average age was 33.3 years old, 56% of the patients were women and 44% were married. In relation to schooling, 12% had concluded the 4th grade of elementary school and 24% completed high school. Sickle cell disease represented a barrier in respect to work for 72% of the patients, which demonstrates its negative impact on the development of the work capabilities of the individuals. All quality of life domains advocated by the WHO were present in the patients' replies: physical domain in 84%, psychological and social relationships in 76%, level of independence in 60%, environment in 52% and spirituality/personal believes in 4%. To conclude, the aspects referring to multidimensionality and subjectivity, presented in the quality of life concept advocated by the WHO and represented by their domains, can be taken as a guide for studies which involve the quality of life in sickle cell patients

Erectile insufficiency as first symptom of HTLV-I/II associated myelopathy: case report Insuficiência erétil como primeiro sintoma da mielopatia associada ao HTLV I/II: relato de caso

A case of HTLV-I/II myelopathy in which the initial complaint was erectile insufficiency (EI) is reported. The only abnormalities found on the neurological exam were discrete weakness of the psoas and increased knee jerk reflexes. Diagnosis was made by demonstrating antibodies anti-HTLV I/II in the serum and cerebrospinal fluid (with the techniques of ELISA and Western blot), with confirmation by the polymerase chain reaction (PCR). EI can thus be the first symptom of HTLV-I/II infection and patients with EI of unknown etiology should be tested for HTLV-I/II in endemic areas.<br>É relatado um caso de mielopatia associada ao HTLV I/II cuja primeira manifestação foi insuficiência erétil (IE). O exame neurológico do paciente apresentava somente discreta fraqueza dos psoas e aumento dos reflexos patelares. O diagnóstico foi feito pelo achado de anticorpos anti-HTLV I/II no soro e no líquor (com as técnicas de ELISA e Western blot) e confirmado pela reação em cadeia da polimerase (PCR). Insuficiência erétil pode ser a primeira manifestação clínica de infecção pelo HTLV I/II e pacientes com IE de etiologia desconhecida devem ser testados para HTLV-I/II em áreas endêmicas

HTLV in the Americas: challenges and perspectives.

The first description of the human T-lymphotropic virus type 1 (HTLV-1) was made in 1980, followed closely by the discovery of HTLV-2, in 1982. Since then, the main characteristics of these viruses, commonly referred to as HTLV-1/2, have been thoroughly studied. Central and South America and the Caribbean are areas of high prevalence of HTLV-1 and HTVL-2 and have clusters of infected people. The major modes of transmission have been through sexual contact, blood, and mother to child via breast-feeding. HTLV-1 is associated with adult T-cell leukemia/lymphoma (ATL), HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP), and HTLV-associated uveitis as well as infectious dermatitis of children. More clarification is needed in the possible role of HTLV in rheumatologic, psychiatric, and infectious diseases. Since cures for ATL and HAM/TSP are lacking and no vaccine is available to prevent HTLV-1 and HTLV-2 transmission, these illnesses impose enormous social and financial costs on infected individuals, their families, and health care systems. For this reason, public health interventions aimed at counseling and educating high-risk individuals and populations are of vital importance. In the Americas this is especially important in the areas of high prevalence

Human T-Lymphotropic Virus Type 1 and Type 2 Seroprevalence, Incidence, and Residual Transfusion Risk Among Blood Donors in Brazil During 2007–2009

Human T-lymphotropic virus type 1/2 (HTLV-1/2) infection is endemic in Brazil but representative donor prevalence and incidence data are lacking. All blood donations (2007-2009) from three blood centers in Brazil were studied. Samples reactive on one HTLV screening test (EIA) were retested with a different EIA; dual EIA reactivity correlated strongly with a confirmatory Western blot. Prevalence, incidence, and residual transfusion risk were calculated. Among 281,760 first-time donors, 363 were positive for HTLV on both EIAs (135 per 10(5), 95% CI 122-150). Prevalence differed considerably by region, from 83 to 222 per 10(5). Overall incidence rate was 3.6/10(5) person-years and residual transfusion risk was 5.0/10(6) per blood unit transfused. The logistic regression model showed significant associations with: age [adjusted odds ratio (aOR)=5.23 for age 50+ vs. &lt;20], female sex (aOR=1.97), black (aOR=2.70 vs. white), and mixed skin colors (aOR=1.78 vs. white), and inversely with education (aOR=0.49, college vs. less than high school). HTLV testing with a dual-EIA strategy is feasible and can be useful in areas with low resources. Incidence and residual risk of HTLV-1 transmission by transfusion were relatively high and could be reduced by improving donor recruitment and selection in high prevalence areas. Blood center data may contribute to surveillance for HTLV infection

Human T-lymphotropic virus type 1 and type 2 seroprevalence, incidence, and residual transfusion risk among blood donors in Brazil during 2007-2009.

Human T-lymphotropic virus type 1/2 (HTLV-1/2) infection is endemic in Brazil but representative donor prevalence and incidence data are lacking. All blood donations (2007-2009) from three blood centers in Brazil were studied. Samples reactive on one HTLV screening test (EIA) were retested with a different EIA; dual EIA reactivity correlated strongly with a confirmatory Western blot. Prevalence, incidence, and residual transfusion risk were calculated. Among 281,760 first-time donors, 363 were positive for HTLV on both EIAs (135 per 10(5), 95% CI 122-150). Prevalence differed considerably by region, from 83 to 222 per 10(5). Overall incidence rate was 3.6/10(5) person-years and residual transfusion risk was 5.0/10(6) per blood unit transfused. The logistic regression model showed significant associations with: age [adjusted odds ratio (aOR)=5.23 for age 50+ vs. &lt;20], female sex (aOR=1.97), black (aOR=2.70 vs. white), and mixed skin colors (aOR=1.78 vs. white), and inversely with education (aOR=0.49, college vs. less than high school). HTLV testing with a dual-EIA strategy is feasible and can be useful in areas with low resources. Incidence and residual risk of HTLV-1 transmission by transfusion were relatively high and could be reduced by improving donor recruitment and selection in high prevalence areas. Blood center data may contribute to surveillance for HTLV infection