High Prevalence of Skin Disorders among HTLV-1\ud Infected Individuals Independent of Clinical Status

Background\ud Human T-cell lymphotropic virus type 1 (HTLV-1) infection can increase the risk of developing skin disorders. This study evaluated the correlation between HTLV-1 proviral load and CD4+ and CD8+ T cells count among HTLV-1 infected individuals, with or without skin disorders (SD) associated with HTLV-1 infection [SD-HTLV-1: xerosis/ichthyosis, seborrheic dermatitis or infective dermatitis associated to HTLV-1 (IDH)].\ud \ud Methods\ud A total of 193 HTLV-1-infected subjects underwent an interview, dermatological examination, initial HTLV-1 proviral load assay, CD4+ and CD8+ T cells count, and lymphproliferation assay (LPA).\ud \ud Results\ud A total of 147 patients had an abnormal skin condition; 116 (79%) of them also had SD-HTLV-1 and 21% had other dermatological diagnoses. The most prevalent SD-HTLV-1 was xerosis/acquired ichthyosis (48%), followed by seborrheic dermatitis (28%). Patients with SD-HTLV-1 were older (51 vs. 47 years), had a higher prevalence of myelopathy/tropical spastic paraparesis (HAM/TSP) (75%), and had an increased first HTLV-1 proviral load and basal LPA compared with patients without SD-HTLV-1. When excluding HAM/TSP patients, the first HTLV-1 proviral load of SD-HTLV-1 individuals remains higher than no SD-HTLV-1 patients.\ud \ud Conclusions\ud There was a high prevalence of skin disorders (76%) among HTLV-1-infected individuals, regardless of clinical status, and 60% of these diseases are considered skin disease associated with HTLV-1 infection.This work was partly supported by Fundac¸a˜o de Amparo a` Pesquisa o Estado de Sa˜o Paulo (FAPESP), Grant 2008/56427-4. JC is senior researcher from the National Research Council of Brazil. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Contagens de células T CD4+ na co-infecção HIV-1 e HTLV-1: alta prevalência da paraparesia espástica tropical/mielopatia associada ao HTLV-1

INTRODUCTION: HIV positive patients co-infected with HTLV-1 may have an increase in their T CD4+ cell counts, thus rendering this parameter useless as an AIDS-defining event. OBJECTIVE: To study the effects induced by the co-infection of HIV-1 and HTLV-1 upon CD4+ cells. MATERIAL AND METHODS: Since 1997, our group has been following a cohort of HTLV-1-infected patients, in order to study the interaction of HTLV-1 with HIV and/or with hepatitis C virus (HCV), as well as HTLV-1-only infected asymptomatic carriers and those with tropical spastic paraparesis/HTLV-1 associated myelopathy (TSP/HAM). One hundred and fifty HTLV-1-infected subjects have been referred to our clinic at the Institute of Infectious Diseases "Emílio Ribas", São Paulo. Twenty-seven of them were also infected with HIV-1 and HTLV-1-infection using two ELISAs and confirmed and typed by Western Blot (WB) or polymerase chain reaction (PCR). All subjects were evaluated by two neurologists, blinded to the patient's HTLV status, and the TSP/HAM diagnostic was based on the World Health Organization (WHO) classification. AIDS-defining events were in accordance with the Centers for Disease Control (CDC) classification of 1988. The first T CD4+ cells count available before starting anti-retroviral therapy are shown compared to the HIV-1-infected subjects at the moment of AIDS defining event. RESULTS: A total of 27 HIV-1/HTLV-1 co-infected subjects were identified in this cohort; 15 already had AIDS and 12 remained free of AIDS. The median of T CD4+ cell counts was 189 (98-688) cells/mm³ and 89 (53-196) cells/mm³ for co-infected subjects who had an AIDS-defining event, and HIV-only infected individuals, respectively (p = 0.036). Eight of 27 co-infected subjects (30%) were diagnosed as having a TSP/HAM simile diagnosis, and three of them had opportunistic infections but high T CD4+ cell counts at the time of their AIDS- defining event. DISCUSSION: Our results indicate that higher T CD4+ cells count among HIV-1/HTLV-1-coinfected subjects was found in 12% of the patients who presented an AIDS-defining event. These subjects also showed a TSP/HAM simile picture when it was the first manifestation of disease; this incidence is 20 times higher than that for HTLV-1-only infected subjects in endemic areas.INTRODUÇÃO: A possibilidade que a co-infecção pelo vírus da leucemia de células T humana do tipo 1 (HTLV-1) em indivíduos infectados pelo vírus da imunodeficiência humana do tipo 1 poderia falsamente elevar o número de linfócitos T CD4+ no momento do evento definidor de aids, inferindo que essa contagem poderia ser um marcador laboratorial incompleto nos pacientes com a co-infecção HIV-1/HTLV-1. OBJETIVO: Estudar a interação entre o HIV-1 e a co-infecção como o HTLV-1. MATERIAL E MÉTODO: Desde 1997, nosso grupo tem seguido uma coorte de pacientes para estudar a interação entre HIV e/ou vírus da hepatite C (HCV), como também pacientes assintomáticos ou com TSP/HAM. 150 pacientes infectados pelo HTLV-1, encaminhados à clínica de HTLV do Instituto de Infectologia Emilio Ribas, São Paulo, Brasil, foram estudados. Vinte e sete deles estavam co-infectados pelo HIV-1 e HTLV-1, usando dois ELISAs e confirmados tipados pelo WB ou PCR. Todos os pacientes foram avaliados por dois neurologistas, cegos para o status de HTLV e o diagnóstico de TSP/HAM foi baseado na classificação da Organização Mundial de Saúde, 1988. A primeira contagem de células T disponível antes da terapia anti-retroviral foi mostrada para comparar com os pacientes infectados pelo HIV no momento do evento definidor de aids de acordo com Classificação do Centro de controle de Doenças, 1988. RESULTADOS: Um total de 27 HIV-1/HTLV-1 co-infectados foram identificados na coorte, 15 já apresentavam aids e 12 permaneceram sem evento de aids. A mediana de células T CD4 foi de 189 (98-688) células/mm³ e 89 (53-196) células/mm³ nos co-infectados que tinham evento definidor de aids e naqueles com a infecção somente pelo HIV, respectivamente (p = 0,036). Oito dos 27 co-infectados (30%) foram diagnosticados tendo TSP/HAM símile, e três deles mostraram elevada contagem de células T CD4 e apresentaram infecções oportunistas no momento do evento definidor de aids. DISCUSSÃO: Nossos resultados indicam que a contagem de células T CD4+ entre os indivíduos com HIV-1/HTLV-1 foi somente discrepante em 12% desses pacientes e podem ser relacionados à progressão da infecção HTLV-1, e todos mostraram um quadro de TSP/HAM símile como a primeira manifestação de doença. Entretanto, essa taxa de ataque foi 20 vezes mais alta que a observada em pacientes somente infectados pelo HTLV-1 em área endêmica

Prevalence of anxiety, depression and quality of life in HTLV-1 infected patients

The HAM/TSP caused by HTLV-1 infection usually affects patients to disabling states, and\ud sometimes can lead them to paraplegia presenting symptoms of depression and anxiety, impacting\ud on quality of life. Objective: The purpose of this study was to evaluate the frequency of\ud depression and anxiety and its impact on quality of life in HTLV-1-infected TSP/HAM patients.\ud Material and Methods: This was a cross-sectional study including 67 asymptomatic (control group)\ud and 63 with TSP/HAM subjects. The instruments used were a demographic questionnaire, scales\ud for anxiety and depression diagnosis (BDI and BAI), questionnaire for the assessment of Quality\ud of Life of the World Health Organization (WHOQOL-Brief) and neurological scale to measure the\ud disability level (Osame’s Disability Status Scale). All patients had HTLV-I diagnosis by serological\ud and molecular approaches, monitored at Instituto de Infectologia Emílio Ribas from May 2008 to\ud July 2009. Data were analyzed statistically by frequencies, the Mann-Whitney test and the Spearman\ud correlation test. Data among groups were analyzed and correlated with functional and severity aspects.\ud Results: The results showed that patients with HAM/TSP compared to asymptomatic carriers\ud had higher rates of depression (p < 0.001) and anxiety (p < 0.001), and impairment on quality of\ud life in the areas of: dissatisfaction with health (p < 0.001), physical (p < 0.001) and the environment\ud (p = 0.003). The main factors that correlated with levels of depression and anxiety and the domains of\ud the WHOQOL-brief were: education, family income and social class. Conclusion: A well conducted\ud evaluation and counseling may help in treatment, for a better quality of life of these patients.Financial Support: FAPESP e Coordenadoria de Controle de Doenças CCD/SES-SP

Differences in prefrontal cortex activation and deactivation during strategic episodic verbal memory encoding in mild cognitive impairment

In this study we examined differences in fMRI activation and deactivation patterns during episodic verbal memory encoding between individuals with MCI (n = 18) and healthy controls (HCs) (n = 17). Participants were scanned in two different sessions during the application of self-initiated or directed instructions to apply semantic strategies at encoding of word lists. MCI participants showed reduced free recall scores when using self-initiated encoding strategies that were increased to baseline controls\u27 level after directed instructions were provided. During directed strategic encoding, greater recruitment of frontoparietal regions was observed in both MCI and control groups; group differences between sessions were observed in the ventromedial prefrontal cortex and the right superior frontal gyrus. This study provides evidence suggesting that differences of activity in these regions may be related to encoding deficits in MCI, possibly mediating executive functions during task performance

Small cells lung epidermoid carcinoma in a HTLV1-infected patient: case report and literature review

The human T cell lymphotropic virus type 1 (HTLV-1) is the first human retrovirus discovered. Since then, it has spread worldwide and is mainly associated with adult T cell leukemia/lymphoma (ATLL) and HTLV1-associated myelopathy (HAM). Its relationship, however, with other types of cancer is controversial. We describe the case of a patient presenting with small cells lung epidermoid carcinoma who had recently developed HAM, and a review of the literature related to these conditions. This is the first case of this type of lung cancer, the same of the first description in the literature, associated with HAM outside Japan

Desempenho de uma população brasileira no teste de alfabetização funcional para adultos na área de saúde

OBJECTIVE: To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS: The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS: The mean age of the sample was 47.3 years(sd=16.8) and the mean education was 9.7 years(sd=5; range: 1 - 17). A total of 32.4% of the sample showed literacy/numeracy deficits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; pOBJETIVO: Analizar los escores de instrumento que evalúa habilidad de lectura y comprensión de materiales del área de salud según escolaridad y edad. MÉTODOS: Fueron evaluados 312 participantes saludables de diferentes edades por medio de la versión reducida del instrumento Test of Functional Health Literacy in Adults. El estudio fue realizado entre 2006 y 2007 en la ciudad de Sao Paulo (Sureste de Brasil). El instrumento incluye materiales como frascos de medicamentos y cartones de para marcar consultas, evaluando la comprensión de lectura y de conceptos numéricos. Las pruebas de correlación parcial y de Pearson y un modelo de regresión múltiple fueron usados para verificar la asociación entre los escores en el instrumento, escolaridad y edad. RESULTADOS: Los promedios de edad y de escolaridad de la muestra fueron respectivamente 47,3 (dp=16,8) y 9,7 (dp=5; de uno a 17 años de estudio). El total de 32,4% de la muestra mostraron déficit de alfabetización funcional/uso de conceptos numéricos en el área de salud, con desempeño inadecuado o limítrofe en el instrumento. Entre ancianos (65 años o más) esta tasa afectó 51,6%. Se encontró correlación positiva entre años de estudio y escores en el instrumento (r=0,740; p< 0,01) y correlación negativa entre edad y escores en el instrumento (r=-0,259; p< 0,01).La correlación entre escores en el instrumento y edad no fue significativa cuando los efectos de la escolaridad fueron controlados (r=-0,031, p=0,584). Una asociación significativa (B=3,877, Beta=0,733; p< 0,001) fue encontrada entre años de estudio y escores en el instrumento. La edad no fue una variable predictiva en el modelo (B=-0,035, Beta=-0,22; p=0,584). CONCLUSIONES: El instrumento es adecuado para evaluar la alfabetización funcional en salud en la población brasilera. El elevado número de individuos clasificados como analfabetos funcionales indica la importancia de adopción de medidas especiales para ayudar estos individuos a comprender correctamente las orientaciones para cuidados de salud.OBJETIVO: Analisar os escores de instrumento que avalia habilidade de leitura e compreensão de materiais da área da saúde segundo escolaridade e idade. MÉTODOS: Foram avaliados 312 participantes saudáveis de diferentes idades por meio da versão reduzida do instrumento Test of Functional Health Literacy in Adults. O estudo foi realizado entre 2006 e 2007 na cidade de São Paulo (SP). O instrumento envolve materiais como frascos de medicamentos e cartões de agendamento de consultas, avaliando a compreensão de leitura e de conceitos numéricos. Os testes de correlação parcial e de Pearson e um modelo de regressão múltipla foram usados para verificar a associação entre os escores no instrumento, escolaridade e idade. RESULTADOS: As médias de idade e de escolaridade da amostra foram respectivamente 47,3 (dp=16,8 ) e 9,7 (dp=5; de um a 17 anos de estudo). O total de 32,4% da amostra mostraram déficits de alfabetização funcional/ uso de conceitos numéricos na área de saúde, com desempenho inadequado ou limítrofe no instrumento. Entre idosos (65 anos ou mais) esta taxa atingiu 51,6%. Encontrou-se correlação positiva entre anos de estudo e escores no instrumento (r=0,740;