AbstractObjective: A prospective study was conducted to determine the prevalence of human T-cell lymphotropic virus type I (HTLV-I) infection among healthy Japanese migrants and their descendents in Peru.Methods: A total of 407 persons were enrolled at the Peruvian-Japanese Medical Center in Lima during routine visits for health evaluations. Each study volunteer was interviewed to obtain clinical and epidemiologic data, and a blood sample was obtained for HTLV-I testing. Sera samples were initially tested for antibody by enzyme-linked immunosorbent assay (ELISA). All ELISA reactive sera were further tested by Western Blot assay, and the results were recorded in accordance with the manufacturer's recommendations.Results: Among the 407 study volunteers, HTLV-I infection was demonstrated in 6.8% (19280) of females and 3.2% (4127) of males. Infection rates significantly increased with age, with 28.5% of volunteers over 80 years of age being positive (P < 0.05). The migrants from Japan had the highest infection rate (15.8%), whereas none of the second generation volunteers were positive (P < 0.05). The incidence among those with ancestors from Okinawa was 9.3%, and for those with ancestors from the central zone of Japan, 1.2% (P < 0.05).Conclusions: These data indicated that HTLV-I infection rates were highest among the older volunteers from Okinawa and Kyushu, and that evidence of infection was not found among their offspring

Chauca, Gloria

Gotuzzo, Eduardo

Kanna, Manuel

Watts, Douglas M.

Yamamoto, Victor

International Journal of Infectious Diseases

Elsevier - Publisher Connector 

Human T-cell lymphotropic virus type I infection among Japanese immigrants in Peru 

Original Report 
Human T-Cell Lymphotropic Virus Tfrpe I 
Infection among Japanese Immigrants in Peru 
Eduardo Gotuzzo, MD;* Victor Yamamoto, MD;+ Manuel Kanna, MD;+ Gloria Chauca, BSc;* 
and Douglas M. Watts, PhDS 
ABSTRACT 
Objective: A prospective study was conducted to determine the 
prevalence of human T-cell lymphotropic virus type I (HTLV-I) 
infection among healthy Japanese migrants and their descen- 
dents in Peru. 
Methods: A total of 407 persons were enrolled at the Peruvian- 
Japanese Medical Center in Lima during routine visits for health 
evaluations. Each study volunteer was interviewed to obtain 
clinical and epidemiologic data, and a blood sample was 
obtained for HTLV-I testing. Sera samples were initially tested 
for antibody by enzyme-linked immunosorbent assay(ELISA). 
All ELISA reactive sera were further tested by Western Blot 
assay, and the results were recorded in accordance with the 
manufacturer’s recommendations. 
Results: Among the 407 study volunteers, HTLV-I infection was 
demonstrated in 6.8% (19/280) of females and 3.2% (4/127) 
of males. Infection rates significantly increased with age, with 
28.5% of volunteers over 80 years of age being positive (P < 
0.05). The migrants from Japan had the highest infection rate 
(15.8%), whereas none of the second generation volunteers 
were positive (P < 0.05). The incidence among those with 
ancestors from Okinawa was 9.3%, and for those with ances- 
tors from the central zone of Japan, 1.2% (P < 0.05). 
Conc/usions: These data indicated that HTLV-I infection rates 
were highest among the older volunteers from Okinawa and 
Kyushu, and that evidence of infection was not found among 
their offspring. 
Key Words: HTLV-I, Japanese immigrants, Peru 
Int J Infect Dis 1996; 1:75-77. 
Since human T-cell lymphotropic virus type I (HTLV-I) 
was first recognized as a retrovirus,1~2 studies have shown 
*Institute de Medicina Tropical Alexander von Humboldt, Uoiversidad 
Peruana Cayetano Heredial, +Centro Medico Peruano-Japonts, and *U.S. 
Naval Medical Research Institute Detachment, Lima, Peru. 
Received: May 14, 1996; Accepted: July 1, 1996. 
Address correspondence to Dr. Eduardo Gotuzzo, PO. Box 4314, Lima 
100. Peru. 
that the virus is endemic in some regions of the world, 
especially in the southwest region of Japan, in the 
Caribbean, and in some African countries.‘-j In South 
America, HTLV-I infection has been detected among 
human populations in Colombia, Brazil, Chile, and 
Peru.6-9 This virus is transmitted by sexual intercourse, 
whole blood transfusion, and maternal breast-feeding, 
and recent reports suggest that environmental factors 
also may play a role in transmission.‘O 
When HTLV-I was introduced into Latin America is 
unknown. Zaninovic suggested that the virus may have 
arrived with infected Asian migrants 10,000 years ago.‘l 
Other authors have suggested that the virus may have 
been introduced with African slaves transported to the 
Caribbean 300 years ago, and then to Venezuela, Colom- 
bia, and Peru,’ or more recently with Japanese immi- 
grants to some Latin-American countries, such as Peru.12 
The migrant Japanese population arrived in Peru 100 
years ago, and settled primarily in and on the outskirts 
of Lima. Initially, marriage occurred only among the 
Japanese population, but later Peruvians and other immi- 
grants intermarried. 13,14 The ancestors were mainly from 
Okinawa and Kyushu Island, the regions in Japan where 
HTLV-I infection rates were highest.15 These immigrants 
are known as the Nikkei population to identify their 
Japanese ancestry. 
The objective of this study was to evaluate the preva- 
lence of HTLV-I infection among healthy Nikkei individ- 
uals in Lima, Peru. 
SUBJECTS AND METHODS 
This study was carried out from September 1993 to 
March 1994 and included volunteers from the Nikkei 
population as well as Japanese migrants who attended 
the Peruvian-Japanese Medical Center in Lima for routine 
health evaluations. Subjects with chronic neurologic 
lesions as well as those with malignancies were excluded. 
Written informed consent was obtained from each vol- 
unteer, or from parents of minor subjects. 
Patients were interviewed to obtain clinical and epi- 
demiologic data, mainly about their origin, blood trans- 
fusions, tattoos, or needle injections; no questions were 
asked about sexual behavior. A blood sample was 
obtained from each volunteer and tested by an enzyme 
75 
76 International Journal of Infectious Diseases / Volume 1, Number 2, November 1996 
-linked immunosorbent assay (ELISA) for HTLV-I (Gentic 
Systems, Seattle, WA). All ELISA reactive sera were fur- 
ther tested by Western Blot assay (Cambridge Biotech, 
Worcester, MA). Results were recorded in accordance 
with the manufacturer’s recommendations. 
Category variables were tested using Fisher’s exact 
test or chi-square 2 X 2 or 2 X n as it corresponds; chi- 
square for trend was used to evaluate difference in preva- 
lent rates by age groups. A level of significance less 
than 0.05 was considered to be significant. 
RESULTS 
Among the 407 volunteers, 280 were females and 127 
were males; age ranged from 7 to 92 years. These vol- 
unteers included 82 migrants and 247 first, and 78 sec- 
ond generation Japanese. Assay results indicated that 6.8% 
(19/280) of the females and 3.2% (4/127) of the males 
were infected with HTLV-I. Infection rates increased sig- 
nificantly with age, with a rate of 28.5% (6/21) among the 
volunteers who were more than 80 years of age, P < 0.05 
(Table 1). 
Analysis by generation showed that HTLV-I infection 
rates were 15.8% among migrants from Japan, whereas 
none of the second generation Peruvian Japanese (grand- 
children) were positive. Thus, the rate was significantly 
greater among the Japanese migrants, P < 0.05 (Table 2). 
The majority of the study subjects (n = 215) were 
from Okinawa, an island in the southern area of Japan. 
Of these, 20 (9.3%) were HTLV-I positive. In contrast, 
infection was demonstrated in only 3.0% (2/65) of the vol- 
unteers from Kyushu Island, located in southern Japan, 
and in 1.2% (l/83) from the central region of Japan (Table 
3). 
DISCUSSION 
Human T-cell lymphotropic virus type I is an important 
disease in some areas of the world, especially in the 
southern region of Japan, where an association between 
HTLV-I infection and adult T-cell leukemia/lymphoma 
(ATL) has been observed.16 Additionally, an association 
Table 1. HTLV-I Infection Rates among Healthy Nikkei Persons 
in Lima, Peru 
Positive 
Sex 
Male 
Female 
Age W 
4/l 27 (3.2%) 
19/280 (6.8%) 
<20 
21-40 
41-60 
6-I-80 
>80 
*P < 0.0004. 
o/34 
o/57 
5/l 35 (3.7%) 
12/l 60 (75%) 
6/21 (28.5%) 
Table 2. HTLV-I Infection Rates among Healthy Nikkei 
Persons in Lima, Peru, by Generations 
Positive (%) 
Born in Japan 13/82 (15.8) 
First generation 1 O/247 (4.0) 
Second generation O/78 
*P = 0.00001 
between HTLV-I and myelopathy (HAM) was observed in 
the same regions where ATL was originally described.” 
Although HTLV-I infection is endemic in these southern 
regions of Japan, infection has not been well documented 
in the northern region of the country. 
It has been suggested that HTLV-I might have been 
introduced into Peru by Japanese immigrants.12 However, 
the results of this study failed to support continued trans- 
mission of this virus among indigenous generations of 
Japanese. Similar observations were reported from 
Hawaii, where the HTLV-I infection rates declined sub- 
stantially among indigenous generations of Japanese.‘* In 
addition, infection rates decreased from 17% among 
Japanese immigrants to 4 to 7% in the next generation, 
in Bolivia. As observed in this study, the seropositivity 
was high, especially in adults who came from Okinawa.19 
Recent reports suggest that the route of HTIV-I trans- 
mission may be related to environmental factors. For 
example, high rates of infection were found among neigh- 
bors of index cases.9 Although conclusive evidence of 
transmission via environmental factors remain to be con- 
fnmed, further studies are warranted in view of the obser- 
vation that HTLV-I is found primarily in the tropical 
regions of the world. 
In Peru, sexual transmission does not appear to 
account for HTLV-I infection in healthy people of Cusco 
and Quillabamba, 2o thus presenting opportunities to con- 
sider other possible routes of transmission. This ethnic 
group in Cusco is Quechua, the descendants of the Inca 
Empire, who did not have any contact with the Japanese 
or with the black population located on the coast of Peru. 
The virus may have been introduced to Peru by the first 
Asian migrants 10,000 years ago, or it may have arrived 
with African slaves in the 17th Century or Japanese immi- 
grants in the 19th Century. As a result, HTLV-I may have 
then spread to the Quechua as well as other ethnic 
Table 3. HTLV-I Infection Rates among Healthy Nikkei Persons 
according to the Origin of Their Ancestors 
Origin of Ancestors 
Okinawa 
Island of Kyushu 
Kumamoto 
Fukuoka 
Kagoshima 
Hiroshima 
Fukushima 
Other regions 
*P = 0.01. 
Positive 
20/215 (9.3%) 
2/65 (3.0%) 
O/32 
O/25 
2/8 (25.0%) 
O/27 
O/l 7 
i/83 (1.2%) 
HTLV-I in Immigrants in Peru / Gotuzzo et al 77 
groups in Peru. Further studies of the nucleotide 
sequences of HTLV-I are needed to clarify the possible ori- 
gin of this virus in Peru. 
Studies conducted on female sex workers in Peru, 
showed a high prevalence of HTLV-I infection among 
workers in Callao, Lima, and Cusco, and that the rates 
were associated with the number of sexual partners 
through time. 2o,21 These groups are different from the 
patients in this study. 
Sonoda and co-workers suggested that in Japan, the 
low risk of developing myelopathy among HTLV-I 
infected persons may be related to genetic factors.22 In 
contrast, the incidence of myelopathy in countries such 
as Colombia, Chile, Brazil, and Peru may be as high as 1 
in every 70 to 100 HTLV-I-infected patients.5-7,23-26 This 
high frequency could be explained as a genetic suscep- 
tibility of the population, according to Sonoda’s proposal. 
The prevalence of tropical spastic paraparesis ob- 
served in Latin America in comparison with the rate in 
the population of South Japan warrants further investi- 
gation. 
The study of the HTLV-I infection has become more 
important recently in relation to the AIDS epidemic, since 
it has been shown that the presence of a coinfection of 
the two retroviruses (HIV and HTLV-I) in a patient indi- 
cates a poor prognosis.27 
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Human T-cell lymphotropic virus type I infection among Japanese immigrants in Peru

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