Extraordinary high rate of HTLV type II seropositivity in intravenous drug abusers in south Vietnam

Intrafamilial Transmission of HTLV-1 and HTLV-2 in Indigenous Peoples of the Brazilian Amazon: Molecular Characterization and Phylogenetic Analysis

Human T-limphotropic virus 1 infection has a global distribution, with a high prevalence in some regions of Brazil and the world, while HTLV-2 infection is endemic mainly among indigenous people and drug users. To analyze intrafamilial transmission of HTLV-1/2 in five Kayapó indigenous peoples (Gorotire, Kararaô, Kokraimoro, Kubenkokre, and Xikrin do Bacajá), we investigated 1452 individuals who underwent serological and molecular tests. Among the 276 indigenous people with positive results, we identified intrafamily transmission in 42.7% of cases, representing 38 families. It was possible to suggest horizontal and vertical transmissions in 15.8% (6/38) and 47.4% (18/38) of the family groups, respectively. In 15.8%, it was not possible to suggest the route, which indicated that the transmission may have occurred through both vertical and horizontal routes. Through phylogenetic analyses, 35 samples positive for HTLV-2 were sequenced and classified as subtype 2c, and the two samples that tested positive for HTLV-1 were shown to belong to the cosmopolitan subtype, transcontinental subgroup (HTLV-1aA). This study confirms the intrafamilial transmission of HTLV-1/2 infection in indigenous people of the Brazilian Amazon, highlighting the importance of the sexual and mother-to-child transmission routes in maintaining the virus in these people.

Is the human T-cell lymphotropic virus type 2 in the process of endogenization into the human genome?

Human T-cell lymphotropic virus type 2 (HTLV-2) infection has been shown to be endemic among intravenous drug users in parts of North America, Europe and Southeast Asia and in a number of Amerindian populations. Despite a 65% genetic similarity and common host humoral response, the human T-cell lymphotropic viruses type 1 (HTLV-1) and 2 display different mechanisms of host interaction and capacity for disease development. While HTLV-1 pathogenicity is well documented, HTLV-2 etiology in human disease is not clearly established. From an evolutionary point of view, its introduction and integration into the germ cell chromosomes of host species could be considered as the final stage of parasitism and evasion from host immunity. The extraordinary abundance of endogenous viral sequences in all vertebrate species genomes, including the hominid family, provides evidence of this invasion. Some of these gene sequences still retain viral characteristics and the ability to replicate and hence are potentially able to elicit responses from the innate and adaptive host immunity, which could result in beneficial or pathogenic effects. Taken together, this data may indicate that HTLV-2 is more likely to progress towards endogenization as has happened to the human endogenous retroviruses millions of years ago. Thus, this intimate association (HTLV-2/human genome) may provide protection from the immune system with better adaptation and low pathogenicity.

Seroprevalence of HTLV-1/2 Among Voluntary Blood Donors in Vietnam

Infection with human T lymphotropic virus (HTLV), although asymptomatic in most cases, can lead to severe illnesses, such as adult T cell leukemia/lymphoma or myelopathy/tropical spastic paraparesis. HTLV can be transmitted by whole-blood (WB) transfusion. The prevalence of HTLV among blood donor populations has not been characterized in Vietnam, although the screening has been partially implemented on voluntary basis since 2016. To determine the seroprevalence of HTLV-1/2 among blood donors, a total of 14,819 healthy blood donors in northern, central, and southern Vietnam and 1,003 samples from hepatitis B surface antigen (HbsAg), anti-hepatitis C (anti-HCV), or HIV Ag/Ab reactive blood donors were screened for anti-HTLV-1/2 antibodies by a chemiluminescence immunoassay using the Abbott ARCHITECT rHTLV-I/II assay. The anti-HTLV-1/2 repeat reactive (RR) samples were further tested by immunoblot (IB) method using MP Biomedicals HTLV Blot 2.4 for confirmation and differentiation of HTLV-1/2 infection. Proviral HTLV subgenomic amplification of the gag and tax regions was performed on the available WB RR samples (N = 11) by polymerase chain reaction (PCR). Among 14,819 blood donors, 34 samples (0.23%) were RR for anti-HTLV-1/2 antibodies, but only 1 case was confirmed HTLV-2 positive (0.0067%) and 5 cases were classified as indeterminate (0.034%) by IB. The RR rate was 0.39% among HBsAg/anti-HCV/HIV reactive sample groups, but none of them was confirmed by IB. Subgenomic PCR failed to amplify proviral DNA from WB samples of 11 RR samples. HTLV-1/2 prevalence was found to be low among blood donors in the study. Continued vigilance remains essential to maintain a low transfusion-transmitted risk in Vietnam.

Human T-cell lymphotropic virus type I and II seroprevalence among volunteer blood donors in Thailand

Human T-cell lymphotrophic virus type I and II (HTLV-I/II) are closely related but distinct retroviruses that can infect humans. Both the viruses can be transmitted via transfusion of contaminated blood components. HTLV pre-transfusion screening is not mandatory in Thailand until now. Current epidemiological data for HTLV prevalence is still lacking since the past surveys were done more than a decade ago. The main objective of this study was to determine the seroprevalence of HTLV-I/II among voluntary blood donors in Thailand. 11,057 volunteer blood donors were screened for HTLV-I/II antibodies using the ARCHITECT rHTLV-I/II chemiluminescent immunoassay (CLIA). Initial-reactive (IR)  samples were subjected to repeat duplicate testing and were also sent for confirmatory testing at Korean Red Cross Society (KRC), Seoul or National Serology Reference Laboratories (NRL), Australia using alternate HTLV serological assays and immunoblot and/or specific nucleic acid testing respectively. Out of 11,057 plasma samples, 10,080 were low-risk seronegative donors and 977 were first-time/high-risk donors. Twenty of 24 IR samples were repeatedly reactive (RR) in low-risk seronegative donors group. On confirmatory testing of these 24 IR by immunoblot, 13 indeterminate and 11 negative results were observed. One out of 977 samples from first-time/high-risk donors was RR for anti-HTLV-I/II antibodies. This sample was co-reactive for HBsAg, but negative for HTLV by EIA or in-house HTLV-I qPCR. The ARCHITECT rHTLV-I/II assay exhibited a specificity of 99.93% in low-risk donors and 99.90% among high-risk donors. This study concluded that HTLV-I/II prevalence is low among blood donors in Thailand. But periodic surveillance should be continually conducted to ensure high blood safety standards in the country.

Seroprevalence and demographic determinants of human T-lymphotropic virus type 1 and 2 infections among first-time blood donors--United States, 2000-2009

BACKGROUND

Human T-lymphotropic virus type 1 (HTLV-1) and HTLV-2 are prevalent at low levels among US blood donors, but recent data on their prevalence is lacking. METHODS. Data on all first-time blood donors in a large network of US blood centers were examined during 2000-2009. HTLV-1 and HTLV-2 antibodies were measured by enzyme immunoassay (EIA) with confirmation by immunofluorescence or recombinant immunoblot. Prevalence rates were calculated, and odds ratios were assessed using multivariable logistic regression.

RESULTS

Among 2 047 740 first-time donors, 104 were seropositive for HTLV-1 (prevalence, 5.1 cases/per 100 000; 95% confidence interval [CI], 4.1-6.1), and 300 were seropositive for HTLV-2 (prevalence, 14.7 cases/per 100 000; 95% CI, 13.0-16.3). The prevalence was lower than reported in the 1990s but stable from 2000 to 2009. HTLV-1 seropositivity was associated with female sex, older age, and black and Asian race/ethnicity. HTLV-2 seropositivity was associated with female sex, older age, nonwhite race/ethnicity, lower educational level, and residence in the western and southwestern United States.

CONCLUSIONS

The HTLV-1 and HTLV-2 prevalences among US blood donors has declined since the early 1990s. A higher prevalence of HTLV-2 in the west and southwest may be attributed to endemic foci among Amerindians.

Cellular Factors Involved in HTLV-1 Entry and Pathogenicit

Human T cell leukemia virus type 1 (HTLV-1) is the causative agent of adult T cell leukemia (ATL) and HTLV-1 – associated myelopathy and tropical spastic paraparesis (HAM/TSP). HTLV-1 has a preferential tropism for CD4 T cells in healthy carriers and ATL patients, while both CD4 and CD8 T cells serve as viral reservoirs in HAM/TSP patients. HTLV-1 has also been detected other cell types, including monocytes, endothelial cells, and dendritic cells. In contrast to the limited cell tropism of HTLV-1 in vivo, the HTLV receptor appears to be expressed in almost all human or animal cell lines. It remains to be examined whether this cell tropism is determined by host factors or by HTLV-1 heterogeneity. Unlike most retroviruses, cell-free virions of HTLV-1 are very poorly infectious. The lack of completely HTLV-1-resistant cells and the low infectivity of HTLV-1 have hampered research on the HTLV entry receptor. Entry of HTLV-1 into target cells is thought to involve interactions between the env (Env) glycoproteins, a surface glycoprotein (surface unit), and a transmembrane glycoprotein. Recent studies have shown that glucose transporter GLUT1, heparan sulfate proteoglycans (HSPGs), and neuropilin-1 (NRP-1) are the three proteins important for the entry of HTLV-1. Studies using adherent cell lines have shown that GLUT1 can function as a receptor for HTLV. HSPGs are required for efficient entry of HTLV-1 into primary CD4 T cells. NRP-1 is expressed in most established cell lines. Further studies have shown that these three molecules work together to promote HTLV-1 binding to cells and fusion of viral and cell membranes. The virus could first contact with HSPGs and then form complexes with NRP-1, followed by association with GLUT1. It remains to be determined whether these three molecules can explain HTLV-1 cell tropism. It also remains to be more definitively proven that these molecules are sufficient to permit HTLV-1 entry into completely HTLV-1-resistant cells.

Retroviral coinfections: HIV and HTLV: taking stock of more than a quarter century of research

Retroviral coinfections with HIV-1 and HTLV-1 or with HIV-1 and HTLV-2 occur with variable frequencies throughout the world with the highest prevalence in large metropolitan areas in the Americas, Europe, and Africa. The recognition that retroviral coinfections exist dates back to the discovery of HIV-1 over 25 years ago. Despite the large body of published information regarding the biological and clinical significance of retroviral coinfections, controversy throughout several decades of research was fueled by several flawed epidemiologic studies and anecdotal reports that were not always supported with ample statistical and scientific evidence. However, the growing consensus obtained from recent systematic and well-devised research provides support for at least three conclusions: (1) HIV-1 and HTLV-1 coinfections are often seen in the context of patients with high CD4(+) T cell counts presenting with lymphoma or neurological complications; (2) HIV-1 and HTLV-2 coinfections have been linked in some cases to a "long term nonprogressor" phenotype; and (3) differential function and/or overexpression of the HTLV-1 and HTLV-2 Tax proteins likely play a pivotal role in the clinical and immunologic manifestations of HIV/HTLV-1 and -2 coinfections. This review will recount the chronology of work regarding retroviral coinfections from 1983 through the present.

Human T Lymphotropic Virus Type 1 (HTLV-1): Molecular Biology and Oncogenesis

Human T lymphotropic viruses (HTLVs) are complex deltaretroviruses that do not contain a proto-oncogene in their genome, yet are capable of transforming primary T lymphocytes both in vitro and in vivo. There are four known strains of HTLV including HTLV type 1 (HTLV-1), HTLV-2, HTLV-3 and HTLV-4. HTLV-1 is primarily associated with adult T cell leukemia (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). HTLV-2 is rarely pathogenic and is sporadically associated with neurological disorders. There have been no diseases associated with HTLV-3 or HTLV-4 to date. Due to the difference in the disease manifestation between HTLV-1 and HTLV-2, a clear understanding of their individual pathobiologies and the role of various viral proteins in transformation should provide insights into better prognosis and prevention strategies. In this review, we aim to summarize the data accumulated so far in the transformation and pathogenesis of HTLV-1, focusing on the viral Tax and HBZ and citing appropriate comparisons to HTLV-2.

Molecular characterization of human T-cell lymphotropic virus type 2 (HTLV-II) from people living in urban areas of Sao Paulo city: Evidence of multiple subtypes circulation

BACKGROUND

In Brazil, human T-cell lymphotropic virus type I and type II (HTLV-I and HTLV-II) are co-circulating and possess approximately 65% homology, which results in high cross-reactivity in serological tests. Based on the detection of EIA and Western blot (WB) tests, HTLV serodiagnosis yields indeterminate results in high-risk population, with the true determination of HTLV-II prevalence requiring a combined serological and molecular analysis. Molecular analysis of HTLV-II isolates has shown the existence of four distinct subtypes: IIa, IIb, IIc, and IId. The aim of this study was to evaluate the routine EIA and WB used in Sao Paulo city, as well as molecular methods for confirmation of infection and HTLV-II subtype distribution.

RESULTS

Two hundred ninety-three individuals, who were enrolled in the HTLV out-clinic in Sao Paulo city, Brazil, between July 1997 and May 2003, were tested by EIAs, and positive sera 232 (79%) reactive by one of the tests. When these sera were tested by WB revealed 134 were HTLV-I, 28 HTLV-II, 4 HTLV-I/II, and 48 were indeterminate. Polymerase chain reaction (PCR) on the indeterminate group showed that 20 (42%) were HTLV-II and 28 were negative. From a total of 48 HTLV-II subjects with DNA available, restriction fragment length polymorphism (RFLP) of the env region revealed 47 HTLV-IIa and 1 HTLV-IIb. The phylogenetic analysis was performed on 23 samples, which identified 19 as subtype a, Brazilian subcluster, and 4 as subtype b. This is the first time HTLV-II subtype b has been described in Brazil. However, further studies, such as a complete nucleotide DNA sequencing, need to be done to confirm these findings.

Seroprevalence and risk factors for human T cell lymphotropic virus type 1 and 2 infection in human immunodeficiency virus-infected patients attending AIDS referral center health units in Londrina and other communities in Paraná, Brazil

The municipality of Londrina ranks second in the number of AIDS cases in the state of Paraná, Brazil, with the Ministry of Health notified of 1070 cases from 1984 to 2002. The aim of this study was to determine the seroprevalence and risk factors for HTLV-1/2 infection in HIV-infected patients attending the AIDS Reference Center serving Londrina (and surrounding region), Paraná, Brazil. Data concerning sociodemographic conditions and risk factors were collected from 784 HIV-infected patients, using a questionnaire. Blood samples were obtained from 758 of the patients and subjected to serologic screening tests for the determination of HTLV-1/2, as well as hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis. Most patients were white (mean age, 35.9 years); 55.9% were males and 44.1% were females. The most frequent sexually transmitted disease was gonorrhea (28.5%), followed by syphilis (14.3%) and condyloma (12.2%). The major risk factors associated with the acquisition of retroviruses were sexual contact (84.8%) and intravenous drug use (IDU, 11.9%). The overall infection seroprevalence was 6.4% for HTLV-1/2, 37.2% for HBV, 21.0% for HCV, and 24.4% for syphilis. HTLV-1 and HTLV-2 infections were confirmed in 0.8 and 4.9% of patients, respectively. HIV/HTLV-1/2 coinfection was more frequent in IDUs (59.2% of cases) and was strongly associated with HCV (22.60 [95% CI, 10.35-49.35]). A weak association with HBV (2.09 [95% CI, 1.13-3.90]) and no association with syphilis were observed. The results showed that human retroviruses are circulating in southern Brazil, mainly among white people of both genders of low socioeconomic conditions and educational level. Although the sexual route was considered to be the major risk factor for HIV infection, HTLV-1/2 infection was strongly associated with IDU.

The seroepidemiology of human T-lymphotropic viruses: types I and II in Europe: a prospective study of pregnant women

BACKGROUND

Up to 20 million persons are infected with the human retroviruses human T-lymphotropic virus (HTLV)-I and HTLV-II globally. Most data on the seroprevalence of HTLV-I and HTLV-II in Europe are from studies of low-risk blood donors or high-risk injection drug users (IDUs). Little is known about the general population.

METHODS

A prospective anonymous study of HTLV-I and HTLV-II seroprevalence among 234,078 pregnant women in Belgium, France, Germany, Italy, Portugal, Spain, and the United Kingdom was conducted. Maternal antibody status was determined by standard methods using sera obtained for routine antenatal infection screens or eluted from infant heel prick dried blood spots obtained for routine neonatal metabolic screens.

RESULTS

Anti-HTLV-I/II antibodies were detected and confirmed in 96 pregnant women (4.4 per 10,000, 95% confidence interval [CI]: 3.5-5.2). Of these, 73 were anti-HTLV-I, 17 were anti-HTLV-II, and 6 were specifically anti-HTLV but untyped. The seroprevalence ranged from 0.7 per 10,000 in Germany to 11.5 per 10,000 in France.

CONCLUSIONS

Pregnant women better reflect the general population than blood donors or IDUs. The seroprevalence of HTLV-I and HTLV-II in Western Europe is 6-fold higher among pregnant women (4.4 per 10,000) than among blood donors (0.07 per 10,000). These data provide a robust baseline against which changes in HTLV-I and HTLV-II seroprevalence in Europe can be measured.

Seroepidemiology of HTLV-I/II in Argentina: an overview

In this report, the results of seroepidemiologic studies of human T-lymphotropic virus type I (HTLV-I) and type II (HTLV-II) infections in different population groups in Argentina have been compiled. The studies have shown a high prevalence of HTLV-I/II infection in blood donors in the provinces in the north of Argentina (1.0% in Jujuy, 0.7% in Salta, and 0.6% in Formosa) and a low prevalence in the provinces in the central region of the country (<or=0.1%). High rates of HTLV-I (0.45%-2.78%) and HTLV-II (2.78%-21.9%) infections have been documented in Native Indian groups and have highlighted the importance of sexual and mother-to-child transmission of the viruses. The presence of HTLV-I/II antibodies in HIV-infected individuals indicates that both viruses are circulating in certain high-risk population groups. HTLV-I/II was detected in intravenous drug users (2.56%-21.7%), homosexual men (0.5-1.33%), prostitutes (0.8%), and hemophiliacs (2.8%). In conclusion, HTLV-I/II infection is circulating in low- and high-risk populations in Argentina, and these findings would support the view that selective screening for HTLV-I/II should be implemented to reduce the spread of infection.

HIV, ethnicity and travel: HIV infection in Vietnamese Australians associated with injecting drug use

BACKGROUND

The movement of people with their constructed identities including ethnicity has always been one of the determinants of the human immunodeficiency virus (HIV) pandemic. An example of the contributions of travel and ethnicity to experiences of HIV can be seen in the Vietnamese community in Australia.

OBJECTIVES

This paper seeks to describe the contributions of ethnicity and travel to the Australian HIV epidemic with particular reference to the evolving epidemic within the Vietnamese Australian community.

STUDY DESIGN

We reviewed the available data on the HIV epidemic in Australia with reference to overseas acquisition, ethnicity, the epidemic in the Vietnamese community and the determinants of the current patterns of transmission within this community.

RESULTS

Available data suggests that 20-25% of HIV infections notified in Australia are acquired overseas. This proportion is higher in some specific categories such as heterosexually acquired infections. Notification rates are no higher in Vietnamese Australians than in the general Australian population apart from infections associated with injecting drug use (IDU) notified in the state of Victoria. The reasons for this increased rate of notification include increased vulnerability to blood borne virus infection in Australia and the additional, unique risk of frequent travel to Vietnam, a country where IDU carries a high risk of HIV infection.

CONCLUSIONS

Australia has succeeded in stabilising the HIV epidemic partly through successful interventions to limit the spread of infection among IDUs. There is now early evidence that HIV transmission may be increasing amongst Vietnamese Australian IDUs. Timely responses that help Vietnamese Australian IDUs reduce their accumulation of risk are likely to be important in determining the level of harm associated with IDU throughout Australia.

Human retroviruses (HIV and HTLV) in Brazilian Indians: seroepidemiological study and molecular epidemiology of HTLV type 2 isolates

To investigate serological, epidemiological, and molecular aspects of HTLV-1, HTLV-2, and HIV-1 infections in Amerindian populations in Brazil, we tested 683 and 321 sera from Tiriyo and Waiampi Indians, respectively. Both HIV-1 and HTLV-2 infections were detected at low prevalence among the Tiriyos whereas only HTLV-1 was present among the Waiampis, also at low prevalence. Analysis of the nucleotide sequence of the 631 bp of the env gene obtained from the three HTLV-2 isolates detected among the Tiriyos demonstrated by restriction fragment length polymorphism that these viruses belong to subtype IIa. Phylogenetic analysis of this same fragment showed that these sequences cluster closer to HTLV-2 isolates from intravenous drug users living in urban areas of southern Brazil than to the same gene sequence studied in another Brazilian tribe, the Kayapos. Our results confirm the distribution of Brazilian HTLV-2 sequences in a unique cluster I and cluster IIa and suggest that there is a considerable degree of diversity within this cluster. We also report for the first time HIV-1 infection among Brazilian Amerindians.

Os vírus linfotrópicos de células T humanos (HTLV) na última década (1990-2000): aspectos epidemiológicos

Vinte anos após o isolamento do vírus linfotrópico humano tipo I, muitos aspectos epidemiológicos, patogênicos e filogenéticos já estão esclarecidos. Sabe-se que em regiões endêmicas a prevalência aumenta com a idade e é maior no sexo feminino. Três patologias estão claramente relacionadas a ele: paraparesia espástica tropical / mielopatia associada ao HTLV, leucemia de células T do adulto e uveíte. Os modos de infecção, semelhantes aos dos outros retrovírus, são: transfusão de sangue, relações sexuais não protegidas, transplacentária e durante o aleitamento materno. A história natural das doenças relacionadas ao HTLV-I ainda não está bem estabelecida. O risco de portadores da infecção desenvolverem patologias depende de mais estudos de incidência para serem corretamente estimados. Menos se conhece sobre o HTLV-II. A despeito do alto grau de homologia entre os dois tipos, os vírus interagem de forma bem diversa com os infectados, não havendo uma associação clara de doença com o HTLV-II. Relatos recentes têm apontado sua participação em casos de mielopatia crônica semelhante à TSP/HAM. As implicações incertas do prognóstico para pessoas infectadas pelo vírus linfotrópico humano (HTLV-I/II) e suas formas de transmissão constituem um problema de saúde pública, principalmente em áreas consideradas endêmicas para esse vírus.

Evolutionary strategies of human T-cell lymphotropic virus type II

Human T-cell lymphotropic virus type II (HTLV-II) primarily infects two different populations in which the virus is transmitted in very diverse ways. In endemically infected populations, the virus is propagated through sexual contact, and by mother to child transmission via breast-feeding, among intravenous drug users (IDUs), spread is mainly due to blood-borne transmission via needle sharing. The phylogeny of HTLV-II strains isolated from American Indian and Pygmy tribes and strains from IDUs, reveal that the virus originated on the African continent as a result of a simian to human transmission at least 400,000 years ago. HTLV-II was very likely introduced into the American continent during one or more migrations of HTLV-II infected Asian populations over the Bering land bridge, some 15,000-35,000 years ago. During the last few decades, HTLV-II has been transmitted from native American Indians to IDUs at least twice, followed by a rapid spread of the virus in the drug users population world-wide due to the practice of needle sharing. Molecular clock analysis showed that HTLV-II has two different evolutionary rates, with the molecular clock for the virus in IDUs ticking 150-350 times faster than the one in endemically infected tribes: 2.7x10(-4) compared to 1.7/7.3x10(-7) nucleotide substitutions per site per year in the LTR region. Although many of the HTLV-II infected drug users are co-infected with HIV, the dramatic acceleration of the evolutionary rate seems to be mainly related to the different modes of transmission in the two populations. These contrasting evolutionary rates correlate with an endemic spread of HTLV-II in infected tribes compared to an epidemic spread in IDUs.

Spontaneous production of C-C chemokines by individuals infected with human T lymphotropic virus type II (HTLV-II) alone and HTLV-II/HIV-1 coinfected individuals

To investigate the immunological features of human T lymphotropic virus type II (HTLV-II) infection and specific mechanisms whereby HTLV-II might influence the progression of HIV-1 disease in coinfected individuals, we have analyzed the production of the C-C chemokines RANTES and macrophage inflammatory proteins 1alpha and 1alpha (MIP-1alpha and MIP-1beta) by PBMCs from HTLV-II-infected and HTLV-II/HIV-1-coinfected individuals. We observed spontaneous production of significant levels of MIP-1alpha and -1beta and, to a lesser extent, RANTES, from individuals infected with HTLV-II alone or with concomitant HIV-1 infection. Spontaneous C-C chemokine production was not observed in PBMCs from uninfected or HIV-1-infected individuals. Although HTLV-II is known to preferentially infect CD8+ lymphocytes in vivo, we observed that whereas RANTES was produced exclusively by the CD8+-enriched fraction, MIP-1alpha and -1beta were produced by both the CD8+-enriched and CD8+-depleted fractions of HTLV-II-infected PBMCs. RT-PCR demonstrated active expression of the HTLV-II regulatory protein Tax in the infected CD8+ T lymphocyte population, and it was further shown that Tax transactivates the promoters of MIP-1beta and RANTES. Therefore, it appears that HTLV-II stimulates the production of C-C chemokines both directly at a transcriptional level via the viral transactivator Tax and also indirectly. Although the HTLV-II-infected individuals in this study are all virtually asymptomatic, they certainly display an abnormal immune phenotype. Moreover, our findings suggest that HTLV-II, via chemokine production, would be expected to alter the progression of HIV-1 infection in coinfected individuals.

Isolation, cloning, and complete nucleotide sequence of a phenotypically distinct Brazilian isolate of human T-lymphotropic virus type II (HTLV-II)

Analysis of human T-lymphotropic virus type II (HTLV-II) isolates from North America and Europe have demonstrated the existence of two molecular subtypes of the virus, HTLV-IIa and HTLV-IIb. Recently, studies on HTLV-II infections in Brazil have revealed isolates that are related phylogenetically to the HTLV-IIa subtype but have a HTLV-IIb phenotype with respect to the transactivating protein, tax. To more clearly define this relationship, HTLV-II was isolated from peripheral blood of an IVDA from Sao Paulo, Brazil (SP-WV), and the complete provirus was cloned and sequenced. Comparison of HTLV-II(SP-WV) nucleotide sequences to other available complete HTLV-II proviral sequences revealed that HTLV-II(SP-WV) is most closely related to HTLV-II(Mo), the prototypic HTLV-IIa subtype sequence. Phylogenetic analysis of LTR, env, and tax regions unequivocally demonstrated that HTLV-II(SP-WV) and all other Brazilian sequences examined are members of the IIa subtype. The predicted amino acid sequences of the major coding regions of HTLV-II(SP-WV) are also most closely related to HTLV-II(Mo), with the important exception of tax. The tax protein encoded by HTLV-II(SP-WV) is 96-99% identical to the tax of IIb isolates and is similar in that it has an additional 25 amino acids at the carboxy-terminus compared to the HTLV-II(Mo) tax with which it shares 91% identity. Analysis of tax stop codon usage of a number of HTLV-IIa isolates from North American, Europe, and Brazil demonstrated that isolates from the last region appear to be unique in their extended tax phenotype. It could be demonstrated that the extended tax proteins in the HTLV-IIb and Brazilian isolates had equivalent ability to transactivate the viral LTR, and studies with deletion mutants indicated that the extended C-terminus is not essential for transactivation. In contrast, the HTLV-IIa tax was found to have a greatly diminished ability to transactivate the viral LTR, which appeared to be a consequence of reduced expression of the protein. The studies show that although the Brazilian strains do not represent an entirely new subtype based on nucleotide sequence analysis they are a phenotypically unique molecular variant within the HTLV-IIa subtype.

Different population dynamics of human T cell lymphotropic virus type II in intravenous drug users compared with endemically infected tribes

The phylogeny of human T cell lymphotropic virus type II (HTLV-II) was investigated by using strains isolated from Amerindian and Pygmy tribes, in which the virus is maintained primarily through mother-to-child transmission via breast-feeding, and strains from intravenous drug users (IDUs), in which spread is mainly blood-borne via needle sharing. Molecular clock analysis showed that HTLV-II has two different evolutionary rates with the molecular clock for the virus in IDUs ticking 150-350 times faster than the one in endemically infected tribes: 2.7 x 10(-4) compared with 1.71/7.31 x 10(-7) nucleotide substitutions per site per year in the long terminal repeat region. This dramatic acceleration of the evolutionary rate seems to be related with the mode of transmission. Mathematical models showed the correlation of these two molecular clocks with an endemic spread of HTLV-II in infected tribes compared with the epidemic spread in IDUs. We also noted a sharp increase in the population size of the virus among IDUs during the last decades probably caused by the worldwide increase in intravenous drug use.

Genetic similarity of HIV type 1 subtype E in a recent outbreak among injecting drug users in northern Vietnam to strains in Guangxi Province of southern China

To investigate the molecular epidemiology of a recent HIV-1 outbreak in northern Vietnam and its relation to the epidemic in surrounding areas, we analyzed 17 HIV-positive blood specimens from 3 heterosexuals, 2 sexually transmitted disease patients, and 12 injecting drug users (IDUs), collected in 4 provinces near Hanoi in 1998. These were compared with the specimens from Ho Chi Minh City (n = 10) and An Giang Province (n = 10) in southern Vietnam and with published sequences from neighboring countries. Genetic subtyping based on the env C2/V3 sequences revealed that HIV-1 subtype E predominated throughout Vietnam in all risk populations; the exception was one typical United States-European-type HIV-1 subtype B detected in a patient in Ho Chi Minh City, the first case of HIV infection identified in Vietnam in 1990. The HIV-1 subtype E sequences identified in 9 of the 12 IDUs from northern provinces were closely related phylogenetically to those in IDUs in nearby Guangxi Province of China, and also shared a common amino acid signature downstream of the env V3 loop region. The low interperson nucleotide diversity among IDUs in northern Vietnam supports the view that HIV-1 subtype E was introduced recently among IDUs in northern Vietnam. These data indicate a linkage between HIV-1 circulating among IDUs in northern Vietnam and southern China, and suggest recent transborder introductions as the likely source of HIV-1 subtype E in northern Vietnam.

The origin and evolution of human T-cell lymphotropic virus type II (HTLV-II) and the relationship with its replication strategy

In this review, the origin and evolution of the human T-cell lymphotropic virus type II (HTLV-II) are discussed, with particular emphasis on its high genomic stability. In particular, it appears that the virus originated in the African continent and has been infecting human populations for several thousands of years. The very low divergence accumulated on average between different viral strains during such a long period could be explained by considering that in infected individuals the viral amplification could be due mainly to the clonal expansion of the infected cells, via cellular mitosis, rather than to reverse transcription. HTLV-II was introduced into the American continent during one or more migrations of HTLV-II-infected Asian populations over the Bering land bridge, some 15,000-35,000 years ago. Finally, during the last few decades, HTLV-II has been transmitted from native Amerindians to injecting drug users (IDUs). It might be speculated that at least two separate introductions of HTLV-II in European IDUs from US IDUs have occurred, due to the practice of needle-sharing among IDUs.

High rate of human T lymphotropic virus type IIa infection in HIV type 1-infected intravenous drug abusers in Ireland

Serological and molecular analyses of a cohort of HIV-1-infected intravenous drug abusers (IVDAs) (n = 103) in Dublin, Ireland have demonstrated that 15 of 103 (14.6%) were infected with HTLV-II, which is the highest infection rate yet recorded for any European country. Restriction fragment length polymorphism (RFLP) analysis of the env region of the provirus demonstrated that the infection involved only the HTLV-IIa subtype; the HTLV-IIb subtype was not detected. Phylogenetic analysis of the nucleotide sequences of the long terminal repeat (LTR) confirmed infection with the HTLV-IIa subtype, and demonstrated that the viruses clustered closely with HTLV-IIa isolates from North American IVDAs. Previous observations that IVDAs in southern Europe, specifically Spain and Italy, appear to be infected predominantly with the HTLV-IIb subtype, along with the present report and evidence that IVDAs in Sweden are infected with the HTLV-IIa subtype, suggest different origins of HTLV-II infection in Europe.

African origin of human T-lymphotropic virus type 2 (HTLV-2) supported by a potential new HTLV-2d subtype in Congolese Bambuti Efe Pygmies

We identified a potential new subtype within human T-cell lymphotropic virus type 2 (HTLV-2), HTLV-2d, present in members of an isolated Efe Bambuti Pygmy tribe. Two of 23 Efe Pygmies were HTLV-2 seropositive, with HTLV-2 Western blot and enzyme-linked immunosorbent assay reactivities. From one of them the entire genome of the HTLV-2 strain Efe2 could be amplified and sequenced. In all gene regions analyzed, this strain was the most divergent HTLV-2 strain, differing by 2.4% (tax/rex) to 10.7% (long terminal repeat) from both subtypes HTLV-2a and HTLV-2b, yet major functional elements are conserved. The similarity between the HTLV-2 Efe2 Gag and Env proteins and the corresponding HTLV-2a and -2b proteins is consistent with the observed serological reactivity. In the proximal pX region, one of the two alternative splice acceptor sites is abolished in HTLV-2 Efe2. Another interesting feature of this potential new subtype is that it has a Tax protein of 344 amino acids (aa), which is intermediate in length between the HTLV-2a Tax protein (331 aa) and the HTLV-2b and -2c Tax proteins (356 aa) and similar to the simian T-cell lymphotropic virus type 2 (STLV-2) PP1664 Tax protein. Together these two findings suggest a different phenotype for the HTLV-2 Efe2 strain. Phylogenetic analyses confirmed that the Pygmy Efe2 strain potentially belonged to a new and quite divergent subtype, HTLV-2d. When the STLV-2 bonobo viruses PP1664 and PanP were used as an outgroup, it was clear that the Pygmy HTLV-2 Efe2 strain had the longest independent evolution and that HTLV-2 evolution is consistent with an African origin.

The simian T-lymphotropic virus STLV-PP1664 from Pan paniscus is distinctly related to HTLV-2 but differs in genomic organization

We have isolated a highly divergent simian T-lymphotropic virus, STLV-PP1664, from a wild-caught bonobo (Pan paniscus). Previous phylogenetic analysis suggested that this virus represents an additional type of STLV but this has now become a matter of discussion. We have now obtained and analyzed the entire genome of STLV-PP1664. All major genes and their corresponding viral messengers were identified. Sequence comparison and phylogenetic analysis indicated that this virus, together with the closely related panp isolate, belongs to an early lineage within the PTLV-2 clade, differing from HTLV-2 by about 25%. In contrast to the HTLV-1 and HTLV-2 LTR, only two 21-bp repeats instead of three were found in the STLV-PP1664 LTR. Additional messengers, resulting from alternative splicing, potentially encode five different accessory proteins from open reading frames in the pX region: prorfI, porfII, ptorfV', and two isoforms of Rex. The amino acid sequences of these proteins are only distinctly related to the accessory proteins from HTLV-2. These data suggest a different genomic organization of the STLV-PP1664 pX region than that of HTLV-2. We conclude that STLV-PP1664, although related to HTLV-2, has some distinct features in the LTR and the pX regions, the impact of which needs further investigation. Although arguments pro and contra a distinct classification are nearly equally balanced, we propose to classify this virus as an STLV-2, designated STLV-2PP1664.

Identification and molecular characterization of human T lymphotropic virus type II infections in intravenous drug abusers in the former South Vietnam

Previous serological studies have demonstrated that some 60% of intravenous drug abusers (IVDAs) in urban areas of the former South Vietnam are infected with HTLV-II. In the present report we have attempted to characterize the viruses using restriction fragment length polymorphism (RFLP) and nucleotide sequence analysis of the provirus long terminal repeat (LTR) region. RFLP analysis of nine samples demonstrated that all were infected with the HTLV-IIb subtype. The HTLV-IIa subtype was not detected. Phylogenetic analysis of the nucleotide sequences demonstrated that the viruses clustered closely with HTLV-IIb isolates present in IVDAs from the New York City area. The present molecular analysis together with the previously reported absence of HTLV-II infection in North Vietnam supports the view that HTLV-II may have been introduced from the United States to this part of Asia by military personnel during the Vietnam conflict.

Nucleotide sequence variation of human T-lymphotropic virus type II in Vietnam

A high rate of human T-lymphotropic virus type II (HTLV-II) infection has been documented in intravenous drug abusers (IVDAs) in South Vietnam. We have investigated the molecular characteristics of the virus and have shown that one HTLV-II subtype is predominant in Ho Chi Minh City. This molecular subtype, HTLV-IIb, was identified in a number of South Vietnamese by nucleotide sequence analysis of the long terminal repeat (LTR) region. HTLV-IIa was not found. These findings suggest that HTLV-IIb is endemic in IVDAs in South Vietnam, although IVDAs in urban areas in North America are predominantly infected with HTLV-IIa.

Human T-cell leukemia viruses: epidemiology, biology, and pathogenesis

The human T-cell lymphotropic viruses type I and type II are closely related human retroviruses that have similar biological properties, genetic organization and tropism for T lymphocytes. Along with the simian T-cell lymphoma virus type I, they define the group of retroviruses known as the primate T-cell leukemia/lymphoma viruses. Initially identified in 1980, the human T-cell lymphotropic virus type I has been implicated as the etiologic agent of adult T-cell leukemia/lymphoma and of a degenerative neurologic disorder known as tropical spastic paraparesis or human T-cell lymphotropic virus type I-associated myelopathy. The intriguing link between human T-cell lymphotropic virus type, T-cell malignancy, and a totally unrelated and non-overlapping neurological disorder suggests divergent and unique pathogenetic mechanisms. This review will address the epidemiology, molecular biology, and pathogenesis of human T-cell leukemia viruses.

No proof of HTLV-I/II in intravenous drug abusers with a high rate of HIV-1 infection in central Thailand

Serum specimens of 1,074 intravenous drug abusers (IVDA) were examined for infection with HIV-1, HTLV-I and HTLV-II in central Thailand. Three hundred and sixty-two of the specimens were seropositive for HIV-1 (33.7%). The HIV-1 seropositive IVDAs exhibited increased seropositivity with age through group 40-44 and significantly decreased seropositivity over the age of 45. In contrast, no seropositivity to either HTLV-I or -II was detected in the samples tested by a particle-agglutination assay for HTLV followed by type-specific Western blotting for HTLV. Reference to previous reports suggested that the rate of HIV infection in IVDAs has decreased with no HTLV-I or HTLV-II in Thailand when compared with that of the HIV infection in 1992.

Identification and characterization of a new and distinct molecular subtype of human T-cell lymphotropic virus type 2

Molecular studies have demonstrated the existence of at least two major subtypes of human T-cell lymphotropic virus type 2 (HTLV-2), designated HTLV-2a and HTLV-2b. To further investigate the heterogeneity of this family of viruses, we have characterized the HTLV-2 subtypes present in several urban areas in Brazil. DNAs from peripheral blood mononuclear cells of a large number of infected individuals, the majority of whom were intravenous drug abusers, were analyzed by using PCR with restriction fragment length polymorphism and nucleotide sequencing analysis. Restriction fragment length polymorphism analysis of the env region suggested that all individuals were infected with the HTLV-2a subtype, and this was confirmed by nucleotide sequence analysis. In contrast, nucleotide sequence analysis of the long terminal repeat demonstrated that although the viruses were more related to the HTLV-2a than to the HTLV-2b subtype, they clustered in a distinct phylogenetic group, suggesting that they may represent a new and distinct molecular subtype of HTLV-2. This conclusion was supported by nucleotide sequence analysis of the pX region, which demonstrated that the Tax proteins of the Brazilian viruses differed from that of prototype HTLV-2a isolates but were more similar to that of HTLV-2b in that they would be expected to have an additional 25 amino acids at the carboxy terminus. In transient expression assays, the extended Tax protein of the prototype HTLV-2a subtype. The studies suggest that the Brazilian viruses analyzed in this study, while being phylogenetically related to the prototypic HTLV-2a seen in North America, are phenotypically more related to HTLV-2b and can be justifiably classified as a new molecular subtype, which has been tentatively designated HTLV-2c.

Human T lymphotropic virus type II (HTLV-II): epidemiology, molecular properties, and clinical features of infection

Human T lymphotropic virus, type II (HTLV-II), infection has been shown to be endemic in a number of American Indian populations, and high rates of infection have also been documented in intravenous drug abusers in urban areas throughout the world. Although the role of HTLV-II in human disease has yet to be clearly defined, there is accumulating evidence that like HTLV-I, infection may also be associated with rare lymphoproliferative and neurological disorders. In this article we review and summarize the epidemiology, molecular properties and clinical features of HTLV-II infection.

Human T-lymphotropic virus type II in Japan

Serum specimens were assayed for human T-lymphotropic virus type II(HTLV-II) infection in 1,500 individuals known to be seropositive for HTLV-I and 30,000 blood donors in Japan. All HTLV-I-positive individuals were negative for HTLV-II. However, one of the blood donors was clearly seropositive for HTLV-II. Further, the donor was shown to be positive for HTLV-IIb. Here we report at least one case with HTLV-II in Japan and discuss the origin of the infection.