HTLV in the Americas

Clinical course of HTLV-1 infection associated intermediate uveitis

OBJECTIVE

To describe the clinical features at presentation, delivered treatment and follow-up of a case series of human T-cell lymphotropic virus type 1 (HTLV-1) associated intermediate uveitis.

PATIENTS AND METHODS

Retrospective, descriptive and longitudinal study of patients with HTLV-1 associated intermediate uveitis treated at a reference ophthalmology facility in Lima, Peru, during the years 2012 to 2018.

RESULTS

A total of 18 patients (28 eyes) were included, the average age at presentation was 57.3 years, 66.6% were women, and the average follow-up time was 1,280 days. The most frequent symptoms were blurred or diminished vision (78.6%) and floaters (57.1%). Best corrected visual acuity was 20/40 or better in 53.6%. The mean initial intraocular pressure was 14.95 mmHg. Keratic precipitates were observed in 50% of eyes, 17.9% were of the stellate type. The most frequent treatment was periocular corticosteroid injections (53.6%). Complications such as epimacular membrane (50%), cataract (21.4%) and glaucoma (7.1%) occurred. At the end of follow-up, only 2 eyes lost one line of vision; the final best corrected visual acuity was 20/40 or better in 85.7%, and 20/70 or better in 96.4%. Patients with both eyes affected increased from 33% at presentation to 55.5%. The course of the disease was chronic in 60.7%.

CONCLUSION

HTLV-1 associated intermediate uveitis mainly occurred in patients in the second half of life, developing a chronic course and with good visual prognosis.

Association between human papillomavirus and human T-lymphotropic virus in indigenous women from the Peruvian Amazon

Background

No association between the Human T-cell lymphotropic virus (HTLV), an oncogenic virus that alters host immunity, and the Human Papillomavirus (HPV) has previously been reported. Examining the association between these two viruses may permit the identification of a population at increased risk for developing cervical cancer.

Methods and Findings

Between July 2010 and February 2011, we conducted a cross-sectional study among indigenous Amazonian Peruvian women from the Shipibo-Konibo ethnic group, a group with endemic HTLV infection. We recruited women between 15 and 39 years of age who were living in the cities of Lima and Ucayali. Our objectives were to determine the association between HTLV and: (i) HPV infection of any type, and (ii) high-risk HPV type infection. Sexually active Shipibo-Konibo women were screened for HTLV-1 and HTLV-2 infections. All HTLV-1 or -2 positive women, along with two community-matched HTLV negative sexually active Shipibo-Konibo controls were later tested for the presence of HPV DNA, conventional cytology, and HIV. We screened 1,253 Shipibo-Konibo women, observing a prevalence of 5.9% (n = 74) for HTLV-1 and 3.8% (n = 47) for HTLV-2 infections. We enrolled 62 (60.8%) HTLV-1 positive women, 40 (39.2%) HTLV-2 positive women, and 205 community-matched HTLV negative controls. HTLV-1 infection was strongly associated with HPV infection of any type (43.6% vs. 29.3%; Prevalence Ratio (PR): 2.10, 95% CI: 1.53–2.87), and with high-risk HPV infection (32.3% vs. 22.4%; PR: 1.93, 95% CI: 1.04–3.59). HTLV-2 was not significantly associated with either of these HPV infections.

Conclusions

HTLV-1 infection was associated with HPV infection of any type and with high-risk HPV infection. Future longitudinal studies are needed to evaluate the incidence of high-risk HPV infection as well as the incidence of cervical neoplasia among HTLV-1 positive women.

HTLV infection and its implication in gynaecology and obstetrics

INTRODUCTION

Worldwide, 20-30 million people are estimated to be infected with HTLV. HTLV-1 is endemic in Western Africa and Southern Japan, whereas HTLV-2 is considered to be spread among native American people.

MATERIALS AND METHODS

The impact of HTLV in gynaecology and obstetrics is being reviewed. Search strategy and selection criteria for identifying relevant data were performed by searching Medline, Current Contents, Web of Science, Embase and references from relevant articles. English and German gynaecological and infectious diseases textbooks as well as national and international guidelines and recommendations were also reviewed.

RESULTS

Transmission may occur by sexual intercourse or cellular blood products. Although materno-fetal transmission is debated, transmission through maternal breast milk has been confirmed. An HTLV-infection can lead to adult T-cell leukaemia (ATL) or cumulative opportunistic and neurological disorders that can occur with varying degrees of severity. Diagnosis can be done by antibody detection via the use of ELISA and western blot analysis as well as PCR diagnosis.

CONCLUSION

Due to inadequate treatment options and the lack of an effective vaccination, prevention is currently only possible by restricting transmission, including the usage of condoms during sexual intercourse or avoiding breastfeeding in HTLV-seropositive mothers. If, due to socio-economic reasons, breastfeeding cannot be avoided, short-term breastfeeding for a maximum of up to 6 months is suggested.

Transmission of tropical and geographically restricted infections during solid-organ transplantation

In recent years, the increasing number of donors from different regions of the world is providing a new challenge for the management and selection of suitable donors. This is a worldwide problem in most countries with transplantation programs, especially due to the increase in immigration and international travel. This paper elaborates recommendations regarding the selection criteria for donors from foreign countries who could potentially transmit tropical or geographically restricted infections to solid-organ transplant recipients. For this purpose, an extensive review of the medical literature focusing on viral, fungal, and parasitic infections that could be transmitted during transplantation from donors who have lived or traveled in countries where these infections are endemic has been performed, with special emphasis on tropical and imported infections. The review also includes cases described in the literature as well as risks of transmission during transplantation, microbiological tests available, and recommendations for each infection. A table listing different infectious agents with their geographic distributions and specific recommendations is included.