HTLV infection in England and Wales in 2002--results from an enhanced national surveillance system

Human T-cell lymphotropic virus (HTLV) is a retrovirus transmitted through breastfeeding, sexual contact, blood transfusion and injecting drug use. HTLV is endemic in the Caribbean and parts of Africa, Japan and South America, with isolated foci in other areas. Infection is life-long. Less than 5% of those infected progress to one of the HTLV-related diseases, but these are debilitating and often fatal. Laboratory reports of new HTLV diagnoses are followed up through clinicians to establish information such as probable country of infection, country of birth, clinical details and reason for test. Clinician reports are also received for HTLV-infected blood donors identified by the National Blood Service. Seventy-seven individuals newly diagnosed with HTLV infection in 2002 were reported to the Communicable Disease Surveillance Centre (CDSC) by June 2003. Thirty-three (43%) were male, and 44 (57%) female, with median ages at diagnosis of 58.5 and 50.1 years respectively. Seventy-three (95%) individuals were HTLV-I positive and three HTLV-II positive, with one remaining untyped. For 52 of the 77 infections, clinician reports were received. Where ethnicity was reported (48), 30 (63%) were Black Caribbean, 12 (25%) White, and the remainder (6) of other ethnicities. Probable route of infection was reported for 31 individuals: nine (29%) were probably infected heterosexually, seven (23%) through mother-to-child transmission, 12 (40%) through either route, two through blood transfusion, and one through injecting drug use (HTLV-II positive). Where probable country of infection was reported (31), 14 (45%) were probably infected in the UK, 13 (42%) in the Caribbean, and four elsewhere. Where reported (50), reason for test was: symptoms for 19 (38%) individuals, blood donation for 21 (42%), and the remainder for other reasons. Numbers of new HTLV diagnoses were relatively high in 2002, and the characteristics of patients and clinical presentations differed from previous years, mainly due to the introduction of blood donor testing for anti-HTLV. Beyond 2004, the number of HTLV-infected individuals detected through blood donation is expected to decline. While numbers of individuals affected are small compared to many other diseases, the infection is chronic and untreatable, and it is important that adequate standards of diagnosis, prevention, care and support are provided, and surveillance maintained.

In the shadow of HIV-HTLV infection in England and Wales, 1987-2001

Like human immunodeficiency virus (HIV), human T-cell leukaemia/ lymphoma viruses (HTLV) I and II are persistent retroviral infections. Once infected, the lifetime risk of developing the HTLV-associated diseases, malignant or inflammatory, is low (approximately 5%). For those affected, however, these diseases are debilitating, with few treatment options and a poor prognosis. Surveillance of HTLV infections by the Communicable Disease Surveillance Centre (CDSC) has been ongoing since serological testing became available in 1986. Testing of blood donations in England and Wales commenced during August 2002 and awareness of HTLV infection is likely to increase. Therefore, a baseline retrospective review of cases prior to 2002 was conducted. The age and sex distribution of identified HTLV cases has differed little over time. Eighty-five per cent of individuals were linked to the Caribbean by birthplace or ethnicity. Though HTLV infection is chronic and incurable, preventive measures are possible. Improved surveillance is needed to support effective prevention activities.

Black Caribbean adults with HIV in England, Wales, and Northern Ireland: an emerging epidemic?

BACKGROUND

HIV is now well established in the Caribbean, with prevalence in several countries being surpassed only by those of sub-Saharan Africa. Continuing inward migration from the Caribbean and a high incidence of some bacterial STIs among Britain's black Caribbean communities, suggests a considerable potential for HIV spread.

METHODS

Data from three national HIV/AIDS surveillance systems were reviewed, providing information on new HIV diagnoses, numbers accessing treatment and care services, and HIV prevalence.

RESULTS

Between 1997 and 2001, 528 black Caribbean adults were newly diagnosed with HIV; 62 new diagnoses in 1997, rising to 176 in 2001. Probable heterosexual acquisition accounted for 335 (63%) infections (161 (48%) males, 174 females), and sex between men 171 (32%). Infection was acquired both in the Caribbean and in the United Kingdom. Numbers of black Caribbeans accessing treatment and care services more than doubled between 1997 (294) and 2001 (691). In 2001, 528 (76%) black Caribbeans accessing services were London residents. Among the Caribbean born previously undiagnosed heterosexuals, HIV prevalence was 0.7%; among men who have sex with men (MSM) it was 10.4%. Of those born in the Caribbean, 73% of male heterosexuals, 50% of female heterosexuals, and 65% of MSM who were previously undiagnosed left the clinic unaware of their HIV infection.

CONCLUSIONS

Numbers of black Caribbean adults newly diagnosed and accessing treatment and care services in England, Wales, and Northern Ireland increased between 1997 and 2001. Despite a high prevalence of diagnosed bacterial STIs, prevalence among Caribbean born heterosexuals remains low, but it is high among MSM. Surveillance data highlight the need for targeted HIV prevention among black Caribbeans.