Prevalence of human T-cell lymphotropic virus and the socio-demographic and risk factors associated with the infection among post-natal clinics women in Zaria, Nigeria

How do socioeconomic determinants of health affect the likelihood of living with HTLV-1 globally? A systematic review with meta-analysis

Introduction

Human T Lymphotropic Virus type 1 (HTLV-1) is a neglected retrovirus associated with many clinical disorders, most notably Adult T-cell Leukemia/Lymphoma and HTLV-1-Associated Myelopathy (HAM). Found in endemic clusters across the world, high prevalence has been reported in minoritized groups who suffer from health inequities. This study investigates the association between HTLV-1 prevalence and the following socioeconomic determinants of health: education, income, and employment, which are markers of health inequity.

Methods

A systematic review was conducted by searching the following databases: Ovid/Medline, Embase, Global Health Database, Web of Science, LILACS and SciELO. Primary studies in English, Spanish and Portuguese mentioning HTLV-1 and one of education, income and/or employment were included. A random-effects meta-analysis was performed, and odds ratios (OR) were calculated to determine the association between these socioeconomic determinants of health and HTLV-1 prevalence.

Results

42 studies were included. The likelihood of having HTLV-1 was higher in individuals with less than completed primary education compared to those who completed primary education (OR 1.86 [95% CI 1.34-2.57]; p < 0.01). This may be because individuals with low education have reduced access to and understanding of health information, thus increasing the prevalence of risk factors associated with HTLV-1 infection. No other determinants were found to be statistically significant.

Conclusion

Fewer years of schooling are associated with increased likelihood of contracting HTLV-1. Therefore, health promotion materials and public health policies regarding HTLV-1 must consider those with lower educational levels to effectively reduce disease transmission.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=335004, identifier (CRD42022335004).

Prevalence and Risk Factors for HTLV-1/2 Infection inRiverside and Rural Populations of the State of Pará

Human T-lymphotropic viruses 1 and 2 (HTLV-1 and HTLV-2) infection has been described in several Amazonian populations; however, there is still a lack of data on the prevalence of the virus in riparian populations living in rural areas of the state of Pará. The present study aimed to evaluate the prevalence of HTLV-1/2 infection in four riverine communities and one rural area in the state of Pará and to describe the possible risk factors for infection. A total of 907 individuals responded to an epidemiological survey and gave blood samples collected for anti-HTLV-1/2 antibodies by immunoenzymatic assay (EIA). The serum-reactive samples were subjected to confirmation by an in-line assay (Inno-Lia) and by proviral DNA screening using real-time PCR (qPCR). The total prevalence was 0.8% (7/907) for HTLV-1/2 (CI: 0.2−1.3%), with 0.66% HTLV-1 and 0.11% HTLV-2. The prevalence by sex was 0.7% in women (4/565) and 0.9% in men (3/342). Among seropositive patients, 83.3% (5/7) reported being sexually active, and 57.1% (4/7) reported not having the habit of using condoms during their sexual relations. Intrafamily infection was also observed. The results reinforce the need for public policies to prevent and block the spread of HTLV, especially in riparian communities that are subject to difficulties in accessing the Unified Health System (Sistema Único de Saúde/SUS) because infected individuals need clinical monitoring for surveillance and early diagnosis of symptoms associated with HTLV-1.

Occupational Therapy for People Living With Human T-Lymphotropic Virus 1: Importance and Effectiveness of an Intervention Plan at the Level of Prevention and Rehabilitation

Introduction

Human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy (HAM) restricts activities of daily living (ADLs), affecting health and quality of life. Occupational therapy is used to promote independence during ADL in people living with HTLV (PLHTLV).

Objective

To quantify the clinical aspects, levels of functionality, performance in ADLs and occupational roles of PLHTLV and propose an occupational therapeutic intervention.

Method

A cross-sectional, descriptive, observational study was designed with 40 PLHTLV monitored at two referral laboratories of the Federal University of Pará. The Evandro Chagas Research Institute Neurological Disability Scale (EIPEC-2), the Barthel Index and the Occupational Roles Identification List were applied. The G test and Fisher’s exact test (to identify associations between qualitative variables), the Mann–Whitney test (to identify associations between quantitative variables) and Pearson correlation analysis (to identify associations between the total Barthel Index and EIPEC-2 scores) were performed with Microsoft Excel and BioEstat 5.0, and the significance level was set at p ≤ 0.05.

Results

Motor aspects, the presence of spasticity, sensory aspects, and pain in the lumbar region and lower limbs were significantly (p = 0.0002) higher among symptomatic individuals, who also had more difficulties urinating, traveling up and down stairs and transferring from a chair to a bed. Being a worker, performing housework and socializing (with friends or family members) were the most affected activities among HAM patients.

Conclusion

The impact of HAM on PLHTLV should include an intervention plan with occupational therapists in rehabilitation programs to create an important third-level prevention initiative, which may help achieve short-, medium-, and long-term goals. Asymptomatic PLHTLV should also be able to prevent future ADL impairment.

Brazilian Protocol for Sexually Transmitted Infections 2020: human T-cell lymphotropic virus (HTLV) infection

This article addresses the Human T-lymphotropic virus (HTLV). This subject comprises the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health. HTLV-1/2 infection is a public health problem globally, and Brazil has the largest number of individuals living with the virus. HTLV-1 causes several clinical manifestations of neoplasm (adult T-cell leukemia/lymphoma) and inflammatory nature, such as HTLV-1-associated myelopathy and other manifestations such as uveitis, arthritis, and infective dermatitis. These pathologies have high morbidity and mortality and negatively impact the quality of life of infected individuals. This review includes relevant information for health authorities professionals regarding viral transmission, diagnosis, treatment, and monitoring of individuals living with HTLV-1 and 2 in Brazil.

HTLV-1/2 transmission can occur through blood transfusion and derivatives, injectable drug use, organ transplantation, unprotected sexual intercourse, and vertical transmission.

[Brazilian Protocol for Sexually Transmitted Infections 2020: human T cell lymphotropic virus (HTLV) infection]

This manuscript is related to the chapter about human T-cell lymphotropic virus (HTLV) that is part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Health Ministry. HTLV-1/2 infection is a worldwide public health problem and Brazil has the largest number of individuals living with the virus. HTLV-1 causes a variety of clinical manifestations of a neoplastic nature, such as adult leukemia/T-cell lymphoma, and also of an inflammatory nature, such as HTLV-1-associated myelopathy, as well as other manifestations such as uveitis, arthritis and infective dermatitis. These pathologies have high morbidity and mortality and negatively impact the quality of life of infected individuals. This review includes relevant information for health service managers and workers regarding virus transmission modes, diagnosis, treatment and monitoring of individuals living with HTLV-1 and 2 in Brazil.

Sero-epidemiology of human T-cell lymphotropic viruses-1 and -2 infection among pregnant women attending Abuja Teaching Hospital, Nigeria

BACKGROUND

There is the paucity of HTLV-1/-2 studies on Nigerian pregnant women despite the medical and public health significance of maternal-to-child transmission of HTLV-1/-2.

OBJECTIVE

This study aims to determine the seroprevalence and risk factors of HTLV-1/-2 infections among pregnant women attending the University of Abuja Teaching Hospital (UATH), Abuja, Nigeria.

MATERIALS AND METHODS

Blood samples were collected from consented pregnant women and analysed for ant-HTLV-1/-2 total antibodies using a commercial Enzyme-Linked Immunosorbent Assay (ELISA) kit. Pretested structured questionnaires were used to collate participants' socio-demographic variables and risk factors of HTLV infection.

RESULTS

Out of the 156 pregnant women tested for HTLV-1/-2 antibodies, 16 (10.3%) were seropositive. There was no significant association between the socio-demographic variables collated and seroprevalence of HTLV-1/-2 infection among pregnant women (p> 0.05). Pregnant women with HIV infection had a lower prevalence of HLTV-1/-2 infection than those without HIV infections (7.5% versus 11.7%). Pregnant women with multiple sexual partners had a higher risk of HTLV-1/-2 infection than those who had single (OR = 2.08, 95% CI: 0.53-8.18). Women with a history of needles injury had a higher risk of HTLV-1/-2 infection than those who do not (OR = 1.24, 95% CI: 0.38-4.08). The history of blood transfusion was significantly associated with HTLV-1/-2 infection (p= 0.027). However, no significant association existed between other risk factors of HTLV-1/-2 infection among pregnant women (p> 0.05).

CONCLUSION

Considering the 3% pooled national prevalence of HTLV-1/-2 infection in Nigeria, the seroprevalence reported in this study is relatively high. Thus, there is a need for more large cohort studies and routine screening of population at increased risk of infection.

The challenge of describing the epidemiology of HTLV in the Amazon region of Brazil

HTLV-1 was the first described human retrovirus and was soon found to be associated with severe clinical diseases, including a devastating lymphoma/leukemia and other inflammatory diseases. Although HTLV-2 is not usually pathogenic, it is widely distributed among native Indian populations in Brazil, particularly in the Amazon region of the country. Presently, HTLV spreads mainly by the sexual route and from mother to child, and virus persistence is an active biological factor aiding its transmission. Recently, the use of illicit drugs has been shown to be an additional risk factor, showing the influence of new habits on the epidemiology of HTLV in the region. Despite the detection of the virus in several different populations in the Amazon region of Brazil for almost 30 years, the exact prevalence of HTLV-1/2 is not well defined. The original biases in sampling and the selection of epidemiologically unsuitable populations were commonly repeated in most prevalence studies, generating unreliable and conflicting figures that do not represent the actual prevalence of HTLV. The improvements in clinical and laboratory facilities have resulted in the description of several clinical manifestations that were previously unknown in the region. The extent of the spread of the virus must be defined in this region, which is the largest geographical area of the country. As prophylaxis advances toward the use of vaccines against HTLV-1, it is important to determine who is at risk of being infected and developing a disease to successfully implement preventive measures, particularly as proposals are made to eradicate the virus among humans.