High prevalence of HTLV-I infection in Argentinian blood donors: a new HTLV-I-endemic area?

Lymphotropic Viruses EBV, KSHV and HTLV in Latin America: Epidemiology and Associated Malignancies. A Literature-Based Study by the RIAL-CYTED

The Epstein-Barr virus (EBV), Kaposi sarcoma herpesvirus (KSHV) and human T-lymphotropic virus (HTLV-1) are lymphomagenic viruses with region-specific induced morbidity. The RIAL-CYTED aims to increase the knowledge of lymphoma in Latin America (LA), and, as such, we systematically analyzed the literature to better understand our risk for virus-induced lymphoma. We observed that high endemicity regions for certain lymphomas, e.g., Mexico and Peru, have a high incidence of EBV-positive lymphomas of T/NK cell origin. Peru also carries the highest frequency of EBV-positive classical Hodgkin lymphoma (HL) and EBV-positive diffuse large B cell lymphoma, not otherwise specified (NOS), than any other LA country. Adult T cell lymphoma is endemic to the North of Brazil and Chile. While only few cases of KSHV-positive lymphomas were found, in spite of the close correlation of Kaposi sarcoma and the prevalence of pathogenic types of KSHV. Both EBV-associated HL and Burkitt lymphoma mainly affect young children, unlike in developed countries, in which adolescents and young adults are the most affected, correlating with an early EBV seroconversion for LA population despite of lack of infectious mononucleosis symptoms. High endemicity of KSHV and HTLV infection was observed among Amerindian populations, with differences between Amazonian and Andean populations.

[Detection of Human T lymphotropic virus 1 (HTLV-1) Cosmopolitan subtype Transcontinental subgroup (Aa) and HTLV-2 subtype b in blood donors of Corrientes]

A molecular epidemiological study was conducted in a population of 9422 blood donors in the province of Corrientes, Northeastern Argentina, to determine the prevalence of Human T-cell lymphotropic virus types 1 and 2 (HTLV-1/2), the phylogenetic identification of HTLV-1 and 2 subtypes/subgroups and perform a mutation analysis. Based on the results obtained, it was shown that both HTLV-1 and HTLV-2 are circulating in a low-risk population of Corrientes, although with a similar prevalence to that of non-endemic areas. Phylogenetic studies identified the HTLV-1 Cosmopolitan subtype Transcontinental subgroup (Aa), and the HTLV-2 subtype b. Infected donors reported neither a history of risk factors such as transfusions, intravenous drug use, nor risky or HTLV-1/2 seropositive sexual partners. These results suggest that these viruses were transmitted from mother to child, possibly from generation to generation, and that these strains were introduced into the Caucasian population of this region from ancestors originating from endemic areas of the country either from or through contact with individuals from other countries years ago. Our results demonstrate for the first time the presence of HTLV-1 and HTLV-2 in the province of Corrientes. Moreover, although the province can be considered a non-endemic area, the need to include these retroviruses in a national Public Health program is highlighted, in order to have qualified professionals duly trained to make their diagnosis and provide the necessary information in relation to primary care and patient follow-up.

Stable human T-cell lymphotropic virus type 1 (HTLV-1) subtype a/subgroup a endemicity in Amerindians from Northwest Argentina: a health problem to be resolved

Jujuy province, in Northwest Argentina, is known to be endemic for HTLV-1 infection. Moreover, foci of HTLV-1 associated pathologies have also been described in this region. To gain an insight into the current situation of HTLV-1/2 in this endemic area, a seroprevalence and phylogenetic study was performed among a Kolla community from Abra Pampa city and surroundings. Out of 112 individuals, 11 (9.8%) were confirmed as HTLV-1 positive and no HTLV-2 infection was detected. The phylogenetic analysis of the LTR region showed that all the HTLV-1 sequences belonged to the Cosmopolitan subtype a/transcontinental subgroup A, and were closely related to reference sequences from Peru, Argentina, and the South of Brazil (P = 0.82). Considering the cultural and historical features of this community and in spite of the mandatory detection of anti-HTLV-1/2 antibodies in blood banks since 2005, it would be important to implement new public health measures focused on decreasing HTLV-1 transmission in this endemic area.

HTLV-1a tax gene and long terminal repeat sequences from Argentinean strains reveal disagreement with tax restriction fragment length polymorphism subtyping

Sequence and cluster analysis have shown two HTLV-1a tax gene subgroups, tax A and tax B, which are related to long terminal repeat (LTR) molecular subtypes. On the basis of subgroup-specific nucleotide substitutions, restriction fragment length polymorphism (RFLP) analysis of the tax gene for subtyping HTLV-1a isolates was proposed. In this study we genetically characterized the tax gene from 63 HTLV-1-positive Argentinean individuals, including 14 patients with HTLV-1-associated myelopathy/tropical spastic paraparesis and 49 healthy HTLV-1 carriers. RFLP analysis showed that 48 samples yielded the tax A profile (76.19%) and that 15 samples contained the uncut tax B profile (23.81%). However, the LTR and tax sequence analysis revealed that in fact only 2 from the 15 samples belonged to the HTLV-1aB subgroup, presenting four tax B subgroup-specific nucleotide substitutions. The tax gene cluster analysis also confirmed that the majority of Argentinean strains belonged to the Transcontinental HTLV-1aA subgroup. These results indicate that the tax gene RFLP assay which has been proposed and used by some authors to screen HTLV-1a subgroups, is not a suitable tool to perform molecular epidemiological characterization of HTLV-1a populations.

Human T-cell lymphotropic virus types I and II (HTLV-I and -II) infection among seroindeterminate cases in Argentina

Human T-cell lymphotropic virus (HTLV) seroindeterminate cases have been reported among blood donors (BD) and in at-risk populations worldwide, including Argentina. The objective of the present work was to study the presence of HTLV-I/II infection and its association to specific Western blot (WB) patterns among healthy BD and at-risk populations in Argentina. We analyzed 83 HTLV-I/II seroindeterminate WB cases diagnosed among BD (n = 49) and in different at-risk populations (n = 34) for human retroviruses infections. Multiple indeterminate WB patterns were observed. Out of the total, 13.2% (11/83) of the cases were found to be HTLV-I/II positive by nested-PCR (n-PCR), including 13.2% (11/83) HTLV-I and 2.4% (2/83) presenting HTLV-I and -II co-infection. Most of their serological profiles showed reactivity to gag or env codified proteins. Two samples amplified only one of the six analyzed genes (1 HTLV-I pol gene and 1 HTLV-II tax gene). There was no association between the presence of Trypanosoma cruzi infection and an HTLV-I/II indeterminate WB pattern (only 3 of the 83 samples were positive for T. cruzi antibodies). In conclusion, the majority of HTLV-seroindeterminate WB donors lacked HTLV provirus and was thus considered uninfected. However, when seroreactivity to Env and Gag proteins are observed on the WB and especially in at-risk populations, HTLV infection should be suspected; such individuals should be followed-up and retested.

High prevalence of HTLV-I and HTLV-II among blood donors in Argentina: a South American health concern

After an HTLV-I endemic area was discovered in Jujuy, a northwestern province in Argentina, to detect other possible foci of HTLV-I/II we started in 1997 a multicentric study to estimate the seroprevalence of HTLV-I/II including blood banks from different regions of the country. Out of 123,233 samples from nine different provinces, 68 proved seropositive with a final prevalence of 0.05% (95% CI = 0.0432-0.0704%). The seroprevalence ranged from 0.03 to 0.16% depending on the geographic location. An HTLV-I [odds ratio (OR) 12.7, 95% confidence interval (CI), 3.43-47.60] prevalence significantly greater was found in the northwest (Salta Province) and a nonsignificant but higher prevalence of HTLV-II in the North (Chaco). Two (0.001%) of the seropositive blood donors reported risk factors due to receiving transfusions and 19 (0.01%) were born in HTLV-I/II South American endemic areas. Although Argentina has been considered a nonendemic country for HTLV-I/II, the need for systematic screening for such infection became imperative based on the present study.

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.

A possible case of myelopathy/tropical spastic paraparesis in an Argentinian woman with human T lymphocyte virus type II

A case of neurological disease featuring human T lymphocyte virus-associated myelopathy/tropical spastic paraparesis (HAM/TSP) was diagnosed by serological (Western blot) and molecular (polymerase chain reaction) criteria as related to human T lymphocyte virus (HTLV)-II infection. This is, to our knowledge, the first case of this kind found in Argentina and is additional evidence that HAM/TSP solely related to HTLV-II infection occurs in HTLV-I-negative subjects.

A cluster of human T-cell lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis in Jujuy, Argentina

Compared with other regions in Argentina, greater human T-cell lymphotropic virus type I (HTLV-I) seroprevalence has been reported in Jujuy Province, where it reaches 2.32% in the general population, so that a search for HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) cases deserved to be carried out. Accordingly, a clinically diagnosed and serologically confirmed cluster of cases in 1 man and 10 women, including 2 sisters, is described here. Most patients (9/11) were born in Cochinoca Department, located in an Andes highland area called Puna Jujeña, situated at more that 3400 m above sea level. No history of risk factors was disclosed, except for a single transfusion in 1 patient. In contrast to the Andean region of Bolivia, where high HTLV-I seroprevalence is in part attributable to Japanese immigrants, the Jujuy population mainly consists of aborigines, mestizos, and European descendants. Therefore, the long-term presence of virus in Jujuy natives may be taken for granted. Considering the HAM/TSP cluster described here plus previously reported isolated cases in neighboring Salta Province, we speculate that the Puna Jujeña region and regions in that vicinity would be a microepidemic focus of disease. To determine the role of possible pathogenic cofactors such as geographic, ethnic, genetic, and cultural features, further pertinent surveys are required in subtropical northwestern Argentina.

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.