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Gessain A, Ramassamy JL, Afonso PV, Cassar O. Geographic distribution, clinical epidemiology and genetic diversity of the human oncogenic retrovirus HTLV-1 in Africa, the world's largest endemic area. Front Immunol 2023; 14:1043600. [PMID: 36817417 PMCID: PMC9935834 DOI: 10.3389/fimmu.2023.1043600] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/04/2023] [Indexed: 02/05/2023] Open
Abstract
The African continent is considered the largest high endemic area for the oncogenic retrovirus HTLV-1 with an estimated two to five million infected individuals. However, data on epidemiological aspects, in particular prevalence, risk factors and geographical distribution, are still very limited for many regions: on the one hand, few large-scale and representative studies have been performed and, on the other hand, many studies do not include confirmatory tests, resulting in indeterminate serological results, and a likely overestimation of HTLV-1 seroprevalence. For this review, we included the most robust studies published since 1984 on the prevalence of HTLV-1 and the two major diseases associated with this infection in people living in Africa and the Indian Ocean islands: adult T-cell leukemia (ATL) and tropical spastic paraparesis or HTLV-1-associated myelopathy (HAM/TSP). We also considered most of the book chapters and abstracts published at the 20 international conferences on HTLV and related viruses held since 1985, as well as the results of recent meta-analyses regarding the status of HTLV-1 in West and sub-Saharan Africa. Based on this bibliography, it appears that HTLV-1 distribution is very heterogeneous in Africa: The highest prevalences of HTLV-1 are reported in western, central and southern Africa, while eastern and northern Africa show lower prevalences. In highly endemic areas, the HTLV-1 prevalence in the adult population ranges from 0.3 to 3%, increases with age, and is highest among women. In rural areas of Gabon and the Democratic Republic of the Congo (DRC), HTLV-1 prevalence can reach up to 10-25% in elder women. HTLV-1-associated diseases in African patients have rarely been reported in situ on hospital wards, by local physicians. With the exception of the Republic of South Africa, DRC and Senegal, most reports on ATL and HAM/TSP in African patients have been published by European and American clinicians and involve immigrants or medical returnees to Europe (France and the UK) and the United States. There is clearly a huge underreporting of these diseases on the African continent. The genetic diversity of HTLV-1 is greatest in Africa, where six distinct genotypes (a, b, d, e, f, g) have been identified. The most frequent genotype in central Africa is genotype b. The other genotypes found in central Africa (d, e, f and g) are very rare. The vast majority of HTLV-1 strains from West and North Africa belong to genotype a, the so-called 'Cosmopolitan' genotype. These strains form five clades roughly reflecting the geographic origin of the infected individuals. We have recently shown that some of these clades are the result of recombination between a-WA and a-NA strains. Almost all sequences from southern Africa belong to Transcontinental a-genotype subgroup.
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Affiliation(s)
- Antoine Gessain
- Institut Pasteur, Université Paris Cité, CNRS UMR 3569, Unité d'Épidémiologie et Physiopathologie des Virus Oncogènes, Paris, France
| | - Jill-Léa Ramassamy
- Institut Pasteur, Université Paris Cité, CNRS UMR 3569, Unité d'Épidémiologie et Physiopathologie des Virus Oncogènes, Paris, France
| | - Philippe V Afonso
- Institut Pasteur, Université Paris Cité, CNRS UMR 3569, Unité d'Épidémiologie et Physiopathologie des Virus Oncogènes, Paris, France
| | - Olivier Cassar
- Institut Pasteur, Université Paris Cité, CNRS UMR 3569, Unité d'Épidémiologie et Physiopathologie des Virus Oncogènes, Paris, France
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Legrand N, McGregor S, Bull R, Bajis S, Valencia BM, Ronnachit A, Einsiedel L, Gessain A, Kaldor J, Martinello M. Clinical and Public Health Implications of Human T-Lymphotropic Virus Type 1 Infection. Clin Microbiol Rev 2022; 35:e0007821. [PMID: 35195446 PMCID: PMC8941934 DOI: 10.1128/cmr.00078-21] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Human T-lymphotropic virus type 1 (HTLV-1) is estimated to affect 5 to 10 million people globally and can cause severe and potentially fatal disease, including adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The burden of HTLV-1 infection appears to be geographically concentrated, with high prevalence in discrete regions and populations. While most high-income countries have introduced HTLV-1 screening of blood donations, few other public health measures have been implemented to prevent infection or its consequences. Recent advocacy from concerned researchers, clinicians, and community members has emphasized the potential for improved prevention and management of HTLV-1 infection. Despite all that has been learned in the 4 decades following the discovery of HTLV-1, gaps in knowledge across clinical and public health aspects persist, impeding optimal control and prevention, as well as the development of policies and guidelines. Awareness of HTLV-1 among health care providers, communities, and affected individuals remains limited, even in countries of endemicity. This review provides a comprehensive overview on HTLV-1 epidemiology and on clinical and public health and highlights key areas for further research and collaboration to advance the health of people with and at risk of HTLV-1 infection.
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Affiliation(s)
- Nicolas Legrand
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Skye McGregor
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Rowena Bull
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sahar Bajis
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | | | - Amrita Ronnachit
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Lloyd Einsiedel
- Central Australian Health Service, Alice Springs, Northern Territory, Australia
| | - Antoine Gessain
- Institut Pasteur, Epidemiology and Physiopathology of Oncogenic Viruses Unit, Paris, France
| | - John Kaldor
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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Berzow D, Descamps D, Obermeier M, Charpentier C, Kaiser R, Guertler L, Eberle J, Wensing A, Sierra S, Ruelle J, Gomes P, Mansinho K, Taylor N, Jensen B, Döring M, Stürmer M, Rockstroh J, Camacho R. Human Immunodeficiency Virus-2 (HIV-2): A Summary of the Present Standard of Care and Treatment Options for Individuals Living with HIV-2 in Western Europe. Clin Infect Dis 2021; 72:503-509. [PMID: 32227124 DOI: 10.1093/cid/ciaa275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/12/2020] [Indexed: 11/13/2022] Open
Abstract
Human immunodeficiency virus-2 (HIV-2) is endemic in some countries in West Africa. Due to the lower prevalence in industrialized countries, there is limited experience and knowledge on the management of individuals living with HIV-2 in Europe. Compared to HIV-1, there are differential characteristics of HIV-2 regarding diagnostic procedures, the clinical course, and, most importantly, antiretroviral therapy. We integrated the published literature on HIV-2 (studies and reports on epidemiology, diagnostics, the clinical course, and treatment), as well as expert experience in diagnosing and clinical care, to provide recommendations for a present standard of medical care of those living with HIV-2 in Western European countries, including an overview of strategies for diagnosis, monitoring, and treatment, with suggestions for effective drug combinations for first- and second-line treatments, post-exposure prophylaxis, and the prevention of mother-to-child transmission, as well as listings of mutations related to HIV-2 drug resistance and C-C motif chemokine receptor type 5 and C-X-C motif chemokine receptor type 4 coreceptor tropism.
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Affiliation(s)
- Dirk Berzow
- Praxis for Infectiology, Hamburg, Germany.,Deutsche Arbeitsgemeinschaft niedergelassener Ärzte in der Versorgung HIV-Infizierter (DAGNAE) Berlin, Germany
| | - Diane Descamps
- Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Paris, France.,Université de Paris, Institut national de la santé et de la recherche médicale (INSERM), Unité mixte de recherche (UMR),1137, Laboratory Infection, Antimicrobials, Modelling, Evolution (IAME), Paris, France
| | - Martin Obermeier
- Deutsche Arbeitsgemeinschaft niedergelassener Ärzte in der Versorgung HIV-Infizierter (DAGNAE) Berlin, Germany.,Medical Center for Infectious Diseases, Berlin, Germany.,Gesellschaft für Virologie e.V., Freiburg, Germany
| | - Charlotte Charpentier
- Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Paris, France.,Université de Paris, Institut national de la santé et de la recherche médicale (INSERM), Unité mixte de recherche (UMR),1137, Laboratory Infection, Antimicrobials, Modelling, Evolution (IAME), Paris, France
| | - Rolf Kaiser
- Gesellschaft für Virologie e.V., Freiburg, Germany.,Institute of Virology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,German AIDS Society (Deutsche AIDS-Gesellschaft, DAIG), Hamburg, Germany.,Paul-Ehrlich-Gesellschaft für Chemotherapie, Rheinbach, Germany
| | - Lutz Guertler
- Gesellschaft für Virologie e.V., Freiburg, Germany.,German AIDS Society (Deutsche AIDS-Gesellschaft, DAIG), Hamburg, Germany.,National Reference Center for Retroviruses, Max von Pettenkofer Institute for Hygiene and Medical Microbiology, University of Munich, Munich, Germany
| | - Josef Eberle
- Gesellschaft für Virologie e.V., Freiburg, Germany.,German AIDS Society (Deutsche AIDS-Gesellschaft, DAIG), Hamburg, Germany.,National Reference Center for Retroviruses, Max von Pettenkofer Institute for Hygiene and Medical Microbiology, University of Munich, Munich, Germany
| | - Annemarie Wensing
- European AIDS Clinical Society, Brussels, Belgium.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Saleta Sierra
- Institute of Virology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Jean Ruelle
- Laboratories Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Perpetua Gomes
- Instituto Universitário Egas Moniz, Lisboa, Portugal.,Molecular Biology Laboratory, Laboratório de Biologia Molecular, Centro Hospitalar de Lisboa Ocidental, Egas Moniz Hospital, Lisboa, Portugal
| | - Kamal Mansinho
- Centro Hospitalar de Lisboa Occidental, Hospital de Egas Moniz, Lisboa, Portugal
| | - Ninon Taylor
- Third Medical Department with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Björn Jensen
- Paul-Ehrlich-Gesellschaft für Chemotherapie, Rheinbach, Germany.,Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine University Hospital, Düsseldorf, Germany
| | - Matthias Döring
- Department for Computational Biology and Applied Algorithmics, Max-Planck Institute for Informatics, Saarland Informatics Campus, Saarbrücken, Germany
| | - Martin Stürmer
- Medizinisches Versorgungszentrum, Frankfurt am Main, Germany
| | - Jürgen Rockstroh
- European AIDS Clinical Society, Brussels, Belgium.,Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | - Ricardo Camacho
- Katholieke Universiteit, Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Leuven, Belgium
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Kjerulff B, Petersen MS, Rodrigues CM, da Silva Té D, Christiansen M, Erikstrup C, Hønge BL. HTLV infected individuals have increased B-cell activation and proinflammatory regulatory T-cells. Immunobiology 2019; 225:151878. [PMID: 31810824 DOI: 10.1016/j.imbio.2019.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
Abstract
Human T-lymphotropic virus (HTLV) affects the human immune system in many ways, most notably by inducing proliferation of infected CD4 + T cells, but several other cell types are also affected. To characterize the effects of HTLV infection, we analysed blood samples from HTLV-infected individuals by flow cytometry. Samples were collected from visitors at the HIV clinic in Bissau, Guinea-Bissau. These samples were tested for HTLV and HIV, and 199 were analysed by flow cytometry using panels for B cells, T-cell maturation and activation, regulatory T cells (Tregs) and monocytes. CD80+ cell proportions were significantly higher in HTLV infected than in HTLV uninfected in all B cell subsets. Among T cells, there was no change in cell distribution between maturation stages, but a higher CD25+ proportion among Tregs (61.1 % vs 36.3 %, p < 0.001) in HTLV infected than in HTLV uninfected. The level of CD49d on individual cells was also higher (MFI 2734.5 vs 1,041, p < 0.001). In HTLV infected individuals, CD8 + T cells had a lower proportion of CTLA-4+ (2.5 % vs 3.5 %, 0.048) and higher PD1+ proportion on the CD45RO + subset (81.6 % vs 77.1 %, p < 0.001). Together, these findings point toward reduced regulation in HTLV + patients, which leads to immune activation. This study corroborates previous findings and offers new insight into the effects of HTLV by providing a broad flowcytometric analysis of immune cells in HTLV + individuals.
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Affiliation(s)
- Bertram Kjerulff
- Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Skejby, Denmark.
| | - Mikkel Steen Petersen
- Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Skejby, Denmark
| | | | | | - Mette Christiansen
- Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Skejby, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Skejby, Denmark
| | - Bo Langhoff Hønge
- Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Skejby, Denmark; Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau; Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Skejby, Denmark
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5
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Kjerulff B, Hønge BL, Olesen JS, Jensen MM, da Silva ZJ, Erikstrup C, Christiansen M. Phylogeny of human T-lymphotropic virus-1 subtypes in Guinea-Bissau. Trans R Soc Trop Med Hyg 2019; 112:175-180. [PMID: 29733405 DOI: 10.1093/trstmh/try039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/13/2018] [Indexed: 11/14/2022] Open
Abstract
Background Human T-cell leukaemia/lymphoma virus type 1 (HTLV-1) was the first human retrovirus discovered and there is an estimate of 15-20 million infected worldwide. Endemic areas are Japan, West Africa, Central Africa, South America, the Caribbean, Middle East, Australia and the Pacific Islands. In Guinea-Bissau, adult HTLV-1 prevalence is 2-3%, and higher among HIV-infected patients. Materials and methods Blood samples were collected in a recent HIV/HTLV survey in Bissau, the capital of Guinea-Bissau. Initially, participants were tested for HTLV serologically. The p24 and LTR regions of the proviral genome were then attempted sequenced. Sequences were analysed phylogenetically and compared with reference sequences for HTLV-1. Results A total of 3% (78/2583) participants were positive on chemiluminesent assay, six additional samples came from another study. Of the 84 seropositive participants we successfully performed sequencing on samples, from 66 participants, 17 were positive for LTR only, one for p24 only and 48 for both. Sequences were in subgroup D of HTLV-1a cosmopolitan, while HTLV-1g was present in one participant. Conclusion HTLV-1a subgroup D and, to a lesser extent HTLV-1g, is present in Guinea-Bissau and sequences are very similar, especially within households. Presence of HTLV-1g indicates monkey-to-man zoonotic events and at least two circulating HTLV strains in Guinea-Bissau. New sequences accession numbers MG387979-MG388043 for LTR and MG388044-MG388092 for p24.
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Affiliation(s)
- Bertram Kjerulff
- Aarhus University Hospital Skejby, Department of Clinical Immunology, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Bo Langhoff Hønge
- Aarhus University Hospital Skejby, Department of Clinical Immunology, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Bandim Health Project, Bissau, Guinea-Bissau
| | | | | | | | - Christian Erikstrup
- Aarhus University Hospital Skejby, Department of Clinical Immunology, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Bandim Health Project, Bissau, Guinea-Bissau
| | - Mette Christiansen
- Aarhus University Hospital Skejby, Department of Clinical Immunology, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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6
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Jensen MM, Olesen JS, Kjerulff B, Byberg S, da Silva ZJ, Rodrigues A, Jespersen S, Wejse C, Aaby P, Erikstrup C, Hønge BL. HTLV prevalence is no longer following the decreasing HIV prevalence - 20 years of retroviral surveillance in Guinea-Bissau, West Africa. Acta Trop 2019; 192:144-150. [PMID: 30771284 DOI: 10.1016/j.actatropica.2019.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 02/09/2019] [Accepted: 02/12/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND The HIV-2 and HTLV-1 prevalences in Bissau have followed similar trends in surveys from 1996 and 2006 with HTLV-1 prevalences of 3.6% and 2.3%, respectively. However, following the introduction of antiretroviral treatment (ART) and informative campaigns about HIV, the epidemics may have shifted. To evaluate the current HTLV prevalence and the continued association with HIV, we performed a third survey. METHODS A cross-sectional survey was performed from November 2014 to February 2016. In total, 2583 participants were interviewed, tested for HIV, and had blood samples collected. Samples were analysed for anti-HTLV using chemiluminescence and immunoblot assays. We calculated the HTLV prevalence for 2016 and examined risk factors for HTLV and associations with HIV using binominal regression. RESULTS The prevalence of HTLV was 2.8% (71/2583), 1.5% (16/1,089) for men and 3.7% (55/1,494) for women. Old age, female sex, HIV-2 infection and sharing a house with a HTLV- infected person were strong risk factors for HTLV. In contrast to previous studies, we found a non-significant increase in prevalence among the 15-24 year-olds since 2006, supporting ongoing transmission. CONCLUSIONS The HTLV prevalence in Bissau showed a non-significant increase. We found evidence supporting continuous vertical and horizontal routes of transmissions.
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Stewart J, Heitzinger K, Pollett S, Calderón M, Alarcón J, Ton TGN, Zunt JR. The Changing Epidemiology of Human T-Cell Lymphotropic Virus Type 1 Infection in Peruvian Female Sex Workers, 1993-2010. Am J Trop Med Hyg 2016; 96:373-379. [PMID: 27879458 DOI: 10.4269/ajtmh.16-0014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 10/10/2016] [Indexed: 11/07/2022] Open
Abstract
Human T-cell lymphotropic virus type 1 (HTLV-1) was the first human retrovirus to be reported and is associated with neoplastic, neurological, autoimmune, and infectious complications. HTLV-1 is endemic in Peru, with the highest prevalence reported among commercial sex workers. Seroprevalence data collected from Peruvian female sex workers (FSWs) working in Callao over three study periods between 1993 and 2010 were used to examine the secular trend in HTLV-1 prevalence. Between 1993 and 2010, the prevalence of HTLV-1 decreased significantly from 14.5% to 3.1% (P < 0.01). The prevalence of HTLV-1 seropositivity differed significantly by birth cohort (1922-1959, 1960-1969, 1970-1979, and 1980-1992), and for each of the four birth cohorts, the prevalence did not significantly decrease by screening year (P > 0.07). There were no cases of HTLV-1 detected among FSW born after 1979 (N = 224). Participant characteristics associated with HTLV-1 seropositivity were birth in the Andes Mountains region, age, increased time in sex work, younger age of starting sex work, and human immunodeficiency virus (HIV) seropositivity. The secular trend in declining prevalence persisted after adjustment for age, time in sex work, place of birth, and HIV serostatus, with the odds of HTLV-1 infection decreasing approximately 16% per year (adjusted odds ratio = 0.84, 95% confidence interval = 0.78, 0.90). The increasing use of condoms by later birth cohorts noted in our analysis, as well as the increasing availability of free condoms provided by the Peruvian government-which started in the late 1980s before this study-may have been responsible for declining HTLV seroprevalence.
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Affiliation(s)
- Jenell Stewart
- Department of Internal Medicine, University of Washington, Seattle, Washington.
| | - Kristen Heitzinger
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Simon Pollett
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - Martha Calderón
- Clínica de Salud Pública "Alberto Barton" del Callao, Callao, Peru
| | - Jorge Alarcón
- Instituto de Medicina Tropical, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Thanh G N Ton
- Department of Global Health and Neurology, University of Washington, Seattle, Washington
| | - Joseph R Zunt
- Department of Internal Medicine, University of Washington, Seattle, Washington.,Department of Epidemiology, University of Washington, Seattle, Washington.,Department of Global Health and Neurology, University of Washington, Seattle, Washington
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8
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Einsiedel L, Woodman RJ, Flynn M, Wilson K, Cassar O, Gessain A. Human T-Lymphotropic Virus type 1 infection in an Indigenous Australian population: epidemiological insights from a hospital-based cohort study. BMC Public Health 2016; 16:787. [PMID: 27526923 PMCID: PMC4986258 DOI: 10.1186/s12889-016-3366-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 07/23/2016] [Indexed: 11/17/2022] Open
Abstract
Background The Human T Lymphotropic Virus type 1 (HTLV-1) subtype C is endemic to central Australia where each of the major sequelae of HTLV-1 infection has been documented in the socially disadvantaged Indigenous population. Nevertheless, available epidemiological information relating to HTLV-1c infection is very limited, risk factors for transmission are unknown and no coordinated program has been implemented to reduce transmission among Indigenous Australians. Identifying risk factors for HTLV-1 infection is essential to direct strategies that could control HTLV-1 transmission. Methods Risk factors for HTLV-1 infection were retrospectively determined for a cohort of Indigenous Australians who were tested for HTLV-1 at Alice Springs Hospital (ASH), 1st January 2000 to 30th June 2013. Demographic details were obtained from the ASH patient management database and the results of tests for sexually transmitted infections (STI) were obtained from the ASH pathology database. Results Among 1889 Indigenous patients whose HTLV-1 serostatus was known, 635 (33.6 %) were HTLV-1 Western blot positive. Only one of 77 (1.3 %) children tested was HTLV-1 infected. Thereafter, rates progressively increased with age (15–29 years, 17.3 %; 30–49 years, 36.2 %; 50–64 years, 41.7 %) reaching 48.5 % among men aged 50–64 years. In a multivariable model, increasing age (OR, 1.04; 95 % CI, 1.03–1.04), male gender (OR, 1.41; 95 % CI, 1.08–1.85), residence in the south (OR, 10.7; 95 % CI, 7.4–15.6) or west (OR, 4.4; 95 % CI, 3.1–6.3) of central Australia and previous STI (OR, 1.42; 95 % CI, 1.04–1.95) were associated with HTLV-1 infection. Infection was acquired by three of 351 adults who were tested more than once during the study period (seroconversion rate, 0.24 (95 % CI = 0.18–2.48) per 100 person-years). Conclusions This study confirms that HTLV-1 is highly endemic to central Australia. Although childhood infection was documented, HTLV-1 infection in adults was closely associated with increasing age, male gender and STI history. Multiple modes of transmission are therefore likely to contribute to high rates of HTLV-1 infection in the Indigenous Australian population. Future strategies to control HTLV-1 transmission in this population require careful community engagement, cultural understanding and Indigenous leadership.
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Affiliation(s)
- Lloyd Einsiedel
- Flinders University/Northern Territory Rural Clinical School, Alice Springs Hospital, Rubuntja Building, 0870, Northern Territory, Australia. .,Aboriginal Health Unit, BakerIDI,central Australia, Alice Springs Hospital, 0870, Northern Territory, Australia.
| | - Richard J Woodman
- Flinders University/Northern Territory Rural Clinical School, Alice Springs Hospital, Rubuntja Building, 0870, Northern Territory, Australia
| | - Maria Flynn
- Flinders University/Northern Territory Rural Clinical School, Alice Springs Hospital, Rubuntja Building, 0870, Northern Territory, Australia
| | - Kim Wilson
- National Serological Reference Laboratory, Melbourne, Australia
| | - Olivier Cassar
- Institut Pasteur, Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, F-75015, Paris, France.,CNRS, UMR 3569, 28 Rue du Dr. Roux, F-75015, Paris, France
| | - Antoine Gessain
- Institut Pasteur, Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, F-75015, Paris, France.,CNRS, UMR 3569, 28 Rue du Dr. Roux, F-75015, Paris, France
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9
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Fox JM, Mutalima N, Molyneux E, Carpenter LM, Taylor GP, Bland M, Newton R, Martin F. Seroprevalence of HTLV-1 and HTLV-2 amongst mothers and children in Malawi within the context of a systematic review and meta-analysis of HTLV seroprevalence in Africa. Trop Med Int Health 2016; 21:312-24. [PMID: 26700941 PMCID: PMC4819700 DOI: 10.1111/tmi.12659] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Human T-lymphotropic virus (HTLV)-1 causes T-cell leukaemia and myelopathy. Together with HTLV-2, it is endemic in some African nations. Seroprevalence data from Malawi are scarce, with no reports on associated disease incidence. HTLV seroprevalence and type were tested in 418 healthy mothers from Malawi. In addition, we tested the sera of 534 children to investigate mother-to-child transmission. To provide context, we conducted a systematic review and meta-analysis of HTLV seroprevalence in African women and children. METHODS Stored samples from a previous childhood cancer and BBV study were analysed. ELISA was used for HTLV screening followed by immunoblot for confirmation and typing. Standard methods were used for the systematic review. RESULTS HTLV seroprevalence was 2.6% (11/418) in mothers and 2.2% (12/534) in children. Three mothers carried HTLV-1 alone, seven had HTLV-2 and one was dually infected. Three children carried HTLV-1 alone, seven had HTLV-2 and two were dually infected. Only two corresponding mothers of the 12 HTLV-positive children were HTLV positive. The systematic review included 66 studies of women and 13 of children conducted in 25 African countries. Seroprevalence of HTLV-1 varied from 0 to 17% and of HTLV-2 from 0 to 4%. CONCLUSIONS In contrast to findings from other studies in Africa, the seroprevalence of HTLV-2 was higher than that of HTLV-1 in Malawi and one of the highest for the African region. The lack of mother-child concordance suggests alternative sources of infection among children. Our data and analyses contribute to HTLV prevalence mapping in Africa.
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Affiliation(s)
- James M Fox
- Centre for Immunology and Infection, Department of Biology and Hull York Medical School, University of York, York, UK
| | - Nora Mutalima
- Health Sciences, University of York, York, UK.,Department of Orthopaedic Surgery, Monash Health, Melbourne, Australia
| | - Elizabeth Molyneux
- Paediatric Department, College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - Graham P Taylor
- National Centre for Human Retrovirology/HTLV clinic, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | | | - Robert Newton
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Fabiola Martin
- Centre for Immunology and Infection, Department of Biology and Hull York Medical School, University of York, York, UK
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Gessain A, Cassar O. Epidemiological Aspects and World Distribution of HTLV-1 Infection. Front Microbiol 2012; 3:388. [PMID: 23162541 PMCID: PMC3498738 DOI: 10.3389/fmicb.2012.00388] [Citation(s) in RCA: 941] [Impact Index Per Article: 78.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/18/2012] [Indexed: 01/12/2023] Open
Abstract
The human T-cell leukemia virus type 1 (HTLV-1), identified as the first human oncogenic retrovirus 30 years ago, is not an ubiquitous virus. HTLV-1 is present throughout the world, with clusters of high endemicity located often nearby areas where the virus is nearly absent. The main HTLV-1 highly endemic regions are the Southwestern part of Japan, sub-Saharan Africa and South America, the Caribbean area, and foci in Middle East and Australo-Melanesia. The origin of this puzzling geographical or rather ethnic repartition is probably linked to a founder effect in some groups with the persistence of a high viral transmission rate. Despite different socio-economic and cultural environments, the HTLV-1 prevalence increases gradually with age, especially among women in all highly endemic areas. The three modes of HTLV-1 transmission are mother to child, sexual transmission, and transmission with contaminated blood products. Twenty years ago, de Thé and Bomford estimated the total number of HTLV-1 carriers to be 10-20 millions people. At that time, large regions had not been investigated, few population-based studies were available and the assays used for HTLV-1 serology were not enough specific. Despite the fact that there is still a lot of data lacking in large areas of the world and that most of the HTLV-1 studies concern only blood donors, pregnant women, or different selected patients or high-risk groups, we shall try based on the most recent data, to revisit the world distribution and the estimates of the number of HTLV-1 infected persons. Our best estimates range from 5-10 millions HTLV-1 infected individuals. However, these results were based on only approximately 1.5 billion of individuals originating from known HTLV-1 endemic areas with reliable available epidemiological data. Correct estimates in other highly populated regions, such as China, India, the Maghreb, and East Africa, is currently not possible, thus, the current number of HTLV-1 carriers is very probably much higher.
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Affiliation(s)
- Antoine Gessain
- Département de Virologie, Unité d'épidémiologie et physiopathologie des virus oncogènes, Institut Pasteur Paris, France ; CNRS, URA3015 Paris, France
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van Tienen C, McConkey SJ, de Silva TI, Cotten M, Kaye S, Sarge-Njie R, da Costa C, Gonçalves N, Parker J, Vincent T, Jaye A, Aaby P, Whittle H, Schim van der Loeff M. Maternal proviral load and vertical transmission of human T cell lymphotropic virus type 1 in Guinea-Bissau. AIDS Res Hum Retroviruses 2012; 28:584-90. [PMID: 22066980 DOI: 10.1089/aid.2011.0219] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The relative importance of routes of transmission of human T cell lymphotropic virus type 1 (HTLV-1) in Guinea-Bissau is largely unknown; vertical transmission is thought to be important, but there are very few existing data. We aimed to examine factors associated with transmission in mothers and children in Guinea-Bissau, where HTLV-1 is endemic (prevalence of 5% in the adult population). A cross-sectional survey was performed among mothers and their children (aged <15 years) in a rural community in Guinea-Bissau. A questionnaire to identify risk factors for infection and a blood sample were obtained. HTLV-1 proviral load in peripheral blood was determined and PCR was performed to compare long terminal repeat (LTR) sequences in mother-child pairs. Fourteen out of 55 children (25%) of 31 HTLV-1-infected mothers were infected versus none of 70 children of 30 uninfected mothers. The only factor significantly associated with HTLV-1 infection in the child was the proviral load of the mother; the risk of infection increased significantly with the log(10) proviral load in the mother's peripheral blood (OR 5.5, 95% CI 2.1-14.6, per quartile), adjusted for weaning age and maternal income. HTLV-1 sequences of the LTR region obtained from mother-child pairs were identical within pairs but differed between the pairs. Vertical transmission plays an important role in HTLV-1 transmission in this community in Guinea-Bissau. The risk of transmission increases with the mother's proviral load in the peripheral blood. Identical sequences in mother-child pairs give additional support to the maternal source of the children's infection.
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Affiliation(s)
- Carla van Tienen
- Viral Diseases Program, Medical Research Council, Fajara, The Gambia and Erasmus Medical Centre, Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Samuel J. McConkey
- Viral Diseases Program, Medical Research Council, The Gambia and Department of International Health and Tropical Medicine, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Thushan I. de Silva
- Viral Diseases Program, Medical Research Council, Fajara, The Gambia and UCL Centre for Medical Molecular Virology, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Matthew Cotten
- Viral Diseases Program, Medical Research Council, Fajara, The Gambia and Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Steve Kaye
- Viral Diseases Program, Medical Research Council, Fajara, The Gambia and Department of Medicine, Imperial College London, London, United Kingdom
| | - Ramu Sarge-Njie
- Viral Diseases Program, Medical Research Council, Fajara, The Gambia
| | - Carlos da Costa
- Viral Diseases Program, Medical Research Council, Fajara, The Gambia and Projecto de Saúde de Bandim, Bissau Codex, Guinea-Bissau
| | - Nato Gonçalves
- Viral Diseases Program, Medical Research Council, Fajara, The Gambia and Projecto de Saúde de Bandim, Bissau Codex, Guinea-Bissau
| | - Julia Parker
- Viral Diseases Program, Medical Research Council, Fajara, The Gambia and Public Health and Primary Care, NHS Hertfordshire, Welwyn Garden City, United Kingdom
| | - Tim Vincent
- Viral Diseases Program, Medical Research Council, Fajara, The Gambia
| | - Assan Jaye
- Viral Diseases Program, Medical Research Council, Fajara, The Gambia
| | - Peter Aaby
- Projecto de Saúde de Bandim/Indepth Network, Bissau Codex, Guinea-Bissau
| | - Hilton Whittle
- Viral Diseases Program, Medical Research Council, Fajara, The Gambia
| | - Maarten Schim van der Loeff
- Viral Diseases Program, Medical Research Council, Fajara, The Gambia and Health Service of Amsterdam (GGD) and Academic Medical Centre, Amsterdam, The Netherlands
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van Tienen C, Schim van der Loeff M, Peterson I, Cotten M, Andersson S, Holmgren B, Vincent T, de Silva T, Rowland-Jones S, Aaby P, Whittle H. HTLV-1 and HIV-2 infection are associated with increased mortality in a rural West African community. PLoS One 2011; 6:e29026. [PMID: 22194980 PMCID: PMC3237577 DOI: 10.1371/journal.pone.0029026] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 11/18/2011] [Indexed: 11/19/2022] Open
Abstract
Background Survival of people with HIV-2 and HTLV-1 infection is better than that of HIV-1 infected people, but long-term follow-up data are rare. We compared mortality rates of HIV-1, HIV-2, and HTLV-1 infected subjects with those of retrovirus-uninfected people in a rural community in Guinea-Bissau. Methods In 1990, 1997 and 2007, adult residents (aged ≥15 years) were interviewed, a blood sample was drawn and retroviral status was determined. An annual census was used to ascertain the vital status of all subjects. Cox regression analysis was used to estimate mortality hazard ratios (HR), comparing retrovirus-infected versus uninfected people. Results A total of 5376 subjects were included; 197 with HIV-1, 424 with HIV-2 and 325 with HTLV-1 infection. The median follow-up time was 10.9 years (range 0.0–20.3). The crude mortality rates were 9.6 per 100 person-years of observation (95% confidence interval 7.1-12.9) for HIV-1, 4.1 (3.4–5.0) for HIV-2, 3.6 (2.9–4.6) for HTLV-1, and 1.6 (1.5–1.8) for retrovirus-negative subjects. The HR comparing the mortality rate of infected to that of uninfected subjects varied significantly with age. The adjusted HR for HIV-1 infection varied from 4.0 in the oldest age group (≥60 years) to 12.7 in the youngest (15–29 years). The HR for HIV-2 infection varied from 1.2 (oldest) to 9.1 (youngest), and for HTLV-1 infection from 1.2 (oldest) to 3.8 (youngest). Conclusions HTLV-1 infection is associated with significantly increased mortality. The mortality rate of HIV-2 infection, although lower than that of HIV-1 infection, is also increased, especially among young people.
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Affiliation(s)
| | | | | | | | - Sören Andersson
- Swedish Institute of Infectious Disease Control, Stockholm, Sweden
| | - Birgitta Holmgren
- Department of Laboratory Medicine, Malmö, Lund University, Lund, Sweden
| | - Tim Vincent
- Medical Research Council, Fajara, The Gambia
| | - Thushan de Silva
- Medical Research Council, Fajara, The Gambia
- University College London Centre for Medical Molecular Virology, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Sarah Rowland-Jones
- Weatherall Institute of Molecular Medicine, Human Immunology Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - Peter Aaby
- Projecto de Saúde de Bandim, Indepth Network, Bissau, Guinea-Bissau
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Månsson F, Camara C, Biai A, Monteiro M, da Silva ZJ, Dias F, Alves A, Andersson S, Fenyö EM, Norrgren H, Unemo M. High prevalence of HIV-1, HIV-2 and other sexually transmitted infections among women attending two sexual health clinics in Bissau, Guinea-Bissau, West Africa. Int J STD AIDS 2011; 21:631-5. [PMID: 21097735 DOI: 10.1258/ijsa.2010.009584] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective was to examine the prevalence of HIV-1, HIV-2 and 10 other sexually transmitted infections (STIs), and to explore the relationship between HIV and those STIs in women attending two sexual health clinics in Bissau, Guinea-Bissau. In all, 711 women with urogenital problems were included. Clinical examination was performed and HIV-1, HIV-2, human T-cell lymphotropic virus (HTLV)-1, HTLV-2 and syphilis were diagnosed by serology. Trichomonas vaginalis was examined using wet mount microscopy. Cervical samples (and swabs from visible ulcers, if present) were used for polymerase chain reaction (PCR) diagnosis of Chlamydia trachomatis, Mycoplasma genitalium, Haemophilus ducreyi, herpes simplex virus (HSV)-1 and HSV-2, and culture diagnosis of Neisseria gonorrhoeae. The prevalence of HIV-1, HIV-2, and HIV-1 and HIV-2 (dual infection) was 9.5%, 1.8% and 1.1%, respectively. The prevalence of HTLV-1 was 2.8%, HTLV-2 0%, HSV-1 1.4%, HSV-2 7.7%, T. vaginalis 20.4%, syphilis 1.0%, N. gonorrhoeae 1.3%, H. ducreyi 2.7%, M. genitalium 7.7% and C. trachomatis 12.6%. HIV-1 and/or HIV-2 infection was significantly associated with active HSV-2 and HIV-1 was significantly associated with M. genitalium infection. In conclusion, HIV-1 and HIV-2 prevalence was higher compared with previous studies of pregnant women in Guinea-Bissau. The prevalence of co-infection of HIV and other STIs is high. National evidence-based guidelines for the management of STIs in Guinea-Bissau are essential.
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Affiliation(s)
- F Månsson
- Infectious Diseases Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.
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van Tienen C, van der Loeff MFS, Peterson I, Cotten M, Holmgren B, Andersson S, Vincent T, Sarge-Njie R, Rowland-Jones S, Jaye A, Aaby P, Whittle H. HTLV-1 in rural Guinea-Bissau: prevalence, incidence and a continued association with HIV between 1990 and 2007. Retrovirology 2010; 7:50. [PMID: 20525366 PMCID: PMC2894744 DOI: 10.1186/1742-4690-7-50] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 06/04/2010] [Indexed: 11/25/2022] Open
Abstract
Background HTLV-1 is endemic in Guinea-Bissau, and the highest prevalence in the adult population (5.2%) was observed in a rural area, Caió, in 1990. HIV-1 and HIV-2 are both prevalent in this area as well. Cross-sectional associations have been reported for HTLV-1 with HIV infection, but the trends in prevalence of HTLV-1 and HIV associations are largely unknown, especially in Sub Saharan Africa. In the current study, data from three cross-sectional community surveys performed in 1990, 1997 and 2007, were used to assess changes in HTLV-1 prevalence, incidence and its associations with HIV-1 and HIV-2 and potential risk factors. Results HTLV-1 prevalence was 5.2% in 1990, 5.9% in 1997 and 4.6% in 2007. Prevalence was higher among women than men in all 3 surveys and increased with age. The Odds Ratio (OR) of being infected with HTLV-1 was significantly higher for HIV positive subjects in all surveys after adjustment for potential confounding factors. The risk of HTLV-1 infection was higher in subjects with an HTLV-1 positive mother versus an uninfected mother (OR 4.6, CI 2.6-8.0). The HTLV-1 incidence was stable between 1990-1997 (Incidence Rate (IR) 1.8/1,000 pyo) and 1997-2007 (IR 1.6/1,000 pyo) (Incidence Rate Ratio (IRR) 0.9, CI 0.4-1.7). The incidence of HTLV-1 among HIV-positive individuals was higher compared to HIV negative individuals (IRR 2.5, CI 1.0-6.2), while the HIV incidence did not differ by HTLV-1 status (IRR 1.2, CI 0.5-2.7). Conclusions To our knowledge, this is the largest community based study that has reported on HTLV-1 prevalence and associations with HIV. HTLV-1 is endemic in this rural community in West Africa with a stable incidence and a high prevalence. The prevalence increases with age and is higher in women than men. HTLV-1 infection is associated with HIV infection, and longitudinal data indicate HIV infection may be a risk factor for acquiring HTLV-1, but not vice versa. Mother to child transmission is likely to contribute to the epidemic.
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Trends in HTLV-1 prevalence and incidence of adult T-cell leukemia/lymphoma in Nagasaki, Japan. J Med Virol 2010; 82:668-74. [DOI: 10.1002/jmv.21738] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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