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O'Donnell JS, Jaberolansar N, Chappell KJ. Human T-lymphotropic virus type 1 and antiretroviral therapy: practical considerations for pre-exposure and post-exposure prophylaxis, transmission prevention, and mitigation of severe disease. THE LANCET. MICROBE 2024; 5:e400-e408. [PMID: 38246188 DOI: 10.1016/s2666-5247(23)00359-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 01/23/2024]
Abstract
Human T-lymphotropic virus type 1 (HTLV-1) is a retrovirus associated with substantial risk of secondary (often life-threatening) disease for the estimated 10 million to 20 million people infected globally. Despite a clear need, no HTLV-1-specific vaccine or antiretroviral therapy has been developed to date. Instead, existing public and primary health-care interventions inadequately focus on infection prevention and management of secondary diseases. In this Personal View, we discuss the evidence that exists to support the sensitivity of HTLV-1 to antiretroviral therapies approved by the US Food and Drug Administration for the treatment of HIV-1, how this sensitivity is affected by clinically relevant virological and immunological features, and additional practical considerations for the use of antiretroviral therapies in the context of HTLV-1.
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Affiliation(s)
- Jake S O'Donnell
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD, Australia; The Australian Institute for Biotechnology and Nanotechnology, The University of Queensland, St Lucia, QLD, Australia.
| | - Noushin Jaberolansar
- The Australian Institute for Biotechnology and Nanotechnology, The University of Queensland, St Lucia, QLD, Australia
| | - Keith J Chappell
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, QLD, Australia; The Australian Institute for Biotechnology and Nanotechnology, The University of Queensland, St Lucia, QLD, Australia; Australian Infectious Disease Research Centre, The University of Queensland, St Lucia, QLD, Australia
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2
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Gutowska A, Sarkis S, Rahman MA, Goldfarbmuren KC, Moles R, Bissa M, Doster M, Washington-Parks R, McKinnon K, Silva de Castro I, Schifanella L, Franchini G, Pise-Masison CA. Complete Rescue of HTLV-1 p12KO Infectivity by Depletion of Monocytes Together with NK and CD8 + T Cells. Pathogens 2024; 13:292. [PMID: 38668247 PMCID: PMC11054408 DOI: 10.3390/pathogens13040292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/29/2024] Open
Abstract
The transient depletion of monocytes alone prior to exposure of macaques to HTLV-1 enhances both HTLV-1WT (wild type) and HTLV-1p12KO (Orf-1 knockout) infectivity, but seroconversion to either virus is not sustained over time, suggesting a progressive decrease in virus expression. These results raise the hypotheses that either HTLV-1 persistence depends on a monocyte reservoir or monocyte depletion provides a transient immune evasion benefit. To test these hypotheses, we simultaneously depleted NK cells, CD8+ T cells, and monocytes (triple depletion) prior to exposure to HTLV-1WT or HTLV-1p12KO. Remarkably, triple depletion resulted in exacerbation of infection by both viruses and complete rescue of HTLV-1p12KO infectivity. Following triple depletion, we observed rapid and sustained seroconversion, high titers of antibodies against HTLV-1 p24Gag, and frequent detection of viral DNA in the blood and tissues of all animals when compared with depletion of only CD8+ and NK cells, or monocytes alone. The infection of macaques with HTLV-1WT or HTLV-1p12KO was associated with higher plasma levels of IL-10 after 21 weeks, while IL-6, IFN-γ, IL-18, and IL-1β were only elevated in animals infected with HTLV-1WT. The repeat depletion of monocytes, NK, and CD8+ cells seven months following the first exposure to HTLV-1 did not further exacerbate viral replication. These results underscore the contribution of monocytes in orchestrating anti-viral immunity. Indeed, the absence of orf-1 expression was fully compensated by the simultaneous depletion of CD8+ T cells, NK cells, and monocytes, underlining the primary role of orf-1 in hijacking host immunity.
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Affiliation(s)
- Anna Gutowska
- Animal Models and Retroviral Vaccines Section, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA; (A.G.); (S.S.); (I.S.d.C.)
| | - Sarkis Sarkis
- Animal Models and Retroviral Vaccines Section, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA; (A.G.); (S.S.); (I.S.d.C.)
| | - Mohammad Arif Rahman
- Animal Models and Retroviral Vaccines Section, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA; (A.G.); (S.S.); (I.S.d.C.)
| | - Katherine C. Goldfarbmuren
- Vaccine Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA;
- Advanced Biomedical Computational Science, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, MD 21702, USA
| | - Ramona Moles
- Animal Models and Retroviral Vaccines Section, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA; (A.G.); (S.S.); (I.S.d.C.)
| | - Massimiliano Bissa
- Animal Models and Retroviral Vaccines Section, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA; (A.G.); (S.S.); (I.S.d.C.)
| | - Melvin Doster
- Animal Models and Retroviral Vaccines Section, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA; (A.G.); (S.S.); (I.S.d.C.)
| | - Robyn Washington-Parks
- Animal Models and Retroviral Vaccines Section, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA; (A.G.); (S.S.); (I.S.d.C.)
| | - Katherine McKinnon
- Vaccine Branch Flow Cytometry Core, National Cancer Institute, Bethesda, MD 20892, USA;
| | - Isabela Silva de Castro
- Animal Models and Retroviral Vaccines Section, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA; (A.G.); (S.S.); (I.S.d.C.)
| | - Luca Schifanella
- Animal Models and Retroviral Vaccines Section, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA; (A.G.); (S.S.); (I.S.d.C.)
| | - Genoveffa Franchini
- Animal Models and Retroviral Vaccines Section, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA; (A.G.); (S.S.); (I.S.d.C.)
| | - Cynthia A. Pise-Masison
- Animal Models and Retroviral Vaccines Section, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA; (A.G.); (S.S.); (I.S.d.C.)
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Puccioni-Sohler M, Poton AR, Cabral-Castro MJ, Yamano Y, Taylor G, Casseb J. Human T Lymphotropic Virus 1-Associated Myelopathy: Overview of Human T Cell Lymphotropic Virus-1/2 Tests and Potential Biomarkers. AIDS Res Hum Retroviruses 2022; 38:924-932. [PMID: 35819286 DOI: 10.1089/aid.2022.0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Human T cell lymphotropic virus (HTLV)-1-associated myelopathy is a chronic, disabling inflammatory disorder of the spinal cord caused by HTLV-1 infection. The diagnosis of HTLV-1-associated myelopathy (HAM) is based on clinical and laboratorial findings. The disease is characterized by the presence of spastic paraparesis associated with detection of anti-HTLV-1 antibodies or HTLV-1 genomes in blood and cerebrospinal fluid (CSF). New inflammatory markers have been proposed for the diagnosis and assessment of the prognosis of HAM. We reviewed the laboratory diagnostic and potential surrogate markers for HAM. The serological screening tests for detection of anti-HTLV-1/2 antibodies are highly sensitive and specific, but confirmation and typing of HTLV-1 or HTLV-2 infection by other serological or molecular methods are essential. Detection of intrathecal anti-HTLV-1 antibodies and quantification of the HTLV-1 provirus in CSF provide additional evidence for diagnosis especially in atypical cases or where alternative causes of neuroinflammation cannot be excluded. The CXC motif chemokine ligand 10 and neopterin in serum and CSF are now emerging as inflammatory markers with prognostic value and for HAM monitoring and management. In addition, measures of neurodegeneration, such as neurofilament light chain in the CSF and blood, may also contribute to the HAM prognosis. This review is useful for clinicians and researchers evaluating potential benefits and limitations of each biomarker in clinical practice. The advent of new markers makes it necessary to update the criteria for the best evidence-based approach and for worldwide consensus regarding the use of diagnostic and surrogate markers for HAM.
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Affiliation(s)
- Marzia Puccioni-Sohler
- Department of Internal Medicine, Escola de Medicina e Cirurgia, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.,Postgraduate Program, Department of Infectious and Parasitic Diseases, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mauro Jorge Cabral-Castro
- Department of Immunology, Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yoshihisa Yamano
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Graham Taylor
- Section of Virology, Department of Infectious Disease, Imperial College, London, United Kingdom
| | - Jorge Casseb
- Department of Dermatology, Faculty of Medicine, Sao Paulo University, Sao Paulo, Brazil
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Komatsu N, Iwanaga M, Hasegawa Y, Miura S, Fuchi N, Moriuchi H, Yanagihara K, Miura K. Frequency of HTLV-1 seroconversion between pregnancies in Nagasaki, Japan, 2011–2018. Front Microbiol 2022; 13:1036955. [DOI: 10.3389/fmicb.2022.1036955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
BackgroundHuman T-cell leukemia virus type-1 (HTLV-1) is transmitted vertically from an infected mother to her child via breastfeeding during infancy or horizontally via sexual contact. However, little information is available on the HTLV-1 seroconversion rate in pregnant mothers and the impact of new HTLV-1 infection on mothers and babies during the perinatal period.MethodsFrom the database of a prefecture-wide antenatal adult T-cell leukemia prevention program in Nagasaki, Japan, we extracted data on 57,323 pregnant women who were screened for anti-HTLV-1 antibody during 2011–2018. Data on the 16,863 subjects whose HTLV-1 proviral load (PVL) was measured more than twice were included in our analyses.ResultsIn total, 133 (0.79%) pregnant women were HTLV-1-positive during their first pregnancy and nine (0.05%) seroconverted before or during subsequent pregnancies (between pregnancies). The median PVL (per 100 peripheral blood mononuclear cells) was significantly lower in the seroconverted mothers (0.10%) than in the initially seropositive mothers (0.15%). A repeated measures correlation analysis for the individual PVLs of the HTLV-1-positive pregnant women showed that PVL increased with parity number (rrm = 0.25) with no perinatal problems.ConclusionThe HTLV-1 seroconversion rate between pregnancies was 0.05%, and their HTLV-1 PVL increased annually but no perinatal problems were noted.
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Pise-Masison CA, Franchini G. Hijacking Host Immunity by the Human T-Cell Leukemia Virus Type-1: Implications for Therapeutic and Preventive Vaccines. Viruses 2022; 14:2084. [PMID: 36298639 PMCID: PMC9609126 DOI: 10.3390/v14102084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2024] Open
Abstract
Human T-cell Leukemia virus type-1 (HTLV-1) causes adult T-cell leukemia/lymphoma (ATLL), HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and other inflammatory diseases. High viral DNA burden (VL) in peripheral blood mononuclear cells is a documented risk factor for ATLL and HAM/TSP, and patients with HAM/TSP have a higher VL in cerebrospinal fluid than in peripheral blood. VL alone is not sufficient to differentiate symptomatic patients from healthy carriers, suggesting the importance of other factors, including host immune response. HTLV-1 infection is life-long; CD4+-infected cells are not eradicated by the immune response because HTLV-1 inhibits the function of dendritic cells, monocytes, Natural Killer cells, and adaptive cytotoxic CD8+ responses. Although the majority of infected CD4+ T-cells adopt a resting phenotype, antigen stimulation may result in bursts of viral expression. The antigen-dependent "on-off" viral expression creates "conditional latency" that when combined with ineffective host responses precludes virus eradication. Epidemiological and clinical data suggest that the continuous attempt of the host immunity to eliminate infected cells results in chronic immune activation that can be further exacerbated by co-morbidities, resulting in the development of severe disease. We review cell and animal model studies that uncovered mechanisms used by HTLV-1 to usurp and/or counteract host immunity.
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Affiliation(s)
- Cynthia A. Pise-Masison
- Animal Models and Retroviral Vaccines Section, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
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Prevalence of Human T-Lymphotropic Virus Type 1 in Brain-Dead Organ Donors. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2022. [DOI: 10.5812/archcid-116005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: This study aimed to assess the prevalence of human T-lymphotropic virus type 1 (HTLV-1) among brain-dead organ donors at Masih Daneshvari Hospital in Tehran, Iran. Methods: By enzyme-linked immunosorbent assay (ELISA), 54 organ donors were screened for HTLV-1 virus in this descriptive cross-sectional study. Following that, Western blot confirmation was performed to confirm the HTLV-I infection. Results: Anti-HTLV-1 antibodies were detected in 2 (3.4%) cases out of 54 patients tested by ELISA. A western blot was performed in cases of positive results, but none of the subjects tested positive for HTLV-1 infection. Conclusions: The results of the present study indicated rare cases of HTLV-I infection in brain-dead organ donors. However, it is recommended that organ donors be investigated for the prevalence of this virus.
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Bradshaw D, Taylor GP. HTLV-1 Transmission and HIV Pre-exposure Prophylaxis: A Scoping Review. Front Med (Lausanne) 2022; 9:881547. [PMID: 35572998 PMCID: PMC9103472 DOI: 10.3389/fmed.2022.881547] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/22/2022] [Indexed: 11/24/2022] Open
Abstract
HIV pre-exposure prophylaxis (HIV-PrEP) is effective in reducing the likelihood of HIV acquisition in HIV-negative people at high risk of exposure. Guidelines recommend testing for sexually transmitted infections (STIs) before starting, and periodically on PrEP, including bacterial infections, HIV, hepatitis C virus, and, for those who are non-immune, hepatitis B virus. Diagnosed infections can be promptly treated to reduce onward transmission. HTLV-1 is not mentioned; however, it is predominantly sexually transmitted, causes adult T-cell leukaemia/lymphoma (ATL) or myelopathy in 10% of those infected, and is associated with an increased risk of death in those without any classically HTLV-associated condition. The 2021 WHO Technical Report on HTLV-1 called for the strengthening of global public health measures against its spread. In this scoping review, we, therefore, (1) discuss the epidemiological context of HIV-PrEP and HTLV-1 transmission; (2) present current knowledge of antiretrovirals in relation to HTLV-1 transmission prevention, including nucleos(t)ide reverse transcriptase inhibitors (NRTIs) and integrase strand transfer inhibitors (INSTIs); and (3) identify knowledge gaps where data are urgently required to inform global public health measures to protect HIV-PrEP users from HTLV-1 acquisition. We suggest that systematic seroprevalence studies among PrEP-using groups, including men who have sex with men (MSM), people who inject drugs (PWIDs), and female sex workers (FSWs), are needed. Further data are required to evaluate antiretroviral efficacy in preventing HTLV-1 transmission from in vitro studies, animal models, and clinical cohorts. PrEP delivery programmes should consider prioritizing the long-acting injectable INSTI, cabotegravir, in HTLV-1 endemic settings.
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Affiliation(s)
- Daniel Bradshaw
- Virus Reference Department, UK Health Security Agency, London, United Kingdom
- National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, London, United Kingdom
- *Correspondence: Daniel Bradshaw
| | - Graham Philip Taylor
- National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial College London, London, United Kingdom
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8
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Ahmadi Ghezeldasht S, Shamsian SAA, Gholizadeh Navashenaq J, Miri R, Ashrafi F, Mosavat A, Rezaee SA. HTLV-1 oncovirus-host interactions: From entry to the manifestation of associated diseases. Rev Med Virol 2021; 31:e2235. [PMID: 33742509 DOI: 10.1002/rmv.2235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 12/19/2022]
Abstract
Human T lymphotropic virus type-1 (HTLV-1) is a well-known human oncovirus, associated with two life-threatening diseases, adult T cell leukaemia/lymphoma (ATL) and HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). The study of this oncogenic virus is significant from two different aspects. First, HTLV-1 can be considered as a neglected public health problem, which may spread slowly worldwide. Second, the incidence of HTLV-1 associated diseases due to oncogenic effects and deterioration of the immune system towards autoimmune diseases are not fully understood. Furthermore, knowledge about viral routes of transmission is important for considering potential interventions, treatments or vaccines in endemic regions. In this review, novel characteristics of HTLV-1, such as the unusual infectivity of virions through the virological synapse, are discussed in the context of the HTLV-1 associated diseases (ATL and HAM/TSP).
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Affiliation(s)
- Sanaz Ahmadi Ghezeldasht
- Inflammation and Inflammatory Diseases Division, Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ali Akbar Shamsian
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Blood Borne Infections Research Center, Academic Center for Education, Culture and Research (ACECR), Mashhad, Iran
| | | | - Raheleh Miri
- Blood Borne Infections Research Center, Academic Center for Education, Culture and Research (ACECR), Mashhad, Iran
| | - Fereshteh Ashrafi
- Department of Animal Science, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Arman Mosavat
- Blood Borne Infections Research Center, Academic Center for Education, Culture and Research (ACECR), Mashhad, Iran
| | - Seyed Abdolrahim Rezaee
- Inflammation and Inflammatory Diseases Division, Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Aghajanian S, Teymoori-Rad M, Molaverdi G, Mozhgani SH. Immunopathogenesis and Cellular Interactions in Human T-Cell Leukemia Virus Type 1 Associated Myelopathy/Tropical Spastic Paraparesis. Front Microbiol 2020; 11:614940. [PMID: 33414779 PMCID: PMC7783048 DOI: 10.3389/fmicb.2020.614940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/17/2020] [Indexed: 01/15/2023] Open
Abstract
HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) is a neuropathological disorder in 1–3% of individuals infected with Human T-lymphotropic virus 1 (HTLV-1). This condition is characterized by progressive spastic lower limb weakness and paralysis, lower back pain, bladder incontinence, and mild sensory disturbances resembling spinal forms of multiple sclerosis. This disease also causes chronic disability and is therefore associated with high health burden in areas where HTLV-1 infection is endemic. Despite various efforts in understanding the virus and discovery of novel diagnostic markers, and cellular and viral interactions, HAM/TSP management is still unsatisfactory and mainly focused on symptomatic alleviation, and it hasn’t been explained why only a minority of the virus carriers develop HAM/TSP. This comprehensive review focuses on host and viral factors in association with immunopathology of the disease in hope of providing new insights for drug therapies or other forms of intervention.
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Affiliation(s)
- Sepehr Aghajanian
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Majid Teymoori-Rad
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazale Molaverdi
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Sayed-Hamidreza Mozhgani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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10
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Novel Use of Normothermic Machine Perfusion of the Liver: A Strategy to Mitigate Unexpected Clinical Events. Transplantation 2020; 104:e281-e282. [PMID: 32826844 DOI: 10.1097/tp.0000000000003288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Patriquin G, Hatchette JE, Hatchette TF. Canadian physicians' knowledge, attitudes, and beliefs about the risk of HTLV infection in solid organ transplantation. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2020; 5:124-126. [PMID: 36341315 PMCID: PMC9608730 DOI: 10.3138/jammi-2019-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 03/15/2020] [Indexed: 06/16/2023]
Affiliation(s)
- Glenn Patriquin
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Jill E Hatchette
- Research Services, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
OBJECTIVE To examine the clinical burden and disease spectrum, as well as time trends for human T-cell leukemia virus type 1 (HTLV-1) and HTLV type 2 (HTLV-2) hospital admissions. DESIGN Retrospective, observational study using the Spanish National Hospital Discharge Database. METHODS Information for the diagnostic codes HTLV-1 and HTLV-2 using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) was retrieved from the national public registry since 1997--2015. RESULTS From a total of 66 462 136 nationwide hospital admissions recorded during the study period, 135 included HTLV diagnosis, being HTLV-1 in 115 (85.2%) and HTLV-2 in 20 (14.8%). The overall hospital admission rate because of HTLV was 2.03 per million, without significant yearly changes. First admissions represented 104 (77%) whereas 31 (23%) were re-admissions. The median in-hospital stay for HTLV patients was 9 days. In-hospital death occurred in 11 (8.1%). The median age of individuals with HTLV admission was 48 years and 60 (44.4%) were women. HTLV was recorded as the main diagnosis in 20%. The most frequent clinical conditions recorded alongside HTLV diagnosis were myelopathy (61; 45.2%), leukemia/lymphoma (30; 22.2%), solid organ transplantation (14; 10.4%) and child delivery (7; 5.2%). CONCLUSION The rate of HTLV diagnosis in hospitalized patients in Spain is low, roughly of two per million admissions. Despite continuous large immigrant flows from HTLV-1 endemic areas, no significant rising in hospitalizations because of HTLV-1 associated illnesses were noticed during the last two decades. Classical clinical complications of HTLV-1 infection, such as myelopathy and lymphoma account for more than two-thirds of cases.
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13
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Marino-Merlo F, Balestrieri E, Matteucci C, Mastino A, Grelli S, Macchi B. Antiretroviral Therapy in HTLV-1 Infection: An Updated Overview. Pathogens 2020; 9:E342. [PMID: 32369988 PMCID: PMC7281255 DOI: 10.3390/pathogens9050342] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/26/2020] [Accepted: 04/29/2020] [Indexed: 12/30/2022] Open
Abstract
The human T cell leukemic/lymphotropic virus type 1 (HTLV-1), discovered several years ago, is the causative agent for a rapid progressive haematological malignancy, adult T cell leukemia (ATL), for debilitating neurological diseases and for a number of inflammatory based diseases. Although the heterogeneous features of the diseases caused by HTLV-1, a common topic concerning related therapeutic treatments relies on the use of antiretrovirals. This review will compare the different approaches and opinions in this matter, giving a concise overview of preclinical as well as clinical studies covering all the aspects of antiretrovirals in HTLV-1 infection. Studies will be grouped on the basis of the class of antiretroviral, putting together both pre-clinical and clinical results and generally following a chronological order. Analysis of the existing literature highlights that a number of preclinical studies clearly demonstrate that different classes of antiretrovirals, already utilized as anti-HIV agents, are actually capable to efficiently contrast HTLV-1 infection. Nevertheless, the results of most of the clinical studies are generally discouraging on the same point. In conclusion, the design of new antiretrovirals more specifically focused on HTLV-1 targets, and/or the establishment of early treatments with antiretrovirals could hopefully change the perspectives of diseases caused by HTLV-1.
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Affiliation(s)
| | - Emanuela Balestrieri
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (E.B.); (C.M.); (S.G.)
| | - Claudia Matteucci
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (E.B.); (C.M.); (S.G.)
| | - Antonio Mastino
- Department of Chemical, Biological, Pharmaceutical, and Environmental Sciences, University of Messina, 98166 Messina, Italy
- The Institute of Translational Pharmacology, Consiglio Nazionale delle Ricerche (CNR), 00133 Rome, Italy
| | - Sandro Grelli
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (E.B.); (C.M.); (S.G.)
| | - Beatrice Macchi
- Department of Chemical Science and Technologies, University of Rome “Tor Vergata”, 00133 Rome, Italy
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14
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Wakabayashi T, Obara H, Seki M, Shinoda M, Kitago M, Yagi H, Abe Y, Matsubara K, Yamada Y, Oshima G, Oki K, Nagoshi N, Watanabe K, Hibi T, Itano O, Hoshino K, Suzuki N, Kuroda T, Kitagawa Y. Myelopathy due to human T-cell leukemia virus type-1 from the donor after ABO-incompatible liver transplantation. Ann Hepatol 2020; 18:397-401. [PMID: 31029562 DOI: 10.1016/j.aohep.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 02/04/2023]
Abstract
We report the case of a 53-year-old-man who developed human T-cell leukemia virus type-1-associated myelopathy (HAM) after ABO-incompatible liver transplantation for alcoholic liver cirrhosis. The living donor was seropositive for human T-cell leukemia virus type-1 (HTLV-1) and the recipient was seronegative for HTLV-1 before transplantation. After transplantation, the recipient developed steroid-resistant acute cellular rejection, which was successfully treated using anti-thymocyte globulin, and he was eventually discharged. He underwent spinal surgery twice after the transplantation for the treatment of cervical spondylosis that had been present for a period of 9 months before the transplantation. The surgery improved his gait impairment temporarily. However, his gait impairment progressed, and magnetic resonance imaging revealed multiple sites of myelopathy. He was diagnosed with HAM 16 months after the transplantation. Pulse steroid therapy (1000mg) was administered over a period of 3 days, and his limb paresis improved. Presently, steroid therapy is being continued, with a plan to eventually taper the dose, and he is being carefully followed up at our institution. Our case suggests that liver transplantation involving an HTLV-1-positive living donor carries the risk of virus transmission and short-term development of HAM after transplantation.
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Affiliation(s)
- Taiga Wakabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Morinobu Seki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Shinoda
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Yagi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Matsubara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Yamada
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Go Oshima
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Oki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taizo Hibi
- Department of Transplantation and Pediatric Surgery, Kumamoto University, Kumamoto, Japan
| | - Osamu Itano
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Ken Hoshino
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Norihiro Suzuki
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Miglioli-Galvão L, Pestana JOM, Lopes-Santoro G, Torres Gonçalves R, Requião Moura LR, Pacheco Silva Á, Camera Pierrotti L, David Neto E, Santana Girão E, Costa de Oliveira CM, Saad Abboud C, Dias França JÍ, Devite Bittante C, Corrêa L, Aranha Camargo LF. Severe Strongyloides stercoralis infection in kidney transplant recipients: A multicenter case-control study. PLoS Negl Trop Dis 2020; 14:e0007998. [PMID: 32004346 PMCID: PMC7015428 DOI: 10.1371/journal.pntd.0007998] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 02/12/2020] [Accepted: 12/16/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Severe Strongyloides stercoralis infection in kidney transplant recipients is associated with considerable morbidity and mortality, although little is known about the risk factors for such infection. METHODOLOGY/PRINCIPAL FINDINGS This was a retrospective, multicenter, case-control study in which we assessed the risk factors for and clinical outcomes of severe S. stercoralis infections in kidney transplant recipients in Brazil. We included 138 kidney transplant recipients: 46 cases and 92 controls. Among the cases, the median number of days from transplantation to diagnosis was 117 (interquartile range [IQR], 73.5-965) and the most common clinical findings were gastrointestinal symptoms (in 78.3%) and respiratory symptoms (in 39.1%), whereas fever and eosinophilia were seen in only 32.6% and 43.5%, respectively. The 30-day all-cause mortality among the cases was 28.3% overall and was significantly higher among the cases of infection occurring within the first three months after transplantation (47% vs. 17.2%, P = 0.04). The independent risk factors were receiving a transplant from a deceased donor (odds ratio [OR] = 6.16, 95% confidence interval [CI] = 2.05-18.5), a history of bacterial infection (OR = 3.04, 95% CI = 1.2-7.5), and a cumulative corticosteroid dose (OR = 1.005, 95% CI = 1.001-1.009). The independent predictors of mortality were respiratory failure (OR = 98.33, 95% CI = 4.46-2169.77) and concomitant bacteremia (OR = 413.00, 95% CI = 4.83-35316.61). CONCLUSIONS/SIGNIFICANCE Severe S. stercoralis infections are associated with considerable morbidity and mortality after kidney transplantation. In endemic areas, such infection may occur late after transplantation, although it seems to be more severe when it occurs earlier after transplantation. Specific risk factors and clinical manifestations can identify patients at risk, who should receive prophylaxis or early treatment.
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Affiliation(s)
- Lísia Miglioli-Galvão
- Infectious Diseases Unit, Universidade Federal de São Paulo, São Paulo, Brazil
- * E-mail:
| | | | - Guilherme Lopes-Santoro
- Department of Preventive Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Álvaro Pacheco Silva
- Kidney Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Kidney Unit, Universidade Federal de São Paulo,São Paulo, Brazil
| | | | - Elias David Neto
- Kidney Transplant Unit, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Cely Saad Abboud
- Infectious Diseases Unit, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - João Ítalo Dias França
- Department of Epidemiology and Statistics, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | | | - Luci Corrêa
- Infectious Diseases Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luís Fernando Aranha Camargo
- Infectious Diseases Unit, Universidade Federal de São Paulo, São Paulo, Brazil
- Infectious Diseases Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
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16
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Roc L, de Mendoza C, Fernández-Alonso M, Reina G, Soriano V. Rapid subacute myelopathy following kidney transplantation from HTLV-1 donors: role of immunosuppresors and failure of antiretrovirals. Ther Adv Infect Dis 2019; 6:2049936119868028. [PMID: 31467675 PMCID: PMC6704407 DOI: 10.1177/2049936119868028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/16/2019] [Indexed: 12/28/2022] Open
Abstract
Two kidney transplant recipients from a single donor became infected with HTLV-1 (human T-lymphotropic virus type 1) in Spain. One developed myelopathy 8 months following surgery despite early prescription of antiretroviral therapy. The allograft was removed from the second recipient at month 8 due to rejection and immunosuppressors discontinued. To date, 3 years later, this patient remains infected but asymptomatic. HTLV-1 infection was recognized retrospectively in the donor, a native Spaniard who had sex partners from endemic regions. Our findings call for a reappraisal of screening policies on donor–recipient organ transplantation. Based on the high risk of disease development and the large flux of persons from HTLV-1 endemic regions, pre-transplant HTLV-1 testing should be mandatory in Spain.
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Affiliation(s)
- Lourdes Roc
- Microbiology Department, Hospital Miguel Servet, Zaragoza
| | - Carmen de Mendoza
- Puerta de Hierro Research Institute and University Hospital, Majadahonda, Madrid, Spain
| | | | - Gabriel Reina
- Microbiology Department, Clinica Universitaria, Pamplona
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17
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Abstract
Donor-derived infections are defined as any infection present in the donor that is transmitted to 1 or more recipients. Donor-derived infections can be categorized into 2 groups: "expected" and "unexpected" infections. Expected transmissions occur when the donor is known to have an infection, such as positive serology for cytomegalovirus, Epstein Barr virus, or hepatitis B core antibody, at the time of donation. Unexpected transmissions occur when a donor has no known infection before donation, but 1 or more transplant recipients develop an infection derived from the common donor. Unexpected infections are estimated to occur in far less than 1% of solid organ transplant recipients. We will review the epidemiology, risk factors, and approaches to prevention and management of donor-derived viral infectious disease transmission in liver transplantation.
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18
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Patriquin G, Hatchette JE, Hatchette TF. Risk acceptance of human T-lymphotropic virus infection in solid organ transplantation-A survey of Atlantic Canadian ambulatory patients. Transpl Infect Dis 2018; 20:e12958. [PMID: 29959880 DOI: 10.1111/tid.12958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/28/2018] [Accepted: 06/22/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Human T-lymphotropic virus (HTLV) has an estimated prevalence of 12 per 100 000 in the general Canadian population (with higher rates in distinct groups) and is most commonly transmitted by breast feeding, sexual intercourse, sharing injection tools, and blood transfusions. A minority of those infected will develop severe disease. Health Canada mandates that people who are positive for HTLV are not suitable to be solid organ donors. Given the apparent low-disease burden of HTLV in Canada, we explored HTLV risk tolerance among patients, in the context of organ transplantations. METHODS Using telephone, and in-person questionnaires, we assessed willingness of patients to accept the risk of HTLV infection in hypothetical scenarios in which they required an organ transplant for survival. RESULTS Seventy-four outpatients attending various medical clinics participated in the survey. In a standard gamble scenario, 37.5% of respondents would have accepted a solid organ transplant regardless of HTLV risk, as compared to 27.3% and 24.6% accepting organ transplantation if there was a risk of human immunodeficiency virus (HIV) or of human virus Y (HVY; a fictitious virus describing HTLV in terms of neurological outcomes), respectively. Similarly, the median longevity traded to ensure a virus-free organ was 4-5 years regarding all viruses, except for HVY, for which the median time exchanged to ensure a virus-free organ was 10 (out of a possible 20) years. CONCLUSIONS These data suggest that patients, though willing to accept some risk of viral infection, would not be willing to forgo HTLV screening of solid organs.
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Affiliation(s)
- Glenn Patriquin
- Division of Medical Microbiology, Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jill E Hatchette
- Research Services, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Division of Medical Microbiology, Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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19
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Moreno-Ajona D, Yuste JR, Martín P, Gállego Pérez-Larraya J. HTLV-1 myelopathy after renal transplant and antiviral prophylaxis: the need for screening. J Neurovirol 2018. [PMID: 29532443 DOI: 10.1007/s13365-018-0627-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The human T-lymphotropic virus type 1 (HTLV-1) is a RNA retrovirus that infects a minimum of 5-10 million people worldwide. Transmission by cell-containing blood products and solid organ transplantation has been reported. Clinical disease occurs in about 5-10% of infected individuals and consists mainly in adult T cell leukemia and HTLV-1-associated myelopathy (HAM). We present a 54-year-old woman who underwent kidney transplant from cadaveric donor in March 2015. Donor also underwent cornea extraction for another recipient (corneal transplant protocol includes HTLV-1/2 serology). Twenty-four hours after completion of kidney transplant donor, HTLV-1 serology was revealed positive. Following experts' recommendations, once donor seropositivity was demonstrated, antiviral prophylaxis including zidovudine and raltegravir was initially given to our patient, in spite of which the patient developed HAM. Once the diagnosis of HAM was established, antiretroviral therapy was restarted, and intravenous pulses of methylprednisolone were periodically administered with transient initial improvement. Later on, the patient experienced neurological deterioration becoming wheelchair dependent. Since the occurrence of this case, HTLV-1 screening has become mandatory for solid organ transplantation in the Spanish province of Navarra, and the same should happen worldwide.
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Affiliation(s)
- David Moreno-Ajona
- Department of Neurology, Clínica Universidad de Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain
| | - José Ramón Yuste
- Division of Infectious Diseases, Clínica Universidad de Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain
| | - Paloma Martín
- Department of Nephrology, Clínica Universidad de Navarra, Avenida Pío XII 36, 31008, Pamplona, Spain
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20
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Abstract
: Human T-lymphotropic virus type 1 (HTLV-1) infection is a neglected disease despite roughly 15 million people are chronically infected worldwide. Lifelong less than 10% of carriers develop life-threatening diseases, mostly a subacute myelopathy known as tropical spastic paraparesis (TSP) and a lymphoproliferative disorder named adult T-cell leukemia (ATL). HTLV-1 is efficiently transmitted perinatally (breastfeeding), sexually (more from men to women) and parenterally (transfusions, injection drug user (IDU), and transplants). To date there is neither prophylactic vaccine nor effective antiviral therapy. A total of 327 cases of HTLV-1 infection had been reported at the HTLV-1 Spanish registry until December 2016, of whom 34 had been diagnosed with TSP and 25 with ATL. Overall 62% were Latin American immigrants and 13% were persons of African origin. The incidence of HTLV-1 in Spain has remained stable for nearly a decade with 20-25 new cases yearly. Of the 21 newly diagnosed HTLV-1 cases during year 2016, one was a native Spaniard pregnant woman, and four presented with symptomatic disease, including three with ATL and one with TSP. Underdiagnosis of HTLV-1 in Spain must be high (iceberg model), which may account for the disproportionate high rate of symptomatic cases (almost 20%) and the late recognition of preventable HTLV-1 transmissions in special populations, such as newborns and transplant recipients. Our current estimate is of 10 000 persons living with HTLV-1 infection in Spain. Given the large flux of immigrants and visitors from HTLV-1 endemic regions to Spain, the expansion of HTLV-1 screening policies is warranted. At this time, it seems worth recommending HTLV testing to all donor/recipient organ transplants and pregnant women regardless place of birth. Although current leukoreduction procedures largely prevent HTLV-1 transmission by blood transfusions, HTLV testing of all first-time donors should be cost-effective contributing to unveil asymptomatic unaware HTLV-1 carriers.
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21
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Westphal GA, Garcia VD, de Souza RL, Franke CA, Vieira KD, Birckholz VRZ, Machado MC, de Almeida ERB, Machado FO, Sardinha LADC, Wanzuita R, Silvado CES, Costa G, Braatz V, Caldeira Filho M, Furtado R, Tannous LA, de Albuquerque AGN, Abdala E, Gonçalves ARR, Pacheco-Moreira LF, Dias FS, Fernandes R, Giovanni FD, de Carvalho FB, Fiorelli A, Teixeira C, Feijó C, Camargo SM, de Oliveira NE, David AI, Prinz RAD, Herranz LB, de Andrade J. Guidelines for the assessment and acceptance of potential brain-dead organ donors. Rev Bras Ter Intensiva 2017; 28:220-255. [PMID: 27737418 PMCID: PMC5051181 DOI: 10.5935/0103-507x.20160049] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Organ transplantation is the only alternative for many patients with terminal diseases. The increasing disproportion between the high demand for organ transplants and the low rate of transplants actually performed is worrisome. Some of the causes of this disproportion are errors in the identification of potential organ donors and in the determination of contraindications by the attending staff. Therefore, the aim of the present document is to provide guidelines for intensive care multi-professional staffs for the recognition, assessment and acceptance of potential organ donors.
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Affiliation(s)
- Glauco Adrieno Westphal
- Corresponding author: Glauco Adrieno Westphal, Centro
Hospitalar Unimed, Rua Orestes Guimarães, 905, Zip code: 89204-060 -
Joinville (SC), Brazil. E-mail:
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22
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Infectious Diseases Transmitted by Grafts. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00222-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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23
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Screening transplant donors for HTLV-1 and -2. Blood 2016; 128:3029-3031. [PMID: 28034870 DOI: 10.1182/blood-2016-09-739433] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/04/2016] [Indexed: 11/20/2022] Open
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24
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Montesdeoca Andrade MJ, Correa Diaz EP, Buestán ME. HTLV-1-associated myelopathy in a solid organ transplant recipient. BMJ Case Rep 2016; 2016:bcr-2016-215243. [PMID: 27268291 DOI: 10.1136/bcr-2016-215243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Human T-cell lymphotropic virus type-1 (HTLV-1) is endemic in Japan, the Caribbean and in South American countries such as Ecuador. This virus is the cause of HTLV-1-associated myelopathy or tropical spastic paraparesis (HAM/TSP), a myelopathy characterised by chronic progressive paraparesis, spasticity and urinary symptoms. We report the case of a 40-year-old man who received a kidney transplant from a living donor and developed HAM/TSP, 24 months after transplant. The diagnosis was confirmed by detection of HTLV-1 in blood and cerebrospinal fluid by the ELISA and Western Blot tests. For myelopathy, the patient was treated with pulse methylprednisolone, but had poor response to treatment. We recommend that all patients receiving transplants and their donors who come from endemic countries be given a mandatory screening for HTLV-1 through an ELISA test, in an effort to inform candidates for renal transplantation of the potential risk of infection and the development of this disease.
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Yoshizumi T, Takada Y, Shirabe K, Kaido T, Hidaka M, Honda M, Ito T, Shinoda M, Ohdan H, Kawagishi N, Sugawara Y, Ogura Y, Kasahara M, Kubo S, Taketomi A, Yamashita N, Uemoto S, Yamaue H, Miyazaki M, Takada T, Maehara Y. Impact of human T-cell leukemia virus type 1 on living donor liver transplantation: a multi-center study in Japan. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 23:333-41. [DOI: 10.1002/jhbp.345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/17/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Tomoharu Yoshizumi
- Department of Surgery and Science; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
| | - Yasutsugu Takada
- The Study Group of the Japanese Society of Hepato-biliary-Pancreatic Surgery and Japanese Liver Transplantation Society; Tokyo Japan
| | - Ken Shirabe
- The Study Group of the Japanese Society of Hepato-biliary-Pancreatic Surgery and Japanese Liver Transplantation Society; Tokyo Japan
| | - Toshimi Kaido
- The Study Group of the Japanese Society of Hepato-biliary-Pancreatic Surgery and Japanese Liver Transplantation Society; Tokyo Japan
| | - Masaaki Hidaka
- The Study Group of the Japanese Society of Hepato-biliary-Pancreatic Surgery and Japanese Liver Transplantation Society; Tokyo Japan
| | - Masaki Honda
- The Study Group of the Japanese Society of Hepato-biliary-Pancreatic Surgery and Japanese Liver Transplantation Society; Tokyo Japan
| | - Takashi Ito
- The Study Group of the Japanese Society of Hepato-biliary-Pancreatic Surgery and Japanese Liver Transplantation Society; Tokyo Japan
| | - Masahiro Shinoda
- The Study Group of the Japanese Society of Hepato-biliary-Pancreatic Surgery and Japanese Liver Transplantation Society; Tokyo Japan
| | - Hideki Ohdan
- The Study Group of the Japanese Society of Hepato-biliary-Pancreatic Surgery and Japanese Liver Transplantation Society; Tokyo Japan
| | - Naoki Kawagishi
- The Study Group of the Japanese Society of Hepato-biliary-Pancreatic Surgery and Japanese Liver Transplantation Society; Tokyo Japan
| | - Yasuhiko Sugawara
- The Study Group of the Japanese Society of Hepato-biliary-Pancreatic Surgery and Japanese Liver Transplantation Society; Tokyo Japan
| | - Yasuhiro Ogura
- The Study Group of the Japanese Society of Hepato-biliary-Pancreatic Surgery and Japanese Liver Transplantation Society; Tokyo Japan
| | - Mureo Kasahara
- The Study Group of the Japanese Society of Hepato-biliary-Pancreatic Surgery and Japanese Liver Transplantation Society; Tokyo Japan
| | - Shoji Kubo
- The Study Group of the Japanese Society of Hepato-biliary-Pancreatic Surgery and Japanese Liver Transplantation Society; Tokyo Japan
| | - Akinobu Taketomi
- The Study Group of the Japanese Society of Hepato-biliary-Pancreatic Surgery and Japanese Liver Transplantation Society; Tokyo Japan
| | | | - Shinji Uemoto
- The Study Group of the Japanese Society of Hepato-biliary-Pancreatic Surgery and Japanese Liver Transplantation Society; Tokyo Japan
| | - Hiroki Yamaue
- The Study Group of the Japanese Society of Hepato-biliary-Pancreatic Surgery and Japanese Liver Transplantation Society; Tokyo Japan
| | - Masaru Miyazaki
- The Study Group of the Japanese Society of Hepato-biliary-Pancreatic Surgery and Japanese Liver Transplantation Society; Tokyo Japan
| | - Tadahiro Takada
- The Study Group of the Japanese Society of Hepato-biliary-Pancreatic Surgery and Japanese Liver Transplantation Society; Tokyo Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
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EXP CLIN TRANSPLANTExp Clin Transplant 2015; 13. [DOI: 10.6002/ect.2013.0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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27
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Ponce-Alonso M, Del Corral-Corral I, Ortiz-Rivera M, Anciones-Martín C, Mateos-Lindemann ML. Indigenous tropical spastic paraparesis in Madrid (Spain). Experience on screening of human T-lymphotropic virus. Enferm Infecc Microbiol Clin 2015; 35:441-443. [PMID: 26282070 DOI: 10.1016/j.eimc.2015.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/30/2015] [Accepted: 07/04/2015] [Indexed: 11/25/2022]
Abstract
We have recently documented a case of tropical spastic paraparesis by HTLV-I in a Spanish patient. HTLV-I infection is rare in Europe, and hardly ever is accompanied by symptoms, but if it does it could trigger a major health issue. This case is presented here, as well as a discussion on the situations in which HTLV-I detection is justified. An analysis was made of the HTLV diagnostic requests at our centre during 2014-2015 (n=123). The diagnostic algorithm was: 1) Enzyme immunoassay, 2) Reverse hybridization, and 3) Proviral DNA detection by PCR. The results showed several situations of HTLV screening, emphasising those related to paraparesis (22%). Seven cases of HTLV-I infection were found: five in patients from endemic regions, one in an HIV-infected patient, and the case of TSP mentioned above. HTLV-I surveillance in non-endemic regions is a challenging issue, as the cost-benefit ratio is not well-established. This case report emphasises the importance of including HTLV within the differential diagnosis of insidious spastic paraparesis.
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Affiliation(s)
- Manuel Ponce-Alonso
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | | | - Marta Ortiz-Rivera
- Unidad de Retrovirus y Papilomavirus, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España
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28
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Pineda JC, Vélez JD, Moncada PA, Rosso F, Jaramillo FJ. Curso clínico de pacientes de trasplante autógeno de médula ósea portadores del virus linfotrópico humano. INFECTIO 2015. [DOI: 10.1016/j.infect.2014.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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29
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Nicolás D, Ambrosioni J, Paredes R, Marcos MÁ, Manzardo C, Moreno A, Miró JM. Infection with human retroviruses other than HIV-1: HIV-2, HTLV-1, HTLV-2, HTLV-3 and HTLV-4. Expert Rev Anti Infect Ther 2015; 13:947-63. [PMID: 26112187 DOI: 10.1586/14787210.2015.1056157] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
HIV-1 is the most prevalent retrovirus, with over 30 million people infected worldwide. Nevertheless, infection caused by other human retroviruses like HIV-2, HTLV-1, HTLV-2, HTLV-3 and HTLV-4 is gaining importance. Initially confined to specific geographical areas, HIV-2, HTLV-1 and HTLV-2 are becoming a major concern in non-endemic countries due to international migration flows. Clinical manifestations of retroviruses range from asymptomatic carriers to life-threatening conditions, such as AIDS in HIV-2 infection or adult T-cell lymphoma/leukemia or tropical spastic paraparesis in HTLV-1 infection. HIV-2 is naturally resistant to some antiretrovirals frequently used to treat HIV-1 infection, but it does have effective antiretroviral therapy options. Unfortunately, HTLV still has limited therapeutic options. In this article, we will review the epidemiological, clinical, diagnostic, pathogenic and therapeutic aspects of infections caused by these human retroviruses.
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Affiliation(s)
- David Nicolás
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
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Postrenal Transplant Human T-Cell Lymphotropic Virus Type I-Associated Myelopathy/Tropical Spastic Paraparesis: A Case Report and Review of the Literature. Transplant Direct 2015; 1:e3. [PMID: 27500208 DOI: 10.1097/txd.0000000000000512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 01/06/2015] [Indexed: 11/26/2022] Open
Abstract
We report a case of human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP), in a 59 year-old, living-donor, renal transplant recipient from Jamaica. The patient's renal transplant had been performed 11 years ago, and her organ donor was also from Jamaica. Pretransplant HTLV-I serologic status for both the donor and recipient was unknown. The prevalence of HTLV-I seropositivity in the United States and Europe is low, and HAM/TSP is a rare occurrence. The positive predictive value of HTLV-I screening in these regions is therefore, low. This has generated debate among transplant societies regarding universal screening for HTLV-I before solid organ transplantation. Very limited evidence is available for the prevention and treatment of this devastating condition. Our case highlights the importance of selected pretransplant screening for HTLV-I infection among organ donors and candidates from endemic areas. We feel such testing may aid in the early recognition of HAM/TSP and more timely initiation of treatment.
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Ramanan P, Deziel PJ, Norby SM, Yao JD, Garza I, Razonable RR. Donor-transmitted HTLV-1-associated myelopathy in a kidney transplant recipient--case report and literature review. Am J Transplant 2014; 14:2417-21. [PMID: 25138148 DOI: 10.1111/ajt.12849] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/20/2014] [Accepted: 05/20/2014] [Indexed: 01/25/2023]
Abstract
Clinical disease due to human T cell lymphotropic virus type 1 (HTLV-1), a retrovirus endemic in certain regions of the world, is rarely reported after solid organ transplantation. In 2009, universal deceased donor organ screening for HTLV-1 was discontinued in the United States. We report the first case of donor-derived HTLV-1-associated myelopathy in a kidney transplant recipient from the United States. The patient, who was HTLV-1-seronegative prior to transplantation, likely acquired HTLV-1 infection from a seropositive organ donor. In this era when screening of donors and recipients for HTLV infection is not mandatory, clinicians should be vigilant in recognizing the risk and potential occurrence of this donor-derived infection in recipients with epidemiologic exposures.
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Affiliation(s)
- P Ramanan
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN; William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
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Jr CSK, Koval CE, Duin DV, Morais AGD, Gonzalez BE, Avery RK, Mawhorter SD, Brizendine KD, Cober ED, Miranda C, Shrestha RK, Teixeira L, Mossad SB. Selecting suitable solid organ transplant donors: Reducing the risk of donor-transmitted infections. World J Transplant 2014; 4:43-56. [PMID: 25032095 PMCID: PMC4094952 DOI: 10.5500/wjt.v4.i2.43] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/21/2014] [Accepted: 05/14/2014] [Indexed: 02/05/2023] Open
Abstract
Selection of the appropriate donor is essential to a successful allograft recipient outcome for solid organ transplantation. Multiple infectious diseases have been transmitted from the donor to the recipient via transplantation. Donor-transmitted infections cause increased morbidity and mortality to the recipient. In recent years, a series of high-profile transmissions of infections have occurred in organ recipients prompting increased attention on the process of improving the selection of an appropriate donor that balances the shortage of needed allografts with an approach that mitigates the risk of donor-transmitted infection to the recipient. Important advances focused on improving donor screening diagnostics, using previously excluded high-risk donors, and individualizing the selection of allografts to recipients based on their prior infection history are serving to increase the donor pool and improve outcomes after transplant. This article serves to review the relevant literature surrounding this topic and to provide a suggested approach to the selection of an appropriate solid organ transplant donor.
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Manifestazioni neurologiche associate al virus HTLV-1. Neurologia 2014. [DOI: 10.1016/s1634-7072(14)67222-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Takatsuki M, Soyama A, Eguchi S. Liver transplantation for HIV/hepatitis C virus co-infected patients. Hepatol Res 2014; 44:17-21. [PMID: 23607831 DOI: 10.1111/hepr.12132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 04/07/2013] [Accepted: 04/07/2013] [Indexed: 12/26/2022]
Abstract
Since the introduction of antiretroviral therapy (ART) in the mid-1990s, AIDS-related death has been dramatically reduced, and hepatitis-C-virus (HCV)-related liver failure or hepatocellular carcinoma has currently become the leading cause of death in HIV/HCV co-infected patients. Liver transplantation may be one of the treatments of choices in such cases, but the indications for transplantation, perioperative management including both HIV and HCV treatments, immunosuppression and the prevention/treatment of infectious complications are all still topics of debate. With the improved understanding of the viral behaviors of both HIV and HCV and the development of novel strategies, especially to avoid drug interactions between ART and immunosuppression, liver transplantation has become a realistic treatment for HIV/HCV co-infected patients.
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Affiliation(s)
- Mitsuhisa Takatsuki
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Routh D, Naidu S, Sharma S, Ranjan P, Godara R. Changing pattern of donor selection criteria in deceased donor liver transplant: a review of literature. J Clin Exp Hepatol 2013; 3:337-46. [PMID: 25755521 PMCID: PMC3940395 DOI: 10.1016/j.jceh.2013.11.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 11/18/2013] [Indexed: 02/06/2023] Open
Abstract
During the last couple of decades, with standardization and progress in surgical techniques, immunosuppression and post liver transplantation patient care, the outcome of liver transplantation has been optimized. However, the principal limitation of transplantation remains access to an allograft. The number of patients who could derive benefit from liver transplantation markedly exceeds the number of available deceased donors. The large gap between the growing list of patients waiting for liver transplantation and the scarcity of donor organs has fueled efforts to maximize existing donor pool and identify new avenues. This article reviews the changing pattern of donor for liver transplantation using grafts from extended criteria donors (elderly donors, steatotic donors, donors with malignancies, donors with viral hepatitis), donation after cardiac death, use of partial grafts (split liver grafts) and other suboptimal donors (hypernatremia, infections, hypotension and inotropic support).
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Key Words
- CIT, cold ischemia time
- DCD, donation after cardiac death
- DGF, delayed graft function
- ECD, extended criteria donor
- ECMO, extra corporeal membrane oxygenation
- HBIg, hepatitis B immune globulin
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- HIV, human immunodeficiency virus
- HTLV, human T-lymphotropic virus
- LDLT, living donor liver transplantation
- LT, liver transplantation
- MELD, Model for End-Stage Liver Disease
- NRP, normothermic regional perfusion
- PNF, primary nonfunction
- SLT, split liver transplantation
- SOFT, survival outcomes following liver transplantation
- SRTR, Scientific Registry of Transplant Recipients
- donor pool
- extended criteria donor
- liver transplantation
- mTOR, mammalian target of rapamycin inhibitors
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Affiliation(s)
- Dronacharya Routh
- Department of GI Surgery and Liver Transplantation, Army Hospital (R&R), New Delhi 110010, India
| | - Sudeep Naidu
- Department of GI Surgery and Liver Transplantation, Army Hospital (R&R), New Delhi 110010, India,Address for correspondence: Sudeep Naidu, Professor and Head, Department of GI Surgery and Liver Transplantation, Army Hospital (R&R), New Delhi 110010, India. Tel.: +91 (0) 9999454052.
| | - Sanjay Sharma
- Department of GI Surgery and Liver Transplantation, Army Hospital (R&R), New Delhi 110010, India
| | - Priya Ranjan
- Department of GI Surgery and Liver Transplantation, Army Hospital (R&R), New Delhi 110010, India
| | - Rajesh Godara
- Department of Surgery, Post Graduate Institute of Medical Sciences, Rhotak, Haryana, India
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Eguchi S, Takatsuki M, Kuroki T. Liver transplantation for patients with human immunodeficiency virus and hepatitis C virus co-infection: update in 2013. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 21:263-8. [PMID: 24027085 DOI: 10.1002/jhbp.31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Because of the progress of anti-retroviral therapy (ART) for human immunodeficiency virus (HIV), mortality due to opportunistic infection resulting in AIDS has been remarkably reduced. However, meanwhile, half of those patients have died of end-stage liver cirrhosis due to hepatitis C virus (HCV) with liver cirrhosis and early occurrence of hepatocellular carcinoma. Recently, in 2013, non-cirrhotic portal hypertension due to ART drugs or still unknown mechanisms have become problematic with early progression of the disease in this patient population. Liver transplantation (LT) could be one treatment of choice in such cases, but the indications for LT perioperative management, including both HIV and HCV treatments and immunosuppression, are still challenging. In this review, we update the literature on HIV/HCV co-infection and LT as well as recent effort for modifying allocation system for those patients.
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Affiliation(s)
- Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
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