1
|
Quintas AE, Cuboia N, Cordeiro L, Sarmento A, Azevedo L. Seroprevalence of human immunodeficiency virus in African blood donors: a systematic review and meta-analysis. EBioMedicine 2024; 105:105210. [PMID: 38941957 PMCID: PMC11260585 DOI: 10.1016/j.ebiom.2024.105210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/07/2024] [Accepted: 06/04/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND In developing countries, the safety of blood transfusions remains an important public health concern as it is associated with a higher risk of transfusion-transmissible infections (TTIs). In this study, we aimed to estimate the seroprevalence of HIV among blood donors in Africa and assess the temporal trends and regional differences within the continent through a systematic review and meta-analysis. METHODS Seven electronic databases (PubMed, Web of Science, Cochrane, Scopus, HINARI, Global Index Medicus and Clinical. TRIAL gov) were searched for relevant studies for our research. We included all primary studies that estimated the seroprevalence of HIV among blood donors in Africa with an age population from 16 to 65 years old, without language restrictions, from inception up to March 1st 2024. The pooled seroprevalence was estimated through the DerSimonian-Laird random effects model. The temporal trends and regional differences were assessed through subgroup and meta-regression analysis. FINDINGS We obtained 122 studies that met our inclusion criteria, comprising 7,814,996 blood donors tested for HIV. Sixty-six percent of the studies were from Western and Eastern Africa. The pooled seroprevalence of HIV among blood donors in Africa was 2.66% (95% CI: 2.17-3.20%; I2 = 99.80%, p < 0.01). The highest prevalence was observed in the Central African region, 3.28% (95% CI: 2.57%-4.06%), followed by the Eastern 3.21% (95% CI: 2.12%-4.52%), and the Western 2.66% (95% CI: 1.93%-3.49%) regions. Lower prevalences were observed in the Northern region, 0.57% (95% CI: 0.0%-2.10%), followed by the Southern African region with 0.45% (95% CI: 0.16%-0.86%). We observed a temporal decreased trend of HIV prevalence. INTERPRETATION The prevalence of HIV infection among African blood donors remains high and is not homogeneous across the continent. Efficient measures to strengthen HIV testing and prevent HIV transmission through blood transfusion are needed in Africa. Systematic review protocol registration: PROSPERO CRD42023395616. FUNDING This article was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDP/4255/2020).
Collapse
Affiliation(s)
- Angelina Edna Quintas
- MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Porto, Portugal; CINTESIS@RISE-Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE) Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Nelson Cuboia
- MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Porto, Portugal; CINTESIS@RISE-Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE) Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Lemuel Cordeiro
- Department of Education Office, Clínica Girassol, Luanda, Angola.
| | - António Sarmento
- CHUSJ, Infectious Diseases Service at the University Hospital Center of São João, Portugal.
| | - Luís Azevedo
- MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine of the University of Porto, Porto, Portugal; CINTESIS@RISE-Center for Health Technology and Services Research (CINTESIS) & Health Research Network Associated Laboratory (RISE) Faculty of Medicine, University of Porto, Porto, Portugal.
| |
Collapse
|
2
|
Maertens GN, Purcell DFJ, Rosadas C, Bradshaw D, Biglione M, Taylor GP, Martin F. Why not eliminate HTLV-1 while eliminating HIV-1? Lancet 2024; 403:2288-2289. [PMID: 38796201 DOI: 10.1016/s0140-6736(24)00295-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/12/2024] [Indexed: 05/28/2024]
Affiliation(s)
- Goedele N Maertens
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK.
| | - Damian F J Purcell
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, VIC, Australia
| | - Carolina Rosadas
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
| | - Daniel Bradshaw
- Virus Reference Department, UK Health Security Agency, London, UK; National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, London, UK
| | - Mirna Biglione
- Instituto de Investigaciones Biomedicas en Retrovirus y SIDA (INBIRS), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Graham P Taylor
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK; National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, London, UK
| | - Fabiola Martin
- Canberra Sexual Health Centre, Canberra Health Services, Canberra, ACT, Australia; School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia; School of Public Health, University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
3
|
Bradshaw D, Khawar A, Patel P, Tosswill J, Brown C, Ogaz D, Mason E, Osman R, Mitchell H, Dosekun O, Peris BM, Pickard G, Rayment M, Jones R, Hopkins M, Williams A, Kingston M, Machin N, Taha Y, Duncan S, Turner N, Gill N, Andrews N, Raza M, Tazzyman S, Nori A, Cunningham E, Taylor GP. HTLV seroprevalence in people using HIV pre-exposure prophylaxis in England. J Infect 2023; 86:245-247. [PMID: 36773896 DOI: 10.1016/j.jinf.2023.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/05/2023] [Accepted: 01/20/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES HTLV-1 is predominantly a sexually-transmitted infection but testing is not mentioned in HIV-PrEP guidelines. We ascertained HTLV-1/HTLV-2 seroprevalence amongst HIV-PrEP users in England. METHODS An unlinked anonymous seroprevalence study. RESULTS Amongst 2015 HIV-PrEP users, 95% were men, 76% of white ethnicity and 83% had been born in Europe. There were no HTLV-1/HTLV-2 seropositive cases (95% confidence interval 0% - 0.18%). CONCLUSIONS There were no HTLV positive cases, likely reflecting the demographic of mostly white and European-born individuals. Similar studies are needed worldwide to inform public health recommendations for HIV-PrEP using populations, particularly in HTLV-endemic settings.
Collapse
Affiliation(s)
- Daniel Bradshaw
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK; National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, London W2 1NY, UK.
| | - Arham Khawar
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Poorvi Patel
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | | | - Colin Brown
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Dana Ogaz
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Emily Mason
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Roeann Osman
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Holly Mitchell
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Olamide Dosekun
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London W2 1NY, UK
| | - Borja Mora Peris
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London W2 1NY, UK
| | - Graham Pickard
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London W2 1NY, UK
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - Rachael Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - Mark Hopkins
- Barts Health NHS Trust, St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Andy Williams
- Barts Health NHS Trust, St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Margaret Kingston
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Nicholas Machin
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Yusri Taha
- Newcastle Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle NE1 4LP, UK
| | - Sarah Duncan
- Newcastle Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle NE1 4LP, UK
| | - Neil Turner
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - Noel Gill
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Nick Andrews
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Mohammad Raza
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, UK
| | - Simon Tazzyman
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, UK
| | - Achyuta Nori
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Emma Cunningham
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Graham P Taylor
- Imperial College London, London W2 1PG, UK; National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Hayashi Y, Kitajima T, Marumo S, Fukui M. Adult T Cell Leukemia/Lymphoma Becoming Apparent during Treatment of Pulmonary Abscess and Empyema Caused by Nocardia asiatica: A Case Report and Review of the Literature. Intern Med 2022; 61:2227-2232. [PMID: 34980794 PMCID: PMC9381332 DOI: 10.2169/internalmedicine.8428-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Nocardia is a Gram-positive bacterium that causes opportunistic infections. Nocardia asiatica was newly isolated in 2004, and there have been no case reports describing the empyema caused by N. asiatica. Adult T-cell leukemia/lymphoma (ATL) is a peripheral T-cell malignancy caused by human T-cell leukemia virus type 1 (HTLV-1). We herein report a case in which immunosuppression attributable to ATL may have led to pulmonary abscess and empyema caused by N. asiatica. Our case demonstrates the need to investigate causes of immunosuppression, including ATL, in patients showing nocardiosis.
Collapse
Affiliation(s)
- Yusuke Hayashi
- Department of Respirology, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, Japan
| | - Takamasa Kitajima
- Department of Respirology, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, Japan
| | - Satoshi Marumo
- Department of Respirology, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, Japan
| | - Motonari Fukui
- Department of Respirology, Kitano Hospital, the Tazuke Kofukai Medical Research Institute, Japan
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Sugahara K, Yanagihara T, Nakamura Y, Nakayama Y, Hanaoka K, Ohgushi M, Ogo N, Inutsuka Y, Asoh T, Harada Y, Yoneda R, Maeyama T. A Refractory, Infected Lung Bulla and an Abscess Treated Using Percutaneous Drainage in a Patient With Human T-Lymphotropic Virus Type 1-Associated Myelopathy. Cureus 2021; 13:e20333. [PMID: 34934596 PMCID: PMC8668043 DOI: 10.7759/cureus.20333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/05/2022] Open
Abstract
We present a case of a 54-year-old Japanese woman with established human T-lymphotropic virus type 1 (HTLV-1)-associated myelopathy who developed a refractory infected lung bulla and lung abscess caused by Pseudomonas aeruginosa, Methicillin-resistant Staphylococcus aureus, and Aspergillusspecies. Since antibiotic treatment alone failed to resolve the infection, percutaneous drainage of the infected bulla was performed. Although a prolonged treatment period was necessary, the infected lung bulla and the lung abscess were eventually resolved. During her illness, the patient also developed arthritis, possibly related to the HTLV-1 infection. Thus, persons infected with HTLV-1 can develop refractory infections, myelopathy, and arthritis. Percutaneous drainage is an option to treat refractory infected lung bullae.
Collapse
|
8
|
Okello CD, Niyonzima N, Ferraresso M, Kadhumbula S, Ddungu H, Tarlock K, Balagadde-Kambugu J, Omoding A, Ngendahayo L, Karagu A, Mwaiselage J, Harlan JM, Uldrick TS, Turner SD, Orem J. Haematological malignancies in sub-Saharan Africa: east Africa as an example for improving care. Lancet Haematol 2021; 8:e756-e769. [PMID: 34481552 DOI: 10.1016/s2352-3026(21)00198-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 06/15/2021] [Accepted: 06/25/2021] [Indexed: 12/13/2022]
Abstract
Haematological malignancies account for almost 10% of all cancers diagnosed in sub-Saharan Africa, although the exact incidences and treatment outcomes are difficult to discern because population-based cancer registries in the region are still underdeveloped. More research on haematological malignancies in sub-Saharan Africa is required to establish whether these cancers have a natural history similar to those diagnosed in high-income countries, about which more is known. Several factors negatively affect the outcome of haematological malignancies in sub-Saharan Africa, showcasing a need for improved understanding of the clinicobiological profile of these cancers to facilitate prevention, early detection, diagnosis, and appropriate treatment through increased capacity building, infrastructure, community awareness, coordinated resource mobilisation, and collaboration across the world. The east African governments have pooled resources for common investments to tackle non-communicable diseases, developing the East Africa's Centres of Excellence for Skills and Tertiary Education project funded by the African Development Bank, an initiative that could be replicated for the care of haematological malignancies in other countries in sub-Saharan Africa. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
| | | | | | | | | | - Katherine Tarlock
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA
| | | | | | - Louis Ngendahayo
- Anatomical Pathology Service, University Teaching Hospital of Kamenge, Bujumbura, Burundi
| | | | | | | | - Thomas S Uldrick
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | | | | |
Collapse
|
9
|
Brites C, Miranda F, Luz E, Netto EM. Early and Successful Combination Antiretroviral Therapy Normalizes Survival Time in Patients Coinfected With Human Immunodeficiency Virus and Human T-cell Lymphotrophic Virus Type 1. Clin Infect Dis 2021; 71:196-200. [PMID: 31406994 DOI: 10.1093/cid/ciz756] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/05/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Coinfection with human T-cell lymphotrophic virus type 1 (HTLV-1) is associated with shorter survival for adults and children infected with human immunodeficiency virus (HIV), although the reasons remain a matter of debate. We evaluated the factors associated with survival time in a large cohort of HIV/HTLV-1-coinfected and HIV-monoinfected individuals on combination antiretroviral therapy (cART). METHODS In a nested, retrospective case-control study (1:1), we reviewed medical records of people with HIV infection on cART in a referral AIDS center in Salvador, Brazil. We matched 149 patients coinfected with HTLV-1 (cases) by age at HIV diagnosis and sex, to an equal number of HTLV-uninfected persons (controls). Death rates, survival time, baseline and current CD4 cell count, last HIV-1 RNA plasma viral load (pVL), and causes of death were compared between groups. RESULTS The overall mortality rate was 2.1 person-years (76 deaths, 53 among coinfected patients). Survival time for cases (16.7 ± 0.7 years) was significantly shorter than for controls (18.1 ± 0.4 years; P = .001). Among patients with pVL >50 copies/mL, coinfected patients had a shorter survival time (8.4 ± 0.8 years) than monoinfected ones (12.9 ± 1.4 years; P = .02), regardless of pVL magnitude. However, survival time did not differ for HIV-monoinfected (19.0 ± 0.4 years) or coinfected patients (20.2 ± 0.6 years) presenting with pVL <50 copies/mL (P = .5). Deceased coinfected patients had higher initial CD4 count (417 ± 219 cells) than monoinfected ones with the same outcome (177 ± 160 cells; P = .004), while survivors had similar CD4 cell count at baseline, regardless of HTLV status. CONCLUSIONS Successful cART is able to normalize survival for coinfected patients and should be introduced for all coinfected patients, regardless of CD4 cell count.HIV/human T-cell lymphotrophic virus type 1 coinfection is believed to decrease survival of coinfected patients. In this case-control study, we demonstrate that successful combination antiretroviral therapy (last HIV viral load <50 copies/mL) is able to improve survival of coinfected patients to levels observed for those monoinfected.
Collapse
Affiliation(s)
- Carlos Brites
- Laboratório de Pesquisa em Infectologia, Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina, Universidade Federal da Bahia, Brazil
| | - Fernanda Miranda
- Laboratório de Pesquisa em Infectologia, Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina, Universidade Federal da Bahia, Brazil
| | - Estela Luz
- Laboratório de Pesquisa em Infectologia, Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina, Universidade Federal da Bahia, Brazil
| | - Eduardo Martins Netto
- Laboratório de Pesquisa em Infectologia, Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina, Universidade Federal da Bahia, Brazil
| |
Collapse
|
10
|
Dangana A, Abdullahi IN, Billyrose OMA, Emeribe AU, Abu JM, Anka AU, Animasaun OS, Ghamba PE. Sero-epidemiology of human T-cell lymphotropic viruses-1 and -2 infection among pregnant women attending Abuja Teaching Hospital, Nigeria. Hum Antibodies 2021; 29:101-108. [PMID: 33523048 DOI: 10.3233/hab-200435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is the paucity of HTLV-1/-2 studies on Nigerian pregnant women despite the medical and public health significance of maternal-to-child transmission of HTLV-1/-2. OBJECTIVE This study aims to determine the seroprevalence and risk factors of HTLV-1/-2 infections among pregnant women attending the University of Abuja Teaching Hospital (UATH), Abuja, Nigeria. MATERIALS AND METHODS Blood samples were collected from consented pregnant women and analysed for ant-HTLV-1/-2 total antibodies using a commercial Enzyme-Linked Immunosorbent Assay (ELISA) kit. Pretested structured questionnaires were used to collate participants' socio-demographic variables and risk factors of HTLV infection. RESULTS Out of the 156 pregnant women tested for HTLV-1/-2 antibodies, 16 (10.3%) were seropositive. There was no significant association between the socio-demographic variables collated and seroprevalence of HTLV-1/-2 infection among pregnant women (p> 0.05). Pregnant women with HIV infection had a lower prevalence of HLTV-1/-2 infection than those without HIV infections (7.5% versus 11.7%). Pregnant women with multiple sexual partners had a higher risk of HTLV-1/-2 infection than those who had single (OR = 2.08, 95% CI: 0.53-8.18). Women with a history of needles injury had a higher risk of HTLV-1/-2 infection than those who do not (OR = 1.24, 95% CI: 0.38-4.08). The history of blood transfusion was significantly associated with HTLV-1/-2 infection (p= 0.027). However, no significant association existed between other risk factors of HTLV-1/-2 infection among pregnant women (p> 0.05). CONCLUSION Considering the 3% pooled national prevalence of HTLV-1/-2 infection in Nigeria, the seroprevalence reported in this study is relatively high. Thus, there is a need for more large cohort studies and routine screening of population at increased risk of infection.
Collapse
Affiliation(s)
- Amos Dangana
- Department of Medical Laboratory Services, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Idris Nasir Abdullahi
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, Ahmadu Bello University, Zaria, Nigeria
| | | | - Anthony Uchenna Emeribe
- Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Joel Monday Abu
- Department of Family Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Abubakar Umar Anka
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Olawale Sunday Animasaun
- Nigeria Field Epidemiology and Laboratory Training Program, African Field Epidemiology Network, Abuja, Nigeria
| | - Peter Elisha Ghamba
- WHO National Polio Laboratory, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| |
Collapse
|
11
|
Zijlstra EE, van Hellemond JJ, Moes AD, de Boer C, Boeschoten SA, van Blijswijk CEM, van der Vuurst de Vries RM, Bailey PAB, Kampondeni S, van Lieshout L, Smits SL, Katchanov J, Mkandawire NM, Rothe C. Nontraumatic Myelopathy in Malawi: A Prospective Study in an Area with High HIV Prevalence. Am J Trop Med Hyg 2020; 102:451-457. [PMID: 31837130 DOI: 10.4269/ajtmh.19-0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Nontraumatic myelopathy causes severe morbidity and is not uncommon in Africa. Clinically, patients often present with paraplegia, and extrinsic cord compression and transverse myelitis are most common causes. Data on exact pathogenesis are scanty because of limitations in diagnostic methods. In Queen Elizabeth Central Hospital, Blantyre, Malawi, we recorded consecutive patients presenting with nontraumatic paraplegia for maximally 6 months between January and July 2010 and from March to December 2011. The diagnostic workup included imaging and examining blood, stool, urine, sputum, and cerebrospinal fluid (CSF) samples for infection. After discharge, additional diagnostic tests, including screening for virus infections, borreliosis, syphilis, and schistosomiasis, were carried out in the Netherlands. The clinical diagnosis was, thus, revised in retrospect with a more accurate final differential diagnosis. Of 58 patients included, the mean age was 41 years (range, 12-83 years) and the median time between onset and presentation was 18 days (range, 0-121 days), and of 55 patients tested, 23 (42%) were HIV positive. Spinal tuberculosis (n = 24, 41%), tumors (n = 16, 28%), and transverse myelitis (n = 6, 10%) were most common; in six cases (10%), no diagnosis could be made. The additional tests yielded evidence for CSF infection with Schistosoma, Treponema pallidum, Epstein-Barr virus (EBV), HHV-6, HIV, as well as a novel cyclovirus. The diagnosis of the cause of paraplegia is complex and requires access to an magnetic resonance imaging (MRI) scan and other diagnostic (molecular) tools to demonstrate infection. The major challenge is to confirm the role of detected pathogens in the pathophysiology and to design an effective and affordable diagnostic approach.
Collapse
Affiliation(s)
| | - Jaap J van Hellemond
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Arthur D Moes
- Division of Nephrology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christa de Boer
- Infectious Disease Control, Municipal Health Service Zuid-Holland Zuid, Dordrecht, The Netherlands
| | - Shelley A Boeschoten
- Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | | | | | | | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Saskia L Smits
- Viroclinics Biosciences BV, Rotterdam Science Tower, Rotterdam, The Netherlands
| | - Juri Katchanov
- Department of Hematology and Oncology, LMU University of Munich, Munich, Germany.,Department of Medicine, College of Medicine, Blantyre, Malawi
| | | | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,Department of Medicine, College of Medicine, Blantyre, Malawi
| |
Collapse
|
12
|
Parkin DM, Hämmerl L, Ferlay J, Kantelhardt EJ. Cancer in Africa 2018: The role of infections. Int J Cancer 2020; 146:2089-2103. [PMID: 31254479 DOI: 10.1002/ijc.32538] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 12/11/2022]
Abstract
We estimate the fractions of cancer attributed to infections in Africa in 2018. The number of new cancer cases occurring was taken from Globocan2018 with some additional estimations based on data from African population-based registries. Population attributable fractions were calculated using prevalence of infection and relative risk in exposed vs. nonexposed. The greatest share of infection-associated cancers is due to the human papillomaviruses (12.1% of all cancers in Africa and 15.4% in sub-Saharan Africa [SSA]); of these, cervical cancer is by far the most common. Kaposi sarcoma-associated herpesvirus is responsible for 3.1% of all cancers in Africa, the hepatitis viruses (B and C) for 2.9% and Helicobacter pylori for 2.7% (non-Cardia Gastric cancer and primary gastric lymphomas). Two percent of cancers are attributable to the Epstein-Barr virus, Schistosoma haematobium increases the risk of bladder cancer resulting in 1.0% of all cancers. HIV-related NHL and squamous cell carcinoma of the conjunctiva account for 0.6% of cancers. Altogether 24.5% of cancers in Africa and 28.7% in SSA are due to infectious agents. Infections are by far the most common cancer risk factor for cancer in Africa-the traditional risk factors (smoking, alcohol and unhealthy diet) probably cause only one in eight cancers in Africa. Prevention should focus on those infectious diseases preventable through vaccination (HPV and hepatitis B) which could reduce two-thirds of the burden. Helicobacter pylori and schistosomiasis are treatable with antibiotics and praziquantel, with a potential reduction of one in eight infection-associated cancers.
Collapse
Affiliation(s)
- Donald M Parkin
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- African Cancer Registry Network, Oxford, United Kingdom
| | - Lucia Hämmerl
- Institute for Medical Epidemiology, Biometry and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Eva J Kantelhardt
- Institute for Medical Epidemiology, Biometry and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| |
Collapse
|
13
|
Human T Cell Lymphotrophic virus infection among sexually active individuals in Nigeria: A cross sectional study. SCIENTIFIC AFRICAN 2019. [DOI: 10.1016/j.sciaf.2019.e00072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
|
14
|
Noubiap JJ, Balti EV, Bigna JJ, Echouffo-Tcheugui JB, Kengne AP. Dyslipidaemia in Africa-comment on a recent systematic review - Authors' reply. LANCET GLOBAL HEALTH 2018; 7:e308-e309. [PMID: 30553650 DOI: 10.1016/s2214-109x(18)30517-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/05/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Jean Jacques Noubiap
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Eric Vounsia Balti
- Diabetes Research Center, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Internal Medicine, Universiteit Ziekenhuis Brussel, Brussels, Belgium
| | - Jean Joel Bigna
- Faculty of Medicine, University of Paris Sud XI, Le Kremlin-Bicêtre, France
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - André Pascal Kengne
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Non-communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| |
Collapse
|
15
|
Weimer A, Tagny CT, Tapko JB, Gouws C, Tobian AAR, Ness PM, Bloch EM. Blood transfusion safety in sub-Saharan Africa: A literature review of changes and challenges in the 21st century. Transfusion 2018; 59:412-427. [PMID: 30615810 DOI: 10.1111/trf.14949] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Access to a safe, adequate blood supply has proven challenging in sub-Saharan Africa, where systemic deficiencies spanning policy, collections, testing, and posttransfusion surveillance have long been recognized. Progress in transfusion safety in the early 2000s was in large part due to intervention by the World Health Organization and other foreign governmental bodies, coupled with an influx of external funding. STUDY DESIGN AND METHODS A review of the literature was conducted to identify articles pertaining to blood safety in sub-Saharan Africa from January 2009 to March 2018. The search was directed toward addressing the major elements of the blood safety chain, in the countries comprising the World Health Organization African region. Of 1380 articles, 531 met inclusion criteria and 136 articles were reviewed. RESULTS External support has been associated with increased recruitment of voluntary donors and expanded testing for the major transfusion-transmitted infections (TTIs). However, the rates of TTIs among donors remain high. Regional education and training initiatives have been implemented, and a tiered accreditation process has been adopted. However, a general decline in funding for transfusion safety (2009 onwards) has strained the ability to maintain or improve transfusion-related services. Critical areas of need include data collection and dissemination, epidemiological surveillance for TTIs, donor recruitment, quality assurance and oversight (notably laboratory testing), and hemovigilance. CONCLUSION Diminishing external support has been challenging for regional transfusion services. Critical areas of deficiency in regional blood transfusion safety remain. Nonetheless, substantive gains in education, training, and accreditation suggest durable gains in regional capacity.
Collapse
Affiliation(s)
- A Weimer
- Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, Baltimore, MD
| | - C T Tagny
- Hematology and Blood Transfusion service, University Teaching Hospital, Yaoundé, Cameroon
| | - J B Tapko
- African Society of Blood Transfusion, Yaoundé, Cameroon
| | - C Gouws
- Blood Transfusion Service of Namibia, Windhoek, Namibia
| | - A A R Tobian
- Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, Baltimore, MD
| | - P M Ness
- Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, Baltimore, MD
| | - E M Bloch
- Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, Baltimore, MD
| |
Collapse
|
16
|
Risk factors for HTLV-1 infection in Central Africa: A rural population-based survey in Gabon. PLoS Negl Trop Dis 2018; 12:e0006832. [PMID: 30312301 PMCID: PMC6200283 DOI: 10.1371/journal.pntd.0006832] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/24/2018] [Accepted: 09/10/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Human T-Lymphotropic Virus type 1 (HTLV-1) is a human oncoretrovirus that infects at least 5 to 10 million people worldwide and is associated with severe diseases. Africa appears as the largest HTLV-1 endemic area. However, the risk factors for the acquisition of HTLV-1 remain poorly understood in Central Africa. METHODS We conducted an epidemiological survey between 2013 and 2017, in rural areas of 6 provinces of Gabon, in a rainforest environment. Epidemiological data were obtained and blood samples were collected after informed consent. Plasma were screened for HTLV-1 antibodies by ELISA and the positive samples were then tested by Western blot (WB). Genomic DNA derived from buffy-coat was subjected to two semi-nested PCRs amplifying either HTLV-1 env gene or LTR region fragments. RESULTS We recruited 2,060 individuals over 15 years old, including 1,205 men and 855 women (mean age: 49 years). Of these, 299 were found to be ELISA HTLV-1/2 seropositive. According to WB criteria, 136 were HTLV-1 (6.6%), 25 HTLV-1/2 (1.2%) and 9 HTLV seroreactive (0.4%). PCR results showed that 146 individuals were positive for at least one PCR: 104 for the env gene and 131 for the LTR region. Based on both serological and molecular results, 179 individuals were considered infected with HTLV-1, leading to an overall prevalence of 8.7%. The distribution of HTLV-1 infection was heterogeneous across the country. Based on multivariable analyses, female gender, increasing age, ethnicity (Pygmy) and multiple hospitalizations (more than 5 times) were found to be independent risk factors for HTLV-1 infection. Furthermore, a non-human primate bite appeared to be marginally associated with a higher risk of HTLV-1 infection. CONCLUSION Based on state-of-the-art serological and molecular methods, we have demonstrated that rural adult populations in Gabon are highly endemic for HTLV-1. Our results regarding risk factors should lead to public health actions aiming to reduce HTLV-1 transmission.
Collapse
|
17
|
Anyanwu NCJ, Ella EE, Ohwofasa A, Aminu M. Re-emergence of human T-lymphotropic viruses in West Africa. Braz J Infect Dis 2018; 22:224-234. [PMID: 29879426 PMCID: PMC9425667 DOI: 10.1016/j.bjid.2018.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/28/2018] [Accepted: 05/07/2018] [Indexed: 11/30/2022] Open
Abstract
Human T-lymphotropic viruses (HTLV) are Deltaretroviruses that infect millions of individuals worldwide via the same transmission routes as HIV. With the aim of exposing the possible re-emergence of HTLV in West Africa since discovery, a systematic review was carried out, focusing on the distribution of the virus types and significance of frequent indeterminate reports, while highlighting the need for mandatory routine blood screening. Capturing relevant data from discovery till date, sources searched were Google Scholar, CrossRef, NCBI (PubMed), MEDLINE, Research Gate, Mendeley, abstracts of Conferences and Proceedings, organization websites and reference lists of selected papers. A total of 2626 references were initially retrieved using search terms: Worldwide prevalence of HTLV, HTLV in Africa, HTLV in West Africa, HTLV subtypes, HTLV 3 and 4 in Africa, HTLV of African origin, HTLV seroindeterminate results, Spread of HTLV. These references were rigorously trimmed down to 76. Although evidence shows that HTLV is still endemic in the region, West Africa lacks recent epidemiological prevalence data. Thorough investigations are needed to ascertain the true cause of indeterminate Western Blot results. It is imperative that routine screening for HTLVs be mandated in West African health care facilities.
Collapse
Affiliation(s)
- Nneoma Confidence JeanStephanie Anyanwu
- Ahmadu Bello University, Faculty of Life Sciences, Department of Microbiology, Zaria, Nigeria; COMSATS University, Department of Biosciences, Islamabad, Pakistan.
| | - Elijah Ekah Ella
- Ahmadu Bello University, Faculty of Life Sciences, Department of Microbiology, Zaria, Nigeria
| | - Aghogho Ohwofasa
- COMSATS University, Department of Biosciences, Islamabad, Pakistan
| | - Maryam Aminu
- Ahmadu Bello University, Faculty of Life Sciences, Department of Microbiology, Zaria, Nigeria
| |
Collapse
|
18
|
Abstract
Human T cell leukemia virus type 1 (HTLV-1), also known as human T lymphotropic virus type 1, was the first exogenous human retrovirus discovered. Unlike the distantly related lentivirus HIV-1, HTLV-1 causes disease in only 5-10% of infected people, depending on their ethnic origin. But whereas HIV-1 infection and the consequent diseases can be efficiently contained in most cases by antiretroviral drug treatment, there is no satisfactory treatment for the malignant or inflammatory diseases caused by HTLV-1. The purpose of the present article is to review recent advances in the understanding of the mechanisms by which the virus persists in vivo and causes disabling or fatal diseases.
Collapse
Affiliation(s)
- Charles R M Bangham
- Division of Infectious Diseases, Faculty of Medicine, Imperial College, London W2 1PG, United Kingdom;
| |
Collapse
|
19
|
Rochford R, Korir A, Newton R. Viral-associated malignancies in Africa: are viruses 'infectious traces' or 'dominant drivers'? Curr Opin Virol 2016; 20:28-33. [PMID: 27551983 DOI: 10.1016/j.coviro.2016.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/08/2016] [Indexed: 12/24/2022]
Abstract
Since the discovery of Epstein-Barr virus (EBV) the first human virus associated with cancer in 1964, the number of human malignancies associated with viruses has grown. A review of cancer incidence reveals substantial variation in the incidence of such cancers around the world. In some parts of Africa, the majority of cancers are caused by infectious agents. However, there remain huge challenges in measuring the burden of cancer, especially in sub-Saharan Africa. Despite this limitation, it is clear that viral-associated malignancies are key drivers of cancer incidence rates in Africa. Prevention is available through vaccination for some but development of vaccines for others remains an important the goal.
Collapse
Affiliation(s)
| | - Anne Korir
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Robert Newton
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda; University of York, UK
| |
Collapse
|