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Lee N, Murphy J, Al-Khudairi R, Sturdy A, Mahungu T, Haque T, Griffiths P, Tosswill J, Irish D. Diagnostic accuracy of Abbott Architect Assay as a screening tool for human T-cell leukaemia virus type-1 and type-2 infection in a London teaching hospital with a large solid organ transplant centre. Transfus Med 2022; 32:256-260. [PMID: 35474619 PMCID: PMC9321154 DOI: 10.1111/tme.12866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/28/2022] [Accepted: 04/03/2022] [Indexed: 12/01/2022]
Abstract
AIM In the United Kingdom, organ donors/recipients are screened for evidence of human T-cell leukaemia virus type-1 and type-2 (HTLV-1/2) infections. Since the United Kingdom is a low prevalence country for HTLV infections, a screening assay with high sensitivity and specificity is required. Samples with repeat reactivity on antibody testing are sent to a reference lab for confirmatory serological and molecular testing. In the case of donor screen, this leads to delays in the release of organs and can result in wastage. We aim to assess whether a signal/cut-off (S/CO) ratio higher than the manufacturer's recommendation of 1.0 in the Abbott Architect antibody assay is a reliable measure of HTLV-1/2 infection. METHODS We conducted a 5 year retrospective analysis of 7245 patients from which 11 766 samples were tested on the Abbott Architect rHTLV I/II assay. Reactive samples (S/CO >1) were referred for confirmatory serological and molecular detection (Western Blot and proviral DNA) at UK Health Security Agency, (formerly PHE, Colindale), the national reference laboratory. Electronic, protected laboratory and hospital patient databases were employed to collate data. RESULTS A total of 45 patients had initially reactive samples. 42.2% (n = 19/45) had an S/CO ratio > 20, with HTLV infection confirmed in n = 18/19 and indeterminate confirmatory results in n = 1/19. No samples with an S/CO ratio <4 (48.9%, n = 22/45) or 4-20 (8.9%, n = 4/45) had positive confirmatory results on subsequent confirmatory testing. CONCLUSION Samples with an S/CO >20 likely represent a true HTLV-1/2 infection. Reactive samples with an S/CO <4 were unlikely to confirm for HTLV infections. Interpretation of these ratios can assist clinicians in the assessment of low reactive samples and reiterates the need for faster access to confirmatory testing.
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Affiliation(s)
- Nathaniel Lee
- Royal Free Hospital NHS Foundation Trust, London, UK
| | - Jamie Murphy
- Royal Free Hospital NHS Foundation Trust, London, UK
| | | | - Ann Sturdy
- Royal Free Hospital NHS Foundation Trust, London, UK
| | | | - Tanzina Haque
- Royal Free Hospital NHS Foundation Trust, London, UK.,Centre for Virology, Division of Infection and Immunity, UCL, London, UK
| | | | | | - Dianne Irish
- Royal Free Hospital NHS Foundation Trust, London, UK
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Clinical and Public Health Implications of Human T-Lymphotropic Virus Type 1 Infection. Clin Microbiol Rev 2022; 35:e0007821. [PMID: 35195446 PMCID: PMC8941934 DOI: 10.1128/cmr.00078-21] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Human T-lymphotropic virus type 1 (HTLV-1) is estimated to affect 5 to 10 million people globally and can cause severe and potentially fatal disease, including adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The burden of HTLV-1 infection appears to be geographically concentrated, with high prevalence in discrete regions and populations. While most high-income countries have introduced HTLV-1 screening of blood donations, few other public health measures have been implemented to prevent infection or its consequences. Recent advocacy from concerned researchers, clinicians, and community members has emphasized the potential for improved prevention and management of HTLV-1 infection. Despite all that has been learned in the 4 decades following the discovery of HTLV-1, gaps in knowledge across clinical and public health aspects persist, impeding optimal control and prevention, as well as the development of policies and guidelines. Awareness of HTLV-1 among health care providers, communities, and affected individuals remains limited, even in countries of endemicity. This review provides a comprehensive overview on HTLV-1 epidemiology and on clinical and public health and highlights key areas for further research and collaboration to advance the health of people with and at risk of HTLV-1 infection.
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Tosswill JHC, Taylor GP. Interpretation of low reactivity in the Abbott Architect rHTLV I/II assay. Transfus Med 2017; 28:326-330. [PMID: 29067784 DOI: 10.1111/tme.12482] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 09/18/2017] [Accepted: 09/26/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study is to reduce donor tissue wastage. AIM The aim of this study is to determine, in the case of the Abbott Architect rHTLV I/II assay, whether a signal/cut-off (S/CO) ratio higher than the manufacturer's recommendation of 1·0 could be applied to diagnose significant HTLV-1 seroreactivity. BACKGROUND The detection of human T cell leukaemia virus type 1 (HTLV-1) infection is primarily based on serology often utilising random access platforms. Although current assays have high sensitivity and specificity, in low-prevalence regions, significant numbers of false-positive reactions occur. A comprehensive follow-up is difficult within the time frame of organ donation. This can lead to donor tissue wastage. METHODS A retrospective analysis of 12 250 samples previously tested on the Abbott Architect rHTLV I/II platform and further tested by confirmatory serology/molecular detection to determine the sensitivity and positive predictive value in the S/CO ratio range was conducted. RESULTS Where the sample S/CO ratio was >20 (n = 498), HTLV infection was confirmed in all but eight subjects. All of these eight had indeterminate confirmatory results, and none were found to be uninfected. Conversely, in the samples within the S/CO ratio range 1-4 (n = 271), no subject was subsequently found to be HTLV-infected although HTLV infection could not be excluded in all cases, primarily due to lack of follow-up samples (n = 60/271). CONCLUSIONS Samples with an S/CO ratio of <4·0 on the Abbott Architect rHTLV I/II platform represent a low risk of HTLV infection in the UK, and organs from such donors might reasonably be considered for transplantation, within the context of appropriate risk-benefit assessment.
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Affiliation(s)
- J H C Tosswill
- Virus Reference Department, Public Health England, London, UK
| | - G P Taylor
- Retrovirology and GU Medicine, Section of Virology, Department of Medicine, Imperial College London, London, UK
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4
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Arif M, Ramia S. Seroprevalence of human T-lymphotropic virus type I (HTLV-I) in Saudi Arabia. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2016. [DOI: 10.1080/00034983.1998.11813294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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5
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Marano G, Vaglio S, Pupella S, Facco G, Catalano L, Piccinini V, Liumbruno GM, Grazzini G. Human T-lymphotropic virus and transfusion safety: does one size fit all? Transfusion 2015; 56:249-60. [PMID: 26388300 DOI: 10.1111/trf.13329] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 07/28/2015] [Accepted: 08/02/2015] [Indexed: 12/17/2022]
Abstract
Human T-cell leukemia viruses (HTLV-1 and HTLV-2) are associated with a variety of human diseases, including some severe ones. Transfusion transmission of HTLV through cellular blood components is undeniable. HTLV screening of blood donations became mandatory in different countries to improve the safety of blood supplies. In Japan and Europe, most HTLV-infected donors are HTLV-1 positive, whereas in the United States a higher prevalence of HTLV-2 is reported. Many industrialized countries have also introduced universal leukoreduction of blood components, and pathogen inactivation technologies might be another effective preventive strategy, especially if and when generalized to all blood cellular products. Considering all measures available to minimize HTLV blood transmission, the question is what would be the most suitable and cost-effective strategy to ensure a high level of blood safety regarding these viruses, considering that there is no solution that can be deemed optimal for all countries.
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Affiliation(s)
| | - Stefania Vaglio
- Italian National Blood Centre, National Institute of Health.,Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | | | - Giuseppina Facco
- Italian National Blood Centre, National Institute of Health.,Immunohaemathology and Transfusion Medicine Unit, Azienda Ospedaliera Città Della Salute e Della Scienza, Turin, Italy
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6
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Editorial Commentary: Lessons on Transplant-Acquired Human T-Cell Lymphotropic Virus Infection. Clin Infect Dis 2013; 57:1425-6. [DOI: 10.1093/cid/cit547] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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7
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Karimi G, Gharehbaghian A, Tafti MF, Vafaiyan V. Emerging infectious threats to the blood supply: seroepidemiological studies in iran - a review. ACTA ACUST UNITED AC 2013; 40:210-7. [PMID: 23922546 DOI: 10.1159/000351540] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 11/07/2012] [Indexed: 12/28/2022]
Abstract
SUMMARY The risk of transfusion-transmitted infections has been greatly reduced by improvements in donor screening and testing. However, newly recognized blood-borne infectious agents can be threats to blood safety. In order to evaluate the prevalence some of these agents in blood donors, a systematic review was conducted. Data were obtained from published papers related to HGV, Torque Teno virus (TTV), HTLV, West Nile virus (WNV) and SEN virus (SEN-V). Based on these studies, the prevalence of HGV varied from 1 to 8.6% for anti-E2 and from 0 to 4.8% for HGV RNA. The prevalence of TTV DNA and HTLV-I varied from 2.7 to 79.5% and from 0.013 to 2.3%, respectively. The WNV-specific IgM antibody and WNV RNA are negative in blood donors. Prevalence rates of SEN-V in Iranian blood donors range from 23 to 90.8%. Consequences of these infectious agents for blood safety are different. Thus, the need to perform laboratory screening as well as effectiveness and efficiency of laboratory tests depend on pathogenicity level and epidemiological conditions of emerging infections. However, being prepared based on the current level of risk and interventions to reduce the risk can be effective in reducing the potential threat for blood supply.
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Affiliation(s)
- Gharib Karimi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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8
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McGill NK, Vyas J, Shimauchi T, Tokura Y, Piguet V. HTLV-1-associated infective dermatitis: updates on the pathogenesis. Exp Dermatol 2012; 21:815-21. [DOI: 10.1111/exd.12007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2012] [Indexed: 12/12/2022]
Affiliation(s)
- Neilia-Kay McGill
- Department of Dermatology and Wound Healing; Institute of Infection and Immunity; Cardiff University; Cardiff, UK
| | - Jui Vyas
- Department of Dermatology and Wound Healing; Institute of Infection and Immunity; Cardiff University; Cardiff, UK
| | - Takatoshi Shimauchi
- Department of Dermatology; Hamamatsu University School of Medicine; Hamamatsu; Japan
| | - Yoshiki Tokura
- Department of Dermatology; Hamamatsu University School of Medicine; Hamamatsu; Japan
| | - Vincent Piguet
- Department of Dermatology and Wound Healing; Institute of Infection and Immunity; Cardiff University; Cardiff, UK
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O'Brien SF, Zou S, Laperche S, Brant LJ, Seed CR, Kleinman SH. Surveillance of transfusion-transmissible infections comparison of systems in five developed countries. Transfus Med Rev 2011; 26:38-57. [PMID: 21944935 PMCID: PMC7134890 DOI: 10.1016/j.tmrv.2011.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Most industrialized countries maintain surveillance programs for monitoring transmissible infection in blood donations, revising approaches to methodology and risk assessment as new threats emerge. A comparison of programs in the United States, Canada, France, the UK, and Australia indicates that they have similar function, although the structure of blood programs vary as does the extent and nature of formal ties with public health. The emergence of HIV in the late 1970s and early 1980s was key in recognizing that surveillance systems specific to blood transfusion were essential. Hence, most industrialized countries monitor transfusion-transmissible infections in donors and evaluate the impact of new testing and of predonation screening strategies. Emerging infections since HIV have had different transmission pathways and challenged blood programs to draw upon resources for a rapid and effective response, with recognition that the original focus on sexual/drug-related risk of HIV and hepatitis was inadequate. The focus of surveillance programs on new and emerging pathogens fulfills a key role in risk assessment and policy formulation. The precise nature of such activities varies by country because of the structure of the blood programs and surveillance systems, the strategic focus of the blood programs, and the epidemiology of disease in each country.
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Affiliation(s)
- Sheila F O'Brien
- National Epidemiology and Surveillance, Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario, Canada K1G 4J5. sheila.o'
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10
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Davison KL, Dow B, Barbara JA, Hewitt PE, Eglin R. The introduction of anti-HTLV testing of blood donations and the risk of transfusion-transmitted HTLV, UK: 2002-2006. Transfus Med 2009; 19:24-34. [DOI: 10.1111/j.1365-3148.2008.00902.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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The seroepidemiology of HTLV-I amongst genitourinary medicine (GUM) attendees in South East London. J Clin Virol 2008; 43:253-4. [DOI: 10.1016/j.jcv.2008.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 06/17/2008] [Accepted: 06/24/2008] [Indexed: 11/18/2022]
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12
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Wang JH, Pazianas M, Fraser WD, Harris F, Eastwood JB. Acute renal failure and hypercalcaemia in a man from Guyana: what is the link? Nephrol Dial Transplant 2005; 20:1505-8. [PMID: 15886219 DOI: 10.1093/ndt/gfh864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jia-Hui Wang
- Department of Renal Medicine, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK
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13
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Taylor GP, Bodéus M, Courtois F, Pauli G, Del Mistro A, Machuca A, Padua E, Andersson S, Goubau P, Chieco-Bianchi L, Soriano V, Coste J, Ades AE, Weber JN. The seroepidemiology of human T-lymphotropic viruses: types I and II in Europe: a prospective study of pregnant women. J Acquir Immune Defic Syndr 2005; 38:104-9. [PMID: 15608533 DOI: 10.1097/00126334-200501010-00018] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Up to 20 million persons are infected with the human retroviruses human T-lymphotropic virus (HTLV)-I and HTLV-II globally. Most data on the seroprevalence of HTLV-I and HTLV-II in Europe are from studies of low-risk blood donors or high-risk injection drug users (IDUs). Little is known about the general population. METHODS A prospective anonymous study of HTLV-I and HTLV-II seroprevalence among 234,078 pregnant women in Belgium, France, Germany, Italy, Portugal, Spain, and the United Kingdom was conducted. Maternal antibody status was determined by standard methods using sera obtained for routine antenatal infection screens or eluted from infant heel prick dried blood spots obtained for routine neonatal metabolic screens. RESULTS Anti-HTLV-I/II antibodies were detected and confirmed in 96 pregnant women (4.4 per 10,000, 95% confidence interval [CI]: 3.5-5.2). Of these, 73 were anti-HTLV-I, 17 were anti-HTLV-II, and 6 were specifically anti-HTLV but untyped. The seroprevalence ranged from 0.7 per 10,000 in Germany to 11.5 per 10,000 in France. CONCLUSIONS Pregnant women better reflect the general population than blood donors or IDUs. The seroprevalence of HTLV-I and HTLV-II in Western Europe is 6-fold higher among pregnant women (4.4 per 10,000) than among blood donors (0.07 per 10,000). These data provide a robust baseline against which changes in HTLV-I and HTLV-II seroprevalence in Europe can be measured.
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Affiliation(s)
- Graham P Taylor
- Faculty of Medicine, Wright Fleming Institute, Imperial College, Norfolk Place, London, United Kingdom.
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14
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Tamim H, Musharrafieh U, Ramia S, Almawi WY, Al-Jisr T, Ayoub T, Nabulsi-Majzoub M, Kazma H, Baz EK. Is seroprevalence of HTLV-I/II among blood donors in Lebanon relevant? Am J Infect Control 2004; 32:220-3. [PMID: 15175617 DOI: 10.1016/j.ajic.2003.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Human T-cell lymphotropic virus type I (HTLV-I) is associated with certain hematologic and neurologic disorders. Seroprevalence studies demonstrated that the distribution of HTLV-I is heterogeneous worldwide and not specific to 1 region. Because blood is one of the major routes of transmission of the virus, blood banks of several countries routinely screen all blood donations for HTLV-I. The aim of the present study was to assess the seroprevalence rate of HTLV-I/II antibodies among Lebanese blood donors. Between August 2001 and March 2002, consecutive blood samples of 3529 blood donors were collected at blood banks of 4 major hospitals in Lebanon. Initial enzyme-linked immunosorbent assay (ELISA) screening resulted in 23 (0.7%) positive samples, of which 12 (0.3%) were reconfirmed positive by ELISA. Further analysis by Western blot resulted in 2 (0.06%) positive samples, of which 1 tested positive for HTLV-I by PCR (0.028%). Although its very low prevalence among Lebanese blood donors does not support routine screening of Lebanese blood donors for HTLV-I, screening of blood donors from other nationalities may be exercised, especially those from HTLV-I endemic areas.
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Affiliation(s)
- Hala Tamim
- Department of Epidemiology and Biostatistics, Faculty of Health Sciences, American University of Beirut Medical Center, Beirut, Lebanon
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15
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Gastaldello R, Hall WW, Gallego S. Seroepidemiology of HTLV-I/II in Argentina: an overview. J Acquir Immune Defic Syndr 2004; 35:301-8. [PMID: 15076246 DOI: 10.1097/00126334-200403010-00012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In this report, the results of seroepidemiologic studies of human T-lymphotropic virus type I (HTLV-I) and type II (HTLV-II) infections in different population groups in Argentina have been compiled. The studies have shown a high prevalence of HTLV-I/II infection in blood donors in the provinces in the north of Argentina (1.0% in Jujuy, 0.7% in Salta, and 0.6% in Formosa) and a low prevalence in the provinces in the central region of the country (<or=0.1%). High rates of HTLV-I (0.45%-2.78%) and HTLV-II (2.78%-21.9%) infections have been documented in Native Indian groups and have highlighted the importance of sexual and mother-to-child transmission of the viruses. The presence of HTLV-I/II antibodies in HIV-infected individuals indicates that both viruses are circulating in certain high-risk population groups. HTLV-I/II was detected in intravenous drug users (2.56%-21.7%), homosexual men (0.5-1.33%), prostitutes (0.8%), and hemophiliacs (2.8%). In conclusion, HTLV-I/II infection is circulating in low- and high-risk populations in Argentina, and these findings would support the view that selective screening for HTLV-I/II should be implemented to reduce the spread of infection.
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Affiliation(s)
- Rene Gastaldello
- Laboratory of Human Lymphotropic Virus, Institute of Virology, School of Medicine, National University of Córdoba, Argentina.
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16
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Abstract
Several public policy decisions in transfusion medicine require information on the long-term (> or =10-year) survival of transfused patients. This information is needed (1) to estimate the number of surviving transfusion recipients who have contracted a particular infection through transfusion, (2) to assess the cost-effectiveness of measures introduced to further improve the safety of the allogeneic blood supply, (3) to estimate the total anticipated number of transfusion-transmitted cases of disease when a novel transfusion-transmitted infection with a long incubation period emerges, and (4) determine the scope of any proposed lookback investigation in terms of the length of time that should be covered retrospectively by the lookback effort. Although the probabilities of survival of Olmsted County, MN, residents transfused in 1981 were often used previously when input data on long-term posttransfusion survival were needed in the United States, these data most likely do not reflect the survival of patients transfused in the 1990s. Recent data from Sweden, Northern England, and New York City suggest that the short-term (up to 5 years posttransfusion) probabilities of survival reported from Olmsted County may have to be reduced by up to 20% before they can be used for making public policy decisions in the future, and that probabilities of survival of 66%, 60%, and 47%, respectively, at 1, 2, and 5 years posttransfusion may reflect the life expectancy of subjects transfused in the 1990s. No empirical data on the 10-year probability of survival of such patients are currently available from population-based studies, but some data suggest that the 10-year survival of an unselected population transfused in 1988 to 1990 may be 40%. A population-based study that includes several US counties has to be undertaken to generate the information needed for public policy decisions in the future.
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Higgins C. The risks associated with blood and blood product transfusion. ACTA ACUST UNITED AC 2003; 9:2281-90. [PMID: 12271194 DOI: 10.12968/bjon.2000.9.22.5415] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2000] [Indexed: 11/11/2022]
Abstract
Although transfusion of blood and blood products is often of life-saving benefit for the many patients who receive transfusions every year, it is not without considerable risk. Nurses need to be aware of these risks so that they can respond to patient anxiety about transfusion. This article outlines risks associated with transfusion and the measures taken to minimize them. Attention will be focused principally on the two most significant risks: transmission of serious blood-borne infection and the potentially fatal acute immune haemolytic reaction that can occur if patients receive incompatible red cells. Other significant adverse effects will be discussed briefly. Recent initiative aimed at monitoring the incidence of these adverse effects and increasing the safety of blood transfusion will be discussed, with special emphasis on the nurse's role in the transfusion process.
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Pennington J, Taylor GP, Sutherland J, Davis RE, Seghatchian J, Allain JP, Williamson LM. Persistence of HTLV-I in blood components after leukocyte depletion. Blood 2002; 100:677-81. [PMID: 12091364 DOI: 10.1182/blood.v100.2.677] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The human T-cell leukemia virus HTLV-I is a transfusion-transmissible retrovirus targeting T lymphocytes for which screening is not currently undertaken in United Kingdom blood donors. The introduction of universal leukocyte depletion (LD) of the United Kingdom blood supply raises the question as to the degree of protection afforded by this procedure against HTLV-I transmission by blood components. HTLV-I viral DNA removal by leukocyte-depleting filters was assessed in units of whole blood and platelets by real-time quantitative polymerase chain reaction (PCR) and by nested PCR for HTLV-I Tax DNA. We examined HTLV-I removal by LD filters using a model system of blood units containing exogenous spiked HTLV-I-positive MT-2 cells at a relevant concentration and whole blood donations from asymptomatic HTLV-I carriers. T-lymphocyte removal was assessed in parallel by measurement of endogenous subset-specific CD3 mRNA. In the MT-2 model system we observed 3.5 log(10) to 4 log(10) removal of HTLV-I Tax DNA by filtration of whole blood and 2 log(10) to 3 log(10) removal across platelet filters with 13 of 16 whole blood and 8 of 8 platelet units still positive after filtration. Despite 3 log(10) to 4 log(10) viral removal, HTLV-I Tax DNA could be detected after whole blood filtration in asymptomatic carriers with viral loads above 10(8) proviral DNA copies/L. T-lymphocyte removal was also between 3.5 log(10) and 4.5 log(10). HTLV-I provirus removal was incomplete in the model system and in asymptomatic carriers with viral loads greater than 10(8) copies/L. These results suggest that LD alone may not provide complete protection from HTLV-I transmission by transfusion.
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Affiliation(s)
- Joanne Pennington
- Department of Haematology, Division of Transfusion Medicine, University of Cambridge, United Kingdom
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Siegel RS, Gartenhaus RB, Kuzel TM. Human T-cell lymphotropic-I-associated leukemia/lymphoma. Curr Treat Options Oncol 2001; 2:291-300. [PMID: 12057109 DOI: 10.1007/s11864-001-0022-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Human T-cell lymphotropic virus-I (HTLV-I)-related adult T-cell leukemia/lymphoma (ATL) is a model disease for proof of viral oncogenesis. HTLV-I infection is endemic in southern Japan and the Caribbean basin, and occurs sporadically in Africa, Central and South America, the Middle East, and the southeastern United States. ATL occurs in only 2% to 4% of HTLV-I-infected people [1-3]. When it does occur, it is usually aggressive and difficult to treat; most people survive for less than 1 year [1-3]. Combination chemotherapy with cytotoxic agents has yielded complete response rates of 20% to 45%, but responses usually last only a few months [3]. Recently, novel treatments, such as monoclonal antibodies directed at the interleukin-2 receptor and the combination of interferon alfa and zidovudine, have been shown to be active in the treatment of patients with ATL. A small percentage of patients achieve long-lasting remissions [2,3].
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Affiliation(s)
- R S Siegel
- Division of Hematology/Oncology, Department of Medicine, Northwestern University Medical School, and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, 676 N. St. Clair, Suite 850, Chicago, IL 60611, USA
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Pawson RACHEL. Malignancy: Human T-Cell Lymphotropic Virus Type I and Adult T-Cell Leukaemia/Lymphoma. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2001; 4:11-27. [PMID: 11399550 DOI: 10.1080/10245332.1999.11746426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Adult T-cell leukaemia/lymphoma (ATLL) was first identified in Japan in 1977 [1,2]. The causative agent, the human T-lymphotropic virus type I (HTLV-I), was isolated 3 years later by Gallo's group from a patient initially diagnosed as having mycosis fungoides but subsequently reclassified as a case of ATLL [3]. Since this time, much has been discovered about the molecular pathogenesis of the disease. Despite this, treatment of ATLL remains disappointing and the prognosis of acute and lymphoma types poor. In the United Kingdom, cases of ATLL are mainly restricted to people of Afro-Caribbean descent but the disease is of general importance because ATLL has also been reported in non-endemic areas and may possibly spread into other populations via blood transfusion as blood donors in the UK are currently not screened for HTLV-I.
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Affiliation(s)
- RACHEL Pawson
- Department of Haematology, Royal Free Hospital, London
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Price J, Cant BA, Barbara JA, Tedder RS. Human T-cell leukaemia/lymphoma virus risk may be enhanced in some selected donor populations. Vox Sang 2001; 80:148-50. [PMID: 11449953 DOI: 10.1046/j.1423-0410.2001.00030.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Certain patient ethnic groups may require blood components from donors under-represented in the UK donor population. Selective recruitment of Afro-Caribbean donors is therefore necessary but was considered to pose an increased risk of human T-cell leukaemia/lymphoma virus (HTLV) infection. To assess this a seroprevalence study of HTLV was undertaken in Afro-Caribbean and Caucasian donors. MATERIALS AND METHODS Sera from 1100 Afro-Caribbean and 1100 Caucasian donors were tested for antibody to HTLV. Reactive samples were confirmed for specificity using an algorithm comprising two additional assays and polymerase chain reaction (PCR) where possible. RESULTS Six Afro-Caribbean donors (0.55%) were considered to be infected with HTLV I. CONCLUSION Donor selection in this case caused a significantly elevated prevalence of HTLV infection and serves as a warning of the need for care in the design of policies for selective donor recruitment.
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Affiliation(s)
- J Price
- National Blood Service, South Thames, London, UK
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Murphy MF, Wallington TB, Kelsey P, Boulton F, Bruce M, Cohen H, Duguid J, Knowles SM, Poole G, Williamson LM. Guidelines for the clinical use of red cell transfusions. Br J Haematol 2001; 113:24-31. [PMID: 11328275 DOI: 10.1046/j.1365-2141.2001.02701.x] [Citation(s) in RCA: 273] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Siegel R, Gartenhaus R, Kuzel T. HTLV-I associated leukemia/lymphoma: epidemiology, biology, and treatment. Cancer Treat Res 2001; 104:75-88. [PMID: 11191136 DOI: 10.1007/978-1-4615-1601-9_3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- R Siegel
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, USA
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Abstract
BACKGROUND Survival and characteristics of transfusion recipients have not been studied enough, although they represent key measures in cost-effectiveness analyses of various donor screening procedures. STUDY DESIGN AND METHODS Hospital and blood bank records were collected on all patients in Orebro County, Sweden, from March through May 1993 (1111 transfusion episodes) and a random sample from Stockholm County during April 1993 (793 transfusion episodes). All patients were then matched with the national register of deaths in Sweden during a follow-up period of 40 months. RESULTS The median patient age was 71 years and the median transfusion total was 2 units. Only 35 percent of the patients were under the age of 65, 9 percent under 40, and 1.6 percent under 1 year. About half (56%) were women. Among the Orebro patients, 47 percent were surgical and 29 percent internal medicine patients. Of 1720 patients whose survival could be investigated, 66 percent were alive after 1 year and 51 percent after 40 months. The survival rates were rather similar in patients receiving RBCs and plasma but lower in those receiving platelets. CONCLUSION The survival of patients transfused in Sweden in 1993 differered significantly from estimations based on studies from the 1980s. This difference has major implications for the estimations of cost-effectiveness of blood donor screening for infectious agents.
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Affiliation(s)
- E Tynell
- Division of Infectious Diseases, Karolinska Hospital, Stockholm, Sweden.
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Ades AE, Parker S, Walker J, Edginton M, Taylor GP, Weber JN. Human T cell leukaemia/lymphoma virus infection in pregnant women in the United Kingdom: population study. BMJ (CLINICAL RESEARCH ED.) 2000; 320:1497-501. [PMID: 10834889 PMCID: PMC27390 DOI: 10.1136/bmj.320.7248.1497] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2000] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the prevalence of human T cell leukaemia/lymphoma virus (HTLV) infection in pregnant women in the United Kingdom. DESIGN Population study. SUBJECTS Guthrie card samples from babies born in 1997-8. Samples were linked to data on mother's age and ethnic status and parents' country of birth and then anonymised. SETTING North Thames Regional Health Authority. MAIN OUTCOME MEASURES Presence of antibodies against HTLV in eluates tested by gelatin particle agglutination assay and results confirmed by immunoblot. RESULTS Of 126 010 samples tested, 67 had confirmed antibodies to HTLV (59 HTLV-I, 2 HTLV-II, 6 untyped) and six had indeterminate results. Seroprevalence was 17.0 per 1000 (95% confidence interval 9.2 to 28.3) in infants whose mothers were born in the Caribbean, 3.2/1000 (1.5 to 5.9) with mothers born in west and central Africa, and 6.8/1000 (3.1 to 12.9) in infants of black Caribbean mothers born in non-endemic regions. In infants with no known risk (both parents born in non-endemic regions and mother not black Caribbean) seroprevalence was 0.06-0.12 per 1000. Mother's country of birth, father's country of birth, and mother's ethnic status were all independently associated with neonatal seroprevalence. An estimated 223 (95% confidence interval 110 to 350) of the 720 000 pregnant women each year in the United Kingdom are infected with HTLV. CONCLUSIONS The prevalence of HTLV and HIV infections in pregnant women in the United Kingdom are comparable. The cost effectiveness of antenatal HTLV screening should be evaluated, and screening of blood donations should be considered.
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Affiliation(s)
- A E Ades
- Department of Epidemiology and Public Health, Institute of Child Health, London WC1N 1EH.
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Barbara J, Moore MC, Hewitt PE. Prevalence of antibodies to HTLV in blood donors in north London. BMJ (CLINICAL RESEARCH ED.) 2000; 320:650. [PMID: 10698901 PMCID: PMC1117671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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27
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Regan FA, Hewitt P, Barbara JA, Contreras M. Prospective investigation of transfusion transmitted infection in recipients of over 20 000 units of blood. TTI Study Group. BMJ (CLINICAL RESEARCH ED.) 2000; 320:403-6. [PMID: 10669443 PMCID: PMC27283 DOI: 10.1136/bmj.320.7232.403] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To follow up recipients of 20 000 units of blood to identify any transmissions of infections through blood transfusion. DESIGN Follow up study of recipients of transfusion. SETTING 22 hospitals in north London. PARTICIPANT Adult patients who had recently been transfused. MAIN OUTCOME MEASURES Patients had further blood samples taken at 9 months that were tested for markers of hepatitis B and C and HIV and human T cell leukaemia/lymphoma virus type I or II (HTLV) infections. Recent infections were distinguished from pre-existing infections by comparison with blood samples taken before transfusion. RESULTS 9220 patients were recruited, and 5579 recipients of 21 923 units of blood were followed up. No transfusion transmitted infections were identified. The incidence of transfusion transmitted infections was 0 in 21 043 units (95% confidence interval for risk 0 to 1 in 5706 recipients) for hepatitis B; 0 in 21 800 units (0 to 1 in 5911 recipients) for hepatitis C; 0 in 21 923 units (0 to 1 in 5944 recipients) for HIV; and 0 in 21 902 units (0 to 1 in 5939 recipients) for human T cell leukaemia/lymphoma virus. Three patients acquired hepatitis B during or after hospital admission but not through transfusion; 176 (3%) had pre-existing hepatitis B infection. Sixteen (0.29%) patients had hepatitis C, and five (0.09%) had human T cell leukaemia/lymphoma virus. CONCLUSIONS The current risk of transfusion transmitted infections in the United Kingdom is very small, though hospital acquired infections may arise from sources other than transfusion. A considerable proportion of patients have pre-existing infections.
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Affiliation(s)
- F A Regan
- National Blood Service, London and South East Zone, North London Centre, London NW9 5BG
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Taylor GP, Tosswill JH, Matutes E, Daenke S, Hall S, Bain BJ, Davis R, Thomas D, Rossor M, Bangham CR, Weber JN. Prospective study of HTLV-I infection in an initially asymptomatic cohort. J Acquir Immune Defic Syndr 1999; 22:92-100. [PMID: 10534152 DOI: 10.1097/00042560-199909010-00012] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A prospective clinical study of 20 initially asymptomatic HTLV-I-seropositive carriers was commenced in 1991 to determine the natural history of the infection in relation to HTLV-I proviral load, immune responses, and lymphocyte phenotype. Proviral load varied widely between carriers but was relatively constant within an individual over time. The lymphocyte phenotype and prevalence of activated lymphocytes were not predictive of disease and the magnitude of the cytotoxic T-lymphocyte response to HTLV-I was independent of proviral load. Incident conditions, some related to HTLV-I infection, including a case of HTLV-I-associated myelopathy (HAM), were documented in 9 carriers. Development of myelopathy and uveitis was associated with high peripheral blood HTLV-I proviral load that predated symptoms. Persistently high proviral load appears to predate the development of HTLV-I-associated inflammation in neuro-ophthalmic tissue.
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Affiliation(s)
- G P Taylor
- Clinical Trials Centre, Imperial College School of Medicine, St. Mary's Hospital, London, UK.
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Regan FA, Hewitt P, Barbara JA, Contreras M. Prevalence of undiagnosed hepatitis B and C, HIV and HTLV infections in hospital in-patients. J Infect 1999; 39:165-7. [PMID: 10609540 DOI: 10.1016/s0163-4453(99)90014-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tosswill JH, Taylor GP, Clewley JP, Weber JN. Quantification of proviral DNA load in human T-cell leukaemia virus type I infections. J Virol Methods 1998; 75:21-6. [PMID: 9820571 DOI: 10.1016/s0166-0934(98)00093-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A nested PCR was designed using primers from the pol and tax genes of human T-cell leukaemia virus type I (HTLV-I). The assay reliably detected a single copy of HTLV-I proviral genome in DNA from 1 x 10(5) Peripheral blood mononuclear cells (PBMCs). Using serial dilutions of sample DNA, the assay was applied prospectively to study proviral load in patients with HTLV-associated disease and carriers. The median proviral load expressed as number of copies/100 PBMCs was found to be 14.0 copies in patients with HAM and 1.55 copies in initially asymptomatic carriers. The assay was used to test for low proviral load in subjects who may have HTLV-I infection, and to monitor response to therapy.
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Affiliation(s)
- J H Tosswill
- Hepatitis and Retrovirus Laboratory, Central Public Health Laboratory, London, UK.
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31
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Abstract
Comparative epidemiological studies have for a long time suggested a link (or links) between infectious agents and hematological malignancies in the young. Identification of Epstein-Barr virus (EBV) as the major cause of specific subtypes of Burkitt's lymphoma and Hodgkin's disease 20 and 10 years ago, respectively, and the recent involvement of human T-cell leukemia virus in non-Hodgkin's lymphomas of the T-cell lineage in young adults in Jamaica have given further credit to early presumptions that these diseases have an infectious etiology. The spectrum of possibly involved viruses: old, EBV, and new, herpesviruses 6, 7 and 8, and unknown retroviruses - as well as the list of partially or totally unresolved disease entities: Hodgkin's disease in adolescents, non-Hodgkin's lymphomas in the immunocompromised, and acute lymphocytic leukemia - is rapidly expanding. Both direct and indirect transforming effects of the above-mentioned viruses are being rapidly disclosed. However, the complex interaction between the different viruses and other causes of hematological malignancies in the young guarantees that many things remain to be discovered also in the future.
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Affiliation(s)
- T Lehtinen
- Department of Clinical Oncology, University of Tampere, National Public Health Institute, Helsinki, Finland
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32
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Tynell E, Andersson S, Lithander E, Arneborn M, Blomberg J, Hansson HB, Krook A, Nomberg M, Ramstedt K, Shanwell A, Bjorkman A. Screening for human T cell leukaemia/lymphoma virus among blood donors in Sweden: cost effectiveness analysis. BMJ (CLINICAL RESEARCH ED.) 1998; 316:1417-22. [PMID: 9572750 PMCID: PMC28538 DOI: 10.1136/bmj.316.7142.1417] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/04/1998] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To analyse the cost effectiveness of a national programme to screen blood donors for infection with the human T cell leukaemia/lymphoma virus. DESIGN Three models for calculating the costs and benefits of screening were developed. The first model analysed the cost of continuously testing all donations; the second analysed the cost of initially testing new blood donors and then retesting them after five years; the third analysed the cost of testing donors only at the time of their first donation. Patients who had received blood components from donors confirmed to be infected with the virus were offered testing. SETTING Sweden. MAIN OUTCOME MEASURES Prevalence of infection with the virus among blood donors, the risk of transmission of the virus, screening costs, and the outcome of infection. RESULTS 648 497 donations were tested for the virus; 1625 samples tested positive by enzyme linked immunosorbent assay. 6 were confirmed positive by western blotting. The prevalence of infection with the virus was 2/100 000 donors. 35 patients who had received blood infected with the virus were tested; 3 were positive. The cost of testing every donation was calculated to be $3.02m (1.88m pounds); this is 18 times higher than the cost of testing new donors only, and only 1 additional positive donor would be discovered in 7 years. Regardless of the model used, screening was estimated to prevent only 1 death every 200 years at a minimum cost of $36m (22.5m pounds). CONCLUSION Based on these estimates the Swedish National Board of Health and Welfare decided that only new blood donors would be screened for infection with the virus.
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Affiliation(s)
- E Tynell
- Division of Infectious Diseases, Karolinska Institutet, Danderyd University Hospital, Danderyd, Sweden.
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Affiliation(s)
- R Pawson
- Department of Haematology, Royal Free Hospital, London
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Hale A, Leung T, Sivasubramaniam S, Kenny J, Sutherland S. Prevalence of antibodies to HTLV in antenatal clinic attenders in South East London. J Med Virol 1997. [DOI: 10.1002/(sici)1096-9071(199707)52:3<326::aid-jmv15>3.0.co;2-g] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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35
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Otigbah C, Kelly A, Aitken C, Norman J, Jeffries D, Erskine KJ. Is HTLV-1 status another antenatal screening test that we need? BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1997; 104:258-60. [PMID: 9070151 DOI: 10.1111/j.1471-0528.1997.tb11057.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Human T-lymphocytic virus type 1 (HTLV-1) carriage is associated with a 2% to 5% lifetime risk of developing a severe, if not fatal, disease. In our Inner London antenatal population, we found that the carrier rate was 0.3%. The antenatal transmission rate is known to be very low, but if the infant is breastfed the transmission rate is up to 25%. It is therefore possible to interrupt the transmission cycle by advising against breastfeeding. The ethical and fiscal issues surrounding antenatal testing are addressed.
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Seroepidemiology of the human T-cell leukaemia/lymphoma viruses in Europe. The HTLV European Research Network. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY : OFFICIAL PUBLICATION OF THE INTERNATIONAL RETROVIROLOGY ASSOCIATION 1996; 13:68-77. [PMID: 8797688 DOI: 10.1097/00042560-199609000-00010] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
An extensive collaboration of laboratories and investigators has been developed to define the seroprevalence of human T-cell leukaemia/ lymphoma virus type I and II (HTLV-I and -II) infection in Europe. An algorithm for serological screening for HTLV-I and -II infection has been established by consensus. Data from screening almost 4 million subjects, including many unpublished studies, which conform to this algorithm are presented. In extensive studies the seroprevalence of HTL.V-I/II in blood donors is low, ranging from < 1 in 100,000 to 30 in 100,000 donors and is due predominantly to HTLV-I. In antenatal clinics in France and the United Kingdom the seroprevalence of HTLV-I is > 0.2%, but surveillance in this setting has been limited and extensive study of the seroprevalence of HTLV-I/II infection in pregnant women in Europe is urgently required to determine the need for HTLV-I/II antenatal screening. HTLV-I is present in populations who have immigrated to Europe from endemic areas and is spreading into indigenous European populations, particularly through sexual transmission to females. HTLV-II infection is present predominantly amongst IVDU and is usually a coinfection with HIV-I. There are considerable regional differences in HTLV-II seroprevalence.
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39
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Kessar P, Raftery MJ, Blakeney CG. Case report: multiple lytic lesions in HTLV1 associated ATLL in the absence of lymphadenopathy and peripheral blood changes. Clin Radiol 1996; 51:299-301. [PMID: 8617047 DOI: 10.1016/s0009-9260(96)80352-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- P Kessar
- Department of Radiology, Royal London Hospital Trust, UK
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Gómez-Hernando C, Gutiérrez M, Toro C, Soriano V. Reliability of a screening assay for the simultaneous detection of antibodies to HIV-1/2 and HTLV-I/II. Vox Sang 1996; 70:119-20. [PMID: 8801762 DOI: 10.1111/j.1423-0410.1996.tb01306.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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41
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Taylor GP. The epidemiology of HTLV-I in Europe. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY : OFFICIAL PUBLICATION OF THE INTERNATIONAL RETROVIROLOGY ASSOCIATION 1996; 13 Suppl 1:S8-14. [PMID: 8797697 DOI: 10.1097/00042560-199600001-00003] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although human T-lymphotropic virus type I (HTLV-I) infection in Europe is thought to be unusual except amongst people who have immigrated from countries where HTLV-I is endemic, the screening of blood donors has revealed a low seroprevalence across Europe, not only in donors originating from endemic areas but also in the indigenous population. Data from blood donors should not be extrapolated to other groups because blood donors are selected to be at low risk of parenterally transmissible infections. Unfortunately only small studies have been conducted in other population groups, including women attending antenatal clinics, despite the importance of breast-feeding in vertical transmission. Data from metropolitan areas of the United Kingdom and France suggest that the seroprevalence of HTLV-I in pregnant women is up to 100 times higher than in blood donors. HTLV-I infection is also more common in patients attending sexually transmitted disease clinics, whilst HTLV-II is endemic in many cities amongst intravenous drug users. There are few incidence data for diseases associated with HTLV-I, even though cases of adult T-cell leukemia/lymphoma and HTLV-I-associated myelopathy have been described in many European countries. Data on the seroprevalence of HTLV-I in central and eastern Europe are scanty but the few published studies suggest a higher rate than has been documented in western Europe.
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Affiliation(s)
- G P Taylor
- St. Mary's Hospital Medical School, London, England, UK
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Hoque S, Kelsey S, van der Walt JD, Breuer J. Experience of human lymphotropic virus type I (HTLV-I) in an East London hospital. J Infect 1996; 32:33-9. [PMID: 8852549 DOI: 10.1016/s0163-4453(96)80007-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We describe the experience of The Royal London Hospital with human T-cell lymphotropic virus type 1 (HTLV-1) related disease. Twelve patients presented from 1988-1993, nine of them in 1993. None were born in the U.K. and 11 were of West Indian origin. Ten had overt lymphomas, one tropical spastic paraparesis/HTLV-1 associated myelopathy (TSP/HAM) and one atypical lymphocytosis and Strongyloidiasis. Five presented acutely ill to Casualty and three died shortly after presentation. Four had been referred to rheumatologists and five had predominantly gastrointestinal symptoms. The population of Caribbean origin served by the hospital is 23,700 and one would only expect one or two cases of lymphoma and one or two cases of TSP/HAM per year. Overall the spectrum of clinical disease at presentation was varied. Suspicion of HTLV-1 infection is merited in patients of West Indian origin between the ages of 30-65 years, who present with a sarcoid-like illness, gastrointestinal symptoms, leukaemia/lymphoma, myelopathy or myositis like-illness.
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Affiliation(s)
- S Hoque
- Department of Medical Microbiology, Royal London Hospital, U.K
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44
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Parker SP, Taylor MB, Ades AE, Cubitt WD, Peckham C. Use of dried blood spots for the detection and confirmation of HTLV-I specific antibodies for epidemiological purposes. J Clin Pathol 1995; 48:904-7. [PMID: 8537486 PMCID: PMC502943 DOI: 10.1136/jcp.48.10.904] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AIMS--To modify and evaluate a gelatin particle agglutination test that could provide a sensitive, specific and inexpensive method for the detection of HTLV-I antibody in dried blood spot samples (DBS) collected on filter paper. METHODS--A set of 26 reference samples confirmed as HTLV-I antibody positive were assembled from patients with tropical spastic paraparesis or adult T cell leukaemia and blood donors. Serum samples and simulated antibody positive dried blood spot eluates were tested using the Serodia assay together with two confirmatory tests: HTLV BLOT 2.3, a western blot, and Select-HTLV, an enzyme immunoassay (EIA). Both confirmatory tests use synthetic peptides to differentiate between antibodies to HTLV-I and -II. The modified Serodia assay was then used to test anonymously 10,135 DBS collected from neonates from London. Samples reactive in the modified Serodia test producing a positive result were titrated to an end point and confirmed as before. RESULTS--All 26 eluates made from simulated DBS derived from positive reference samples were identified as positive by the modified Serodia HTLV-I test and were confirmed as anti-HTLV-I positive by EIA. Two eluates derived from relatively low titre reference samples gave indeterminate results on western blotting. Screening of the 10,135 neonatal DBS resulted in six repeat reactives, five of which were confirmed. The remaining reactive sample gave an indeterminate result on western blotting and there was insufficient eluate for testing by EIA. The overall seroprevalence of HTLV-I in this population was 0.05% (five of 10,135). CONCLUSION--The modified Serodia HTLV-I assay provides a sensitive, specific and inexpensive (10 pence/test) method for screening large numbers of DBS. The format of the assay makes it ideally suited for simultaneous screening of antibodies to HIV-1, HIV-2 and HTLV-I using semi-automated equipment.
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Affiliation(s)
- S P Parker
- Department of Virology, Institute of Child Health, London
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Calderón EJ, Rey C, Medrano FJ, Sánchez-Román J, Soriano V, Torres Y, Ruiz M, Lissen E, Leal M. Prevalence of infection by human T-cell leukemia virus types I and II in southern Spain. Eur J Clin Microbiol Infect Dis 1995; 14:686-90. [PMID: 8565986 DOI: 10.1007/bf01690875] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To assess the spread of human T-cell leukemia virus (HTLV) type I and II in different population groups at potential risk of infection in Spain, a total of 756 subjects were studied: 453 belonging to groups at risk for retrovirus infection, 255 with diseases potentially linked to HTLV-I/II infection and 48 immigrants from endemic areas. An HTLV-I viral-lysate enzyme immunoassay (EIA) with a recombinant transmembrane envelope protein incorporated was used to screen serum samples. Reactive specimens were confirmed by Western blot strips spiked with recombinant proteins that differentiated HTLV-I from HTLV-II. Infection was then verified by the polymerase chain reaction (PCR). Serum samples from 19 of the 756 subjects analyzed (2.5%) were reactive for HTLV by EIA. One of these was from an intravenous drug user (IVDU) in whom HTLV-II infection was confirmed by Western blot and PCR; a specimen from another IVDU showed Western blot reactivity for both retroviruses, but PCR results were negative. Lastly, Western blot confirmed the presence of HTLV in one of the immigrant subjects. Western blot did not verify HTLV infection in the remaining 16 cases, indicating a high rate of nonspecific anti-HTLV reactivity when a second-generation EIA screening test was applied. These results suggest that HTLV is present in Spain among populations at high risk for HTLV, although at a very low rate and restricted to intravenous drug users and individuals immigrating from endemic areas.
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Affiliation(s)
- E J Calderón
- Department of Internal Medicine, Viral Hepatitis and AIDS Study Group, Virgen del Rocio University Hospital, Sevilla, Spain
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D'Incan M, Antoniotti O, Gasmi M, Fonck Y, Chassagne J, Desgranges C, Souteyrand P. HTLV-I-associated lymphoma presenting as mycosis fungoides in an HTLV-I non-endemic area: a viro-molecular study. Br J Dermatol 1995; 132:983-8. [PMID: 7662579 DOI: 10.1111/j.1365-2133.1995.tb16960.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Human T-lymphotropic virus type I (HTLV-I) is endemic in the Caribbean region, south-western Japan and Africa, and is associated with tropical spastic paraparesis and adult T-cell leukaemia/lymphoma (ATLL). Cutaneous forms of ATLL are sometimes indistinguishable from other cutaneous T-cell lymphomas (CTCL). We report a woman living in a non-endemic area for HTLV-I, with no risk factors for viral infection, who developed mycosis fungoides-like ATLL. The findings underline the usefulness of molecular biological techniques in distinguishing between mycosis fungoides and ATLL. We emphasize the need to establish the HTLV-I status of patients with CTCL, even in HTLV-I non-endemic areas, not only to establish a preventive policy in these countries, but also to further our knowledge of the lymphoproliferation spectrum associated with human retroviruses.
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Affiliation(s)
- M D'Incan
- Laboratory of Research on Hepatitis, AIDS and Human Retroviruses, INSERM U 271, Lyon, France
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Flanagan P, McAlpine L, Ramskill SJ, Smith AG, Eglin R, Parry JV, Mortimer PP. Evaluation of a combined HIV-1/2 and HTLV-I/II assay for screening blood donors. Vox Sang 1995; 68:220-4. [PMID: 7660640 DOI: 10.1111/j.1423-0410.1995.tb02576.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A combined immunoassay for the simultaneous detection of antibodies to HIV-1/2 and HTLV-I/II (Bioelisa, Launch Diagnostics) has been evaluated to determine its suitability for routine use in blood screening. 84,222 donations were tested from 76,452 donors. One HIV- and 1 HTLV-1-positive donor were identified. The specificity was 99.7%, and the sensitivity for anti-HIV-1, anti-HIV-2, and anti-HTLV-1 on 173 positive sera was 100%; 2 of 25 anti-HTLV-II-positive sera were non-reactive. Although the specificity of the assay is not as high as that of HIV-1/2 kits currently in UK transfusion use, the information gained about donor HTLV antibody status makes the test an attractive alternative to them.
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Affiliation(s)
- P Flanagan
- Yorkshire Blood Transfusion Service, Leeds, UK
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Christiansen CB, Wantzin P, Dickmeiss E. Prevalence of antibodies to HTLV-I/II in high-risk patients and blood donors in Denmark. Vox Sang 1995; 68:63-4. [PMID: 7725675 DOI: 10.1111/j.1423-0410.1995.tb02550.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Gutfraind Z, Blejer JL, Saguier MC, Gomez Carretero ML, Pirola DA, Carreras Vescio LA. Seroprevalence of HTLV-I/HTLV-II in blood donors in Buenos Aires (Argentina). Vox Sang 1994; 67:408-9. [PMID: 7701816 DOI: 10.1111/j.1423-0410.1994.tb01285.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Copplestone JA, Prentice AG, Hamon MD, Gawler J, Anderson N. Safe blood? HTLV-1 infection is crippling. BMJ (CLINICAL RESEARCH ED.) 1994; 308:273. [PMID: 8111279 PMCID: PMC2539332 DOI: 10.1136/bmj.308.6923.273b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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