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Sánchez-Núñez JP, de-Miguel-Balsa E, Soriano V, Lorenzo-Garrido E, Giménez-Richarte A, Otero-Rodriguez S, Celis-Salinas JC, de-Mendoza C, Casapia-Morales M, Ramos-Rincón JM. Prevalence of HTLV-1/2 infection in pregnant women in Central and South America and the Caribbean: a systematic review and meta-analysis. Int J Infect Dis 2024; 143:107018. [PMID: 38522611 DOI: 10.1016/j.ijid.2024.107018] [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: 02/14/2024] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Human T-lymphotropic viruses (HTLV)-1 infection is endemic in many countries of Central and South America and Caribbean (CSA&C). Neither screening nor surveillance programs exist for HTLV-1/2 infection among pregnant women in this region. Neither in Western nations with large migrant flows from HTLV-1/2 endemic regions. METHODS Systematic review and meta-analysis of the prevalence of HTLV-1/2 infection among CSA&C pregnant women. We included studies searching EMBASE, PubMed/MEDLINE, Scopus, and Web of Science from inception to February 15, 2023. This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. RESULTS We identified a total of 620 studies. Only 41 were finally included in the meta-analysis. Most studies (61.0%) were from Brazil and Peru (14.6%). The total number of participants was 343,707. The pooled prevalence of HTLV-1/2 infection among CSA&C pregnant women was 1.30% (95% CI: 0.96-1.69) using anti-HTLV-1/2 antibody screening tests. There was a high heterogeneity (I2 = 98.6%). Confirmatory tests gave an HTLV-1 infection rate of 1.02% (95% CI: 0.75-1.33). CONCLUSIONS The prevalence of HTLV-1/2 infection among CSA&C pregnant women is 1.3%, most cases being HTLV-1. This rate is greater than for other microbial agents regularly checked as part of antenatal screening (such as HIV, hepatitis B, or syphilis). Thus, HTLV-1/2 antenatal testing should be mandatory among CSA&C pregnant women everywhere.
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Soriano V, de Mendoza C. Screening for HTLV-1 infection should be expanded in Europe. Int J Infect Dis 2024; 140:99-101. [PMID: 38307379 DOI: 10.1016/j.ijid.2024.01.015] [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: 12/22/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024] Open
Abstract
Human T-cell lymphotropic virus type 1 (HTLV-1) infection is spreading globally at an uncertain speed. Sexual, mother-to-child, and parenteral exposure are the major transmission routes. Neither vaccines nor antivirals have been developed to confront HTLV-1, despite infecting over 10 million people globally and causing life-threatening illnesses in 10% of carriers. It is time to place this long-neglected disease firmly into the 2030 elimination agenda. Current evidence supports once-in-life testing for HTLV-1, as recommended for HIV, hepatitis B and C, along with targeted screening of pregnant women, blood donors, and people who attended clinics for sexually transmitted infections (STIs). Similar targeted screening strategies are already being performed for Chagas disease in some Western countries in persons from Latin America. Given the high risk of rapid-onset HTLV-1-associated myelopathy, universal screening of solid organ donors is warranted. To minimize organ wastage, however, the specificity of HTLV screening tests must be improved. HTLV screening of organ donors in Europe has become mandatory in Spain and the United Kingdom. The advent of HTLV point-of-care kits would facilitate testing. Finally, increasing awareness of HTLV-1 will help those living with HTLV-1 to be tested, clinically monitored, and informed about transmission-preventive measures.
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Affiliation(s)
- Vicente Soriano
- Helath Sciences School & Medical Center, Inernational University of La Rioja (UNIR), Madrid, Spain.
| | - Carmen de Mendoza
- Department of Internal Medicine, Puerta de Hierro University Hospital, Madrid, Spain
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Encinas B, Benito R, Rojo S, Reina G, Montiel N, Aguilera A, Eiros JM, García-Costa J, Ortega D, Arco I, Hernánez-Batancor A, Soriano V, de Mendoza C. Human T-lymphotropic virus-1 infection among Latin American pregnant women living in Spain. IJID REGIONS 2024; 10:146-149. [PMID: 38304758 PMCID: PMC10831283 DOI: 10.1016/j.ijregi.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 02/03/2024]
Abstract
Objectives Human T-lymphotropic virus (HTLV) antenatal screening is not mandatory in Spain. Surveys conducted decades ago reported HTLV-1 seroprevalence rates of 0.2% among foreign pregnant women in Spain. The migrant flow to Spain from HTLV-1 endemic regions in Latin America and sub-Saharan Africa has increased during the last decade. Currently, 25% of pregnant women in Spain are foreigners. Methods From January 2021 to October 2023 a cross-sectional study was carried out in all consecutive pregnant women attended at eleven Spanish clinics. A commercial enzyme immunoassay (EIA) was used for screening of serum HTLV-1/2 antibodies. Reactive samples were confirmed by immunoblot. Results A total of 9813 pregnant women with a median age of 34 years-old were examined. Native Spaniards were 6977 (76.5%). Of 2147 foreigners (23.5%), 903566 (9.9%) were Latin Americans, 416 (4.5%) North Africans, 293 (3.2%) from Romania, and 196 (2.1%) from sub-Saharan Africa. A total of 47 samples were EIA reactive but only five were confirmed as HTLV-1 positive using immunoblot. Infected women came from Paraguay, Colombia, the Dominican Republic, Venezuela and Peru. All but one were primigravida, with ages ranging from 20 to 33 years-old. One was HIV-1 positive, and another was infected with Chlamydia trachomatis. Conclusion The overall seroprevalence for HTLV-1 among pregnant women in Spain is 0.05% but rises ten-fold (0.55%) among Latin Americans. This rate is higher than in surveys conducted decades ago. Our results support that anti-HTLV testing should be part of antenatal screening in Spain in pregnant women coming from Latin America, as it is already done with Chagas disease.
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Affiliation(s)
- Begoña Encinas
- Gynecology & Obstetrics Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Rafael Benito
- Microbiology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Silvia Rojo
- Microbiology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Gabriel Reina
- Microbiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Natalia Montiel
- Microbiology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Antonio Aguilera
- Microbiology Department, University of Santiago, Santiago de Compostela, Spain
| | - José María Eiros
- Microbiology Department, Rio Hortega University Hospital, Valladolid, Spain
| | - Juan García-Costa
- Microbiology Department, Complejo Hospitalario de Ourense, Ourense, Spain
| | - Diego Ortega
- Microbiology Department, Hospital Miguel Servet, Zaragoza, Spain
| | - Irene Arco
- Microbiology Department, General University Hospital of Alicante, Pintor Baeza, Alicante, Spain
| | - Araceli Hernánez-Batancor
- Microbioligy Department, Hospital insular Unidad De Traslados, Avenida Maritima del Sur, Las Palmas de Gran Canaria, Spain
| | - Vicente Soriano
- International University of La Rioja (UNIR) Health Sciences School & Medical Center, Madrid, Spain
| | - Carmen de Mendoza
- Puerta de Hierro University Hospital & Research Foundation-IDIPHISA, Madrid, Spain
| | - Spanish HTLV Network
- Gynecology & Obstetrics Department, Puerta de Hierro University Hospital, Madrid, Spain
- Microbiology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Microbiology Department, Hospital Clínico Universitario, Valladolid, Spain
- Microbiology Department, Clínica Universidad de Navarra, Pamplona, Spain
- Microbiology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Microbiology Department, University of Santiago, Santiago de Compostela, Spain
- Microbiology Department, Rio Hortega University Hospital, Valladolid, Spain
- Microbiology Department, Complejo Hospitalario de Ourense, Ourense, Spain
- Microbiology Department, Hospital Miguel Servet, Zaragoza, Spain
- Microbiology Department, General University Hospital of Alicante, Pintor Baeza, Alicante, Spain
- Microbioligy Department, Hospital insular Unidad De Traslados, Avenida Maritima del Sur, Las Palmas de Gran Canaria, Spain
- International University of La Rioja (UNIR) Health Sciences School & Medical Center, Madrid, Spain
- Puerta de Hierro University Hospital & Research Foundation-IDIPHISA, Madrid, Spain
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Ayerdi O, Benito R, Ortega D, Aguilera A, Montiel N, Pintos I, Díaz de Santiago A, Baza B, Soriano V, de Mendoza C. HTLV infection in persons with sexually transmitted diseases in Spain. Front Immunol 2023; 14:1277793. [PMID: 38143748 PMCID: PMC10740202 DOI: 10.3389/fimmu.2023.1277793] [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: 08/15/2023] [Accepted: 11/13/2023] [Indexed: 12/26/2023] Open
Abstract
Background HTLV-1 infection is a neglected disease, despite estimates of 10 million people infected worldwide and producing life-threatening illnesses in 10% of carriers. Sexual transmission is the main route of contagion. However, HTLV-1 is not listed among sexually transmitted infections (STIs). Methods Serum from all consecutive individuals who had attended six STI clinics across Spain during the last 12 months were tested for HTLV antibodies using a commercial enzyme immunoassay (EIA). Reactive samples were confirmed by immunoblot. Results A total of 2,524 samples were examined. The majority (1,936; 76.7%) belonged to men, of whom 676 (34.9%) were men who have sex with men (MSM) receiving HIV pre-exposure prophylaxis. Although native Spaniards predominated (1,470; 58.2%), up to 593 (23.5%) came from Latin America and 139 (5.5%) were African. A total of 26 individuals were initially EIA reactive and immunoblot confirmed 5 as HTLV-1 and 7 as HTLV-2. All but one HTLV-1+ case came from Latin America. Three were men and two were women. Among Latin Americans, the HTLV-1 seroprevalence was 0.67%. In contrast, all seven HTLV-2+ were native Spaniards and former injection drug users, and all but one were HIV+. Conclusion The rate of HTLV infection among individuals with STIs in Spain is 0.5%, which is greater than in the general population. These results support the introduction of universal HTLV screening in persons who attend clinics for STIs.
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Affiliation(s)
- Oskar Ayerdi
- Sexually transmitted Infections Clinic, Centro Sanitario Sandoval, Madrid, Spain
| | - Rafael Benito
- Microbiology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Diego Ortega
- Microbiology Department, Hospital Miguel Servet, Zaragoza, Spain
| | - Antonio Aguilera
- Microbiology Department, University of Santiago, Santiago de Compostela, Spain
| | - Natalia Montiel
- Microbiology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Ilduara Pintos
- Internal Medicine Laboratory, Puerta de Hierro University Hospital and Research Foundation-IDIPHISA, Madrid, Spain
| | - Alberto Díaz de Santiago
- Internal Medicine Laboratory, Puerta de Hierro University Hospital and Research Foundation-IDIPHISA, Madrid, Spain
| | - Begoña Baza
- Sexually transmitted Infections Clinic, Centro Sanitario Sandoval, Madrid, Spain
| | - Vicente Soriano
- Public Health Unit, UNIR Health Sciences School and Medical Center, Madrid, Spain
| | - Carmen de Mendoza
- Internal Medicine Laboratory, Puerta de Hierro University Hospital and Research Foundation-IDIPHISA, Madrid, Spain
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Suzuki S, Hoshi SI, Sekizawa A, Sagara Y, Kinoshita K, Kitamura T. Recent Prevalence of Human T-cell Leukemia Virus Type 1 Carrier Associated with Horizontal Transmission in Pregnant Japanese Women. Jpn J Infect Dis 2021; 74:576-578. [PMID: 33952772 DOI: 10.7883/yoken.jjid.2021.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The current study was conducted to examine the number of human T-cell leukemia virus type 1 (HTLV-1) carrier and how horizontal transmission affects the prevalence of HTLV-1 carrier in pregnant Japanese women in 2019. We requested 2,214 obstetrical facilities to provide information of HTLV-1 tests in pregnant women who delivered in 2019. The estimated number of HTLV-1 carrier in pregnant Japanese women was 952. At least 10% or more of the HTLV-1 carriers were those due to horizontal transmission.
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Affiliation(s)
- Shunji Suzuki
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Japan.,Japan Association of Obstetricians and Gynecologists, Japan
| | | | | | - Yoko Sagara
- Japan Association of Obstetricians and Gynecologists, Japan
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Aghajanian S, Teymoori-Rad M, Molaverdi G, Mozhgani SH. Immunopathogenesis and Cellular Interactions in Human T-Cell Leukemia Virus Type 1 Associated Myelopathy/Tropical Spastic Paraparesis. Front Microbiol 2020; 11:614940. [PMID: 33414779 PMCID: PMC7783048 DOI: 10.3389/fmicb.2020.614940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/17/2020] [Indexed: 01/15/2023] Open
Abstract
HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) is a neuropathological disorder in 1–3% of individuals infected with Human T-lymphotropic virus 1 (HTLV-1). This condition is characterized by progressive spastic lower limb weakness and paralysis, lower back pain, bladder incontinence, and mild sensory disturbances resembling spinal forms of multiple sclerosis. This disease also causes chronic disability and is therefore associated with high health burden in areas where HTLV-1 infection is endemic. Despite various efforts in understanding the virus and discovery of novel diagnostic markers, and cellular and viral interactions, HAM/TSP management is still unsatisfactory and mainly focused on symptomatic alleviation, and it hasn’t been explained why only a minority of the virus carriers develop HAM/TSP. This comprehensive review focuses on host and viral factors in association with immunopathology of the disease in hope of providing new insights for drug therapies or other forms of intervention.
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Affiliation(s)
- Sepehr Aghajanian
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Majid Teymoori-Rad
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazale Molaverdi
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Sayed-Hamidreza Mozhgani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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