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Eades LE, Hoi AY, Liddle R, Sines J, Kandane-Rathnayake R, Khetan S, Nossent J, Lindenmayer G, Morand EF, Liew DFL, Rischmueller M, Brady S, Brown A, Vincent FB. Systemic lupus erythematosus in Aboriginal and Torres Strait Islander peoples in Australia: addressing disparities and barriers to optimising patient care. THE LANCET. RHEUMATOLOGY 2024; 6:e713-e726. [PMID: 38971169 DOI: 10.1016/s2665-9913(24)00095-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/24/2024] [Accepted: 04/10/2024] [Indexed: 07/08/2024]
Abstract
The first inhabitants of Australia and the traditional owners of Australian lands are the Aboriginal and Torres Strait Islander peoples. Aboriginal and Torres Strait Islander peoples are two to four times more likely to have systemic lupus erythematosus (SLE) than the general Australian population. Phenotypically, SLE appears distinctive in Aboriginal and Torres Strait Islander peoples and its severity is substantially increased, with mortality rates up to six times higher than in the general Australian population with SLE. In particular, Aboriginal and Torres Strait Islander peoples with SLE have increased prevalence of lupus nephritis and increased rates of progression to end-stage kidney disease. The reasons for the increased prevalence and severity of SLE in this population are unclear, but socioeconomic, environmental, and biological factors are all likely to be implicated, although there are no published studies investigating these factors in Aboriginal and Torres Strait Islander peoples with SLE specifically, indicating an important knowledge gap. In this Review, we summarise the data on the incidence, prevalence, and clinical and biological findings relating to SLE in Aboriginal and Torres Strait Islander peoples and explore potential factors contributing to its increased prevalence and severity in this population. Importantly, we identify health disparities and deficiencies in health-care provision that limit optimal care and outcomes for many Aboriginal and Torres Strait Islander peoples with SLE and highlight potentially addressable goals to improve outcomes.
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Affiliation(s)
- Laura E Eades
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Rheumatology Department, Monash Health, Clayton, VIC, Australia
| | - Alberta Y Hoi
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Rheumatology Department, Monash Health, Clayton, VIC, Australia
| | - Ruaidhri Liddle
- Primary and Public Health Care Central Australia, Alice Springs, NT, Australia
| | - Jason Sines
- Rheumatology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | - Sachin Khetan
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Rheumatology Department, Royal Darwin Hospital, Tiwi, NT, Australia
| | - Johannes Nossent
- Rheumatology Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; School of Medicine, University of Western Australia, Crawley, WA, Australia
| | | | - Eric F Morand
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Rheumatology Department, Monash Health, Clayton, VIC, Australia
| | - David F L Liew
- Rheumatology Department, Austin Health, Heidelberg, VIC, Australia; Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Maureen Rischmueller
- Rheumatology Department, Royal Darwin Hospital, Tiwi, NT, Australia; Discipline of Medicine, University of Adelaide, SA, Australia; Rheumatology Department, The Queen Elizabeth Hospital, Woodville, SA, Australia; Rheumatology Department, Alice Springs Hospital, The Gap, NT, Australia
| | - Stephen Brady
- Rheumatology Department, Alice Springs Hospital, The Gap, NT, Australia
| | - Alex Brown
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT, Australia
| | - Fabien B Vincent
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia.
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Langham F, Tsai D, Forde BM, Camilleri S, Harris PNA, Roberts JA, Chiong F. Demographic, clinical and molecular epidemiology of extended-spectrum beta-lactamase-producing Escherichia coli bloodstream infections in Central Australia. Pathology 2024:S0031-3025(24)00172-7. [PMID: 39060195 DOI: 10.1016/j.pathol.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/06/2024] [Accepted: 04/28/2024] [Indexed: 07/28/2024]
Abstract
We describe the demographics, clinical and molecular epidemiology of extended-spectrum β-lactamase (ESBL) Escherichia coli bloodstream infections (BSI) in Central Australia. All ESBL-producing E. coli bloodstream isolates from January 2018 to December 2020 were retrospectively identified. Demographic and clinical information was extracted by chart review. Whole-genome sequencing was performed for multi-locus sequence typing, antibiotic-resistance genes, and phylogenetic relationships. We identified 41 non-duplicate episodes of ESBL E. coli BSI. Median age was 55 years (IQR 47-63), 78% were female, 93% were Aboriginal, and half came from a remote community. Infections were predominantly urinary (68%, 28/41). In the 12 months prior, 70% (26/37) of identified patients had been hospitalised and 81% (30/37) prescribed antibiotics. Meropenem and piperacillin-tazobactam susceptibility was maintained in 100% and 95% of isolates, respectively. Co-resistance to non-β-lactam antibiotics was 32% to gentamicin, 61% to trimethoprim/sulfamethoxazole, and 68% to ciprofloxacin. For sequenced isolates, 41% (16/35) were sequence type 131 (ST131). Mean acquired antibiotic-resistance genes for each isolate was 12.3 (SD 3.1). Four isolates carried an OXA-1 gene. Only non-ST131 isolates carried AmpC and acquired quinolone-resistance genes. There was some evidence of clustering of closely related strains, but no evidence of community or healthcare admission overlap. ESBL rates are rapidly rising in Central Australia, which is a conducive environment for antibiotic resistance development (e.g., overcrowding, socioeconomic disadvantages, high healthcare exposure and high antibiotic use). Future research is required to explore resistance-transmission dynamics in this unique setting.
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Affiliation(s)
- Freya Langham
- Department of Infectious Diseases, Monash Health, Melbourne, Vic, Australia; Alice Springs Hospital, Central Australian Health Service, Alice Springs, NT, Australia.
| | - Danny Tsai
- Alice Springs Hospital, Central Australian Health Service, Alice Springs, NT, Australia; Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Brian M Forde
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Shayne Camilleri
- Alice Springs Hospital, Central Australian Health Service, Alice Springs, NT, Australia; Department of Infectious Diseases, Austin Health, Melbourne, Vic, Australia
| | - Patrick N A Harris
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia; Central Microbiology, Pathology Queensland, Royal Brisbane & Women's Hospital, Brisbane, Qld, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia; Herston Infectious Diseases Institute, Metro North Health, Brisbane, Qld, Australia; Division of Anaesthesiology, Critical Care, Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Fabian Chiong
- Alice Springs Hospital, Central Australian Health Service, Alice Springs, NT, Australia; Department of Infectious Diseases, The Canberra Hospital, Canberra, ACT, Australia
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Yan Q, Liu Z, Chen Y, Zhang X, Zheng W, Liu X, Huang H, Liu Q, Jiang Y, Zhan S, Huang X. ITGAM-macrophage modulation as a potential strategy for treating neutrophilic Asthma: insights from bioinformatics analysis and in vivo experiments. Apoptosis 2024; 29:393-411. [PMID: 37950848 DOI: 10.1007/s10495-023-01914-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 11/13/2023]
Abstract
Identification of molecular biomarkers associated with neutrophilic asthma (NA) phenotype may inform the discovery of novel pathobiological mechanisms and the development of diagnostic markers. Three mRNA transcriptome datasets extracted from induced sputum of asthma patients with various inflammatory types were used to screen for macrophage-related molecular mechanisms and targets in NA. Furthermore, the predicted targets were also validated on an independent dataset (N = 3) and animal model (N = 5). A significant increase in total cells, neutrophils and macrophages was observed in bronchoalveolar lavage (BAL) fluid of NA mice induced by ovalbumin/freund's adjuvant, complete (OVA/CFA). And we also found elevated levels of neutrophil and macrophage infiltration in NA subtype in external datasets. NA mice had increased secretion of IgE, IL-1β, TNF-α and IL-6 in serum and BAL fluid. MPO, an enzyme present in neutrophils, was also highly expressed in NA mice. Then, weighted gene co-expression network analysis (WGCNA) identified 684 targets with the strongest correlation with NA, and we obtained 609 macrophage-related specific differentially expressed genes (DEGs) in NA by integrating macrophage-related genes. The top 10 genes with high degree values were obtained and their mRNA levels and diagnostic performance were then determined by RT-qPCR and receiver operator characteristic (ROC) analysis. Statistically significant correlations were found between macrophages and all key targets, with the strongest correlation between ITGAM and macrophages in NA. Double-Immunofluorescence staining further confirmed the co-localization of ITGAM and F4/80 in NA. ITGAM was identified as a critical target to distinguish NA from healthy/non-NA individuals, which may provide a novel avenue to further uncover the mechanisms and therapy of NA.
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Affiliation(s)
- Qian Yan
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Lingnan Medical Research Center of Guangzhou, University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Clinical Research Academy of Chinese Medicine, Guangzhou, China
| | - Zixing Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yujing Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Haikou hospital of Chinese traditional medicine, Haikou, China
| | - Xinxin Zhang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Lingnan Medical Research Center of Guangzhou, University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Clinical Research Academy of Chinese Medicine, Guangzhou, China
| | - Wenjiang Zheng
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaohong Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huiting Huang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiong Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong Jiang
- Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China.
| | - Shaofeng Zhan
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Xiufang Huang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
- Guangzhou University of Chinese Medicine, Guangzhou, China.
- Lingnan Medical Research Center of Guangzhou, University of Chinese Medicine, Guangzhou, China.
- Guangdong Provincial Clinical Research Academy of Chinese Medicine, Guangzhou, China.
- Lingnan Medical Research Center of Guangzhou, University of Chinese Medicine, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Airport Road, Guangzhou, 510405, People's Republic of China.
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Cockbain B, Rosadas C, Taylor GP. HTLV-1 as a contributing factor towards scabies and its systemic sequelae. J Glob Health 2023; 13:03057. [PMID: 37921043 PMCID: PMC10623376 DOI: 10.7189/jogh.13.03057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Affiliation(s)
- Beatrice Cockbain
- Department of Infectious Disease, Imperial College London, London, England, UK
- Chelsea and Westminster NHS Foundation Trust, London, England, UK
| | - Carolina Rosadas
- Department of Infectious Disease, Imperial College London, London, England, UK
| | - Graham P Taylor
- Department of Infectious Disease, Imperial College London, London, England, UK
- National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, London, England, UK
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Howarth TP, Jersmann HPA, Majoni SW, Mo L, Ben Saad H, Ford LP, Heraganahally SS. The 'ABC' of respiratory disorders among adult Indigenous people: asthma, bronchiectasis and COPD among Aboriginal Australians - a systematic review. BMJ Open Respir Res 2023; 10:e001738. [PMID: 37451702 PMCID: PMC10351270 DOI: 10.1136/bmjresp-2023-001738] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Aboriginal Australians are reported to have higher presence of chronic respiratory diseases. However, comprehensive evidence surrounding this is sparse. Hence, a systematic review was undertaken to appraise the current state of knowledge on respiratory health in the adult Aboriginal Australians, in particular among the three most common respiratory disorders: asthma, bronchiectasis and chronic obstructive pulmonary disease (COPD). METHODS A systematic review of primary literature published between January 2012 and October 2022, using the databases PubMed and Scopus, was conducted. Studies were included if they reported adult Aboriginal Australian prevalence's or outcomes related to asthma, bronchiectasis or COPD, and excluded if adult data were not reported separately, if Aboriginal Australian data were not reported separately or if respiratory disorders were combined into a single group. Risk of bias was assessed by both Joanne Briggs Institute checklists and Hoys' bias assessment. Summary data pertaining to prevalence, lung function, symptoms, sputum cultures and mortality for each of asthma, bronchiectasis and COPD were extracted from the included studies. RESULTS Thirty-seven studies were included, involving approximately 33 364 participants (71% female). Eighteen studies reported on asthma, 21 on bronchiectasis and 30 on COPD. The majority of studies (94%) involved patients from hospitals or respiratory clinics and were retrospective in nature. Across studies, the estimated prevalence of asthma was 15.4%, bronchiectasis was 9.4% and COPD was 13.7%, although there was significant geographical variation. Only a minority of studies reported on clinical manifestations (n=7) or symptoms (n=4), and studies reporting on lung function parameters (n=17) showed significant impairment, in particular among those with concurrent bronchiectasis and COPD. Airway exacerbation frequency and hospital admission rates including mortality are high. DISCUSSION Although risk of bias globally was assessed as low, and study quality as high, there was limited diversity of studies with most reporting on referred populations, and the majority originating from two centres in the Northern Territory. The states with the greatest Aboriginal Australian population (Victoria and New South Wales) reported the lowest number of studies and patients. This limits the generalisability of results to the wider Aboriginal Australian population due to significant environmental, cultural and socioeconomic variation across the population. Regardless, Aboriginal Australians appear to display a high prevalence, alongside quite advanced and complex chronic respiratory diseases. There is however significant heterogeneity of prevalence, risk factors and outcomes geographically and by patient population. Further collaborative efforts are required to address specific diagnostic and management pathways in order to close the health gap secondary to respiratory disorders in this population.
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Affiliation(s)
- Timothy P Howarth
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
- Darwin Respiratory and Sleep Health, Darwin private Hospital, Tiwi, Darwin, Northern Territory, Australia
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Hubertus P A Jersmann
- Department of Respiratory and sleep Medicine, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Sandawana W Majoni
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- College of Medicine and Public Health, Flinders University, Northern Territory Medical program, Darwin, Northern Territory, Australia
- Department of Nephrology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Lin Mo
- College of Medicine and Public Health, Flinders University, Northern Territory Medical program, Darwin, Northern Territory, Australia
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Helmi Ben Saad
- University of Sousse, Farhat HACHED Hospital, Heart Failure (LR12SP09) Research Laboratory, Sousse, Tunisia
| | - Linda P Ford
- Northern Institute, Faculty of Arts & Society, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Subash S Heraganahally
- Darwin Respiratory and Sleep Health, Darwin private Hospital, Tiwi, Darwin, Northern Territory, Australia
- College of Medicine and Public Health, Flinders University, Northern Territory Medical program, Darwin, Northern Territory, Australia
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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6
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Susanto M, Dunning J, Chew R. Pantoea abscess mimicking sarcoma in a HTLV-1-infected Indigenous Australian man: Case report and literature review. Clin Case Rep 2023; 11:e7351. [PMID: 37215972 PMCID: PMC10196424 DOI: 10.1002/ccr3.7351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/11/2022] [Accepted: 05/02/2023] [Indexed: 05/24/2023] Open
Abstract
Gram-negative bacteria of the genus Pantoea are emerging bacterial causes of diverse sporadic and outbreak-linked infections. Chronic Pantoea abscesses are unusual and may give rise to a differential diagnosis of malignancy. Foreign body retention and host immune defects may be risk factors for such chronic infections.
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Affiliation(s)
- Maja Susanto
- Infectious Diseases UnitRedcliffe HospitalRedcliffeQueenslandAustralia
| | - Jacki Dunning
- Department of SurgeryAlice Springs HospitalAlice SpringsNorthern TerritoryAustralia
| | - Rusheng Chew
- Infectious Diseases UnitAlice Springs HospitalAlice SpringsNorthern TerritoryAustralia
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
- Centre for Tropical Medicine and Global HealthUniversity of OxfordOxfordUK
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Raw C, Traub RJ, Zendejas-Heredia PA, Stevenson M, Wiethoelter A. A systematic review and meta-analysis of human and zoonotic dog soil-transmitted helminth infections in Australian Indigenous communities. PLoS Negl Trop Dis 2022; 16:e0010895. [PMID: 36279298 PMCID: PMC9632820 DOI: 10.1371/journal.pntd.0010895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/03/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Soil-transmitted helminths (STH) infect 1.5 billion people and countless animals worldwide. In Australian Indigenous communities, STH infections have largely remained endemic despite control efforts, suggesting reservoirs of infection may exist. Dogs fulfil various important cultural, social and occupational roles in Australian Indigenous communities and are populous in these settings. Dogs may also harbour zoonotic STHs capable of producing morbidity and mortality in dogs and humans. This review provides an overview of human and zoonotic STH infections, identifies the Australian Indigenous locations affected and the parasite species and hosts involved. The meta-analysis provides estimates of individual study and pooled true prevalence of STH infections in Australian Indigenous communities and identifies knowledge gaps for further research on zoonotic or anthroponotic potential. A systematic literature search identified 45 eligible studies documenting the presence of Strongyloides stercoralis, Trichuris trichiura, Ancylostoma caninum, Ancylostoma duodenale, Ancylostoma ceylanicum, undifferentiated hookworm, and Ascaris lumbricoides. Of these studies, 26 were also eligible for inclusion in meta-analysis to establish true prevalence in the light of imperfect diagnostic test sensitivity and specificity by Rogan-Gladen and Bayesian methods. These studies revealed pooled true prevalence estimates of 18.9% (95% CI 15.8–22.1) for human and canine S. stercoralis infections and 77.3% (95% CI 63.7–91.0) for canine A. caninum infections indicating continued endemicity, but considerably more heterogenous pooled estimates for canine A. ceylanicum infections, and A. duodenale, undifferentiated hookworm and T. trichiura in humans. This review suggests that the prevalence of STHs in Australian Indigenous communities has likely been underestimated, principally based on imperfect diagnostic tests. Potential misclassification of hookworm species in humans and dogs due to outdated methodology, also obscures this picture. High-quality contemporary studies are required to establish current true prevalence of parasite species in all relevant hosts to guide future policy development and control decisions under a culturally sound One Health framework. Soil-transmitted helminths include hookworms, threadworms, whipworms and roundworms. These worms may infect different hosts including humans and dogs, and some species are zoonotic, meaning that they are able to transmit between animals and humans. In many Australian Indigenous communities, people remain infected with these worms at high rates compared to other parts of the country despite various control strategies. Resource and health literacy inequalities are primary drivers for these differences. However, the potential for dogs to act as reservoirs for zoonotic worm infections in humans must also be considered. For this reason, it’s important to create a clear picture of the level of infection by location and host. Given that tests used to establish prevalence can produce false positive or negative results, we performed a meta-analysis allowing comparison of true prevalence estimates by location and host, regardless of the test used. This review suggests that threadworm and dog hookworm remain endemic in Australian Indigenous communities, though a gap exists to accurately inform the prevalence of the other worms. It also highlights the need for One Health strategies in research, policy and control where humans, all animal hosts and the environment are considered in a culturally relevant way.
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Affiliation(s)
- Cameron Raw
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
- * E-mail:
| | - Rebecca J. Traub
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Patsy A. Zendejas-Heredia
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Mark Stevenson
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Anke Wiethoelter
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
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8
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Fowler F, Einsiedel L. A Qualitative Study Exploring Perceptions to the Human T Cell Leukaemia Virus Type 1 in Central Australia: Barriers to Preventing Transmission in a Remote Aboriginal Population. Front Med (Lausanne) 2022; 9:845594. [PMID: 35572972 PMCID: PMC9100826 DOI: 10.3389/fmed.2022.845594] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/28/2022] [Indexed: 01/24/2023] Open
Abstract
Background Central Australia has the highest recorded prevalence of infection with the human T cell leukaemia virus type 1 (HTLV-1) worldwide. Each of the clinical diseases associated with HTLV-1 have been reported in this region, including deaths due to adult T cell leukaemia, which is causally linked to HTLV-1. Nevertheless, no public health response has been implemented to reduce HTLV-1 transmission among the affected Aboriginal population. In the first study to explore the perceptions of healthcare professionals along with those of Aboriginal people whose communities are actually impacted by HTLV-1, we sought to understand the barriers to preventing HTLV-1 transmission in this remote area. Methodology/Principal Findings Semi and un-structured interviews were conducted with 30 Australian Aboriginal people, 26 non-Aboriginal healthcare professionals and 3 non-Aboriginal community workers. The purpose of the interviews was to explore perceptions towards HTLV-1 in a health context with a focus on sexual and reproductive rights. Deductive and inductive analyses were applied to the data and a decolonizing lens brought peripheral stories to the fore. A major finding was the contrast between views expressed by Aboriginal participants and healthcare professionals regarding the provision of knowledge to those affected. Aboriginal participants consistently articulated that they and their communities should be informed of, and can hold, knowledges pertaining to HTLV-1. This finding controverted the perceptions of healthcare professionals that the complexities of the virus would not be well-understood by their Aboriginal patients and that sharing HTLV-1 knowledges might overwhelm Aboriginal people. Further analyses revealed a spectrum of understanding and clinical practice, while also delineating signs of an imagined public health response. Conclusions/Significance HTLV-1 remains a neglected infection in Australia. Knowledge of HTLV-1 is held by a privileged medical elite and does not flow to marginalised Aboriginal people living in affected communities. We demonstrate that differences in the perspectives of stakeholders presents a significant barrier to the development of cohesive, culturally safe prevention programs that foster a shared knowledge of HTLV-1. The interview data suggests that a successful public health program is likely to require a dual approach that includes clinical care and community-driven health promotion. Aspects of this approach, which would raise awareness and potentially reduce transmission and lower HTLV-1 prevalence in Central Australia, may be applicable to other endemic settings with similar conditions of social disadvantage, geographic remoteness, resource limitations and cross-cultural challenges.
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Affiliation(s)
- Fiona Fowler
- Department of Social Work, Alice Salomon University of Applied Sciences, Berlin, Germany
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9
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Ye L, Taylor GP, Rosadas C. Human T-Cell Lymphotropic Virus Type 1 and Strongyloides stercoralis Co-infection: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:832430. [PMID: 35237633 PMCID: PMC8882768 DOI: 10.3389/fmed.2022.832430] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe distribution of human T cell lymphotropic virus type 1 (HTLV-1) overlaps with that of Strongyloides stercoralis. Strongyloides stercoralis infection has been reported to be impacted by co-infection with HTLV-1. Disseminated strongyloidiasis and hyperinfection syndrome, which are commonly fatal, are observed in HTLV-1 co-infected patients. Reduced efficacy of anti-strongyloidiasis treatment in HTLV-1 carriers has been reported. The aim of this meta-analysis and systematic review is to better understand the association between HTLV-1 and S. stercoralis infection.MethodsPubMed, Embase, MEDLINE, Global Health, Healthcare Management Information Consortium databases were searched. Studies regarding the prevalence of S. stercoralis, those evaluating the frequency of mild or severe strongyloidiasis, and treatment response in people living with and without HTLV-1 infection were included. Data were extracted and odds ratios were calculated. Random-effect meta-analysis was used to assess the pooled OR and 95% confidence intervals.ResultsFourteen studies were included after full-text reviewing of which seven described the prevalence of S. stercoralis and HTLV-1. The odds of S. stercoralis infection were higher in HTLV-1 carriers when compared with HTLV-1 seronegative subjects (OR 3.2 95%CI 1.7–6.2). A strong association was found between severe strongyloidiasis and HTLV-1 infection (OR 59.9, 95%CI 18.1–198). Co-infection with HTLV-1 was associated with a higher rate of strongyloidiasis treatment failure (OR 5.05, 95%CI 2.5–10.1).ConclusionStrongyloides stercoralis infection is more prevalent in people living with HTLV-1. Co-infected patients are more likely to develop severe presentation and to fail treatment. Screening for HTLV-1 and Strongyloides sp. should be routine when either is diagnosed.
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Affiliation(s)
- Lingqing Ye
- Section of Virology, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Graham P. Taylor
- Section of Virology, Department of Infectious Disease, Imperial College London, London, United Kingdom
- National Centre for Human Retrovirology, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- *Correspondence: Graham P. Taylor
| | - Carolina Rosadas
- Section of Virology, Department of Infectious Disease, Imperial College London, London, United Kingdom
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10
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Talukder MR, Pham H, Woodman R, Wilson K, Taylor K, Kaldor J, Einsiedel L. The Association between Diabetes and Human T-Cell Leukaemia Virus Type-1 (HTLV-1) with Strongyloides stercoralis: Results of a Community-Based, Cross-Sectional Survey in Central Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042084. [PMID: 35206272 PMCID: PMC8872355 DOI: 10.3390/ijerph19042084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022]
Abstract
In central Australia, an area that is endemic for the human T-cell leukaemia virus type-1 (HTLV-1), the prevalence of Strongyloides stercoralis and its association with other health conditions are unknown. A cross-sectional community-based survey was conducted in seven remote Aboriginal communities in central Australia, from 2014 to 2018. All residents aged ≥10 years were invited to complete a health survey and to provide blood for Strongyloides serology, HTLV-1 serology and HTLV-1 proviral load (PVL). Risk factors for Strongyloides seropositivity and associations with specific health conditions including diabetes and HTLV-1 were determined using logistic regression. Overall Strongyloides seroprevalence was 27% (156/576) (children, 22% (9/40); adults (≥15 years), 27% (147/536), varied widely between communities (5–42%) and was not associated with an increased risk of gastrointestinal, respiratory or dermatological symptoms. Increasing age, lower HTLV-1 PVL (<1000 copies per 105 peripheral blood leucocytes) compared to the HTLV-1 uninfected group and community of residence were significant risk factors for Strongyloides seropositivity in an adjusted model. A modest reduction in the odds of diabetes among Strongyloides seropositive participants was found (aOR 0.58, 95% CI 0.35, 1.00; p = 0.049); however, this was lost when body mass index was included in the adjusted model (aOR 0.48, 95% CI 0.48, 1.47; p = 0.542). Strongyloides seropositivity had no relationship with anaemia. Exploring social and environmental practices in communities with low Strongyloides seroprevalence may provide useful lessons for similar settings.
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Affiliation(s)
- Mohammad Radwanur Talukder
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, NT 0870, Australia; (M.R.T.); (H.P.)
| | - Hai Pham
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, NT 0870, Australia; (M.R.T.); (H.P.)
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, SA 5001, Australia;
| | - Kim Wilson
- National Serology Reference Laboratory, Melbourne, VIC 3065, Australia;
| | - Kerry Taylor
- Poche Centre for Indigenous Health and Wellbeing, Alice Springs, NT 0870, Australia;
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Lloyd Einsiedel
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, NT 0870, Australia; (M.R.T.); (H.P.)
- Alice Springs Hospital, Alice Springs, NT 0870, Australia
- Correspondence:
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11
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Rosadas C, Taylor GP. HTLV-1 and Co-infections. Front Med (Lausanne) 2022; 9:812016. [PMID: 35187000 PMCID: PMC8850362 DOI: 10.3389/fmed.2022.812016] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/12/2022] [Indexed: 01/02/2023] Open
Abstract
Human T lymphotropic virus type 1 (HTLV-1) is a retrovirus that causes lifelong T-cell infection in humans, impacting the host immune response. This virus causes a range of clinical manifestations, from inflammatory conditions, including neuronal damage (HTLV-1 associated myelopathy, HAM) to life-threatening leukemia (adult T-cell leukemia, ATL). Human T lymphotropic virus type 1 is also associated with increased risk of all-cause mortality, but the mechanisms remain unclear. As a blood-borne and sexually transmitted infection (STI), HTLV-1 shares transmission routes to many other pathogens and although it has worldwide distribution, it affects mainly those in low- and middle-income tropical areas, where the prevalence of other infectious agents is high. These factors contribute to a high incidence of co-infections in people living with HTLV-1 (PLHTLV). This comprehensive review addresses the impact of HTLV-1 on several co-infections and vice-versa. There is evidence of higher rates of HTLV-1 infection in association with other blood borne (HCV, HBV) and sexually transmitted (Syphilis, Chlamydia, HPV, HSV) infections but whether this represents increased susceptibility or opportunity is unclear. Higher frequency of Mycobacterium tuberculosis (MTb) and Mycobacterium leprae (M. leprae) is observed in PLHTLV. Reports of opportunistic infections and high frequency of crusted scabies in patients with HTLV-1 points to immune impairment in those individuals. Human T lymphotropic virus type 1 may influence the persistence of pathogens, exemplified by the higher rates of Schistosoma mansoni and Strongyloides stercoralis (St. stercoralis) treatment failure observed in PLHTLV. This retrovirus is also associated with increased tuberculosis (TB) severity with some evidence pointing to a deleterious impact on leprosy outcome as well. These findings are supported by immune alterations observed in those co-infected individuals. Although the role of HTLV-1 in HCV outcome is debatable, most data indicate that HTLV may negatively impact the clinical course of hepatitis C. Co-infections may also influence the risk of developing HTLV-1 associated disease, but data are still limited. The impact of HTLV-1 on the response to more common infections, might contribute to the increased mortality rate of HTLV-1. Large scale prospective controlled studies on the prevalence and impact of HTLV-1 in co-infections and vice-versa are needed. Human T lymphotropic virus type 1 impact in public health is broad. Measures to increase awareness and to prevent new infections are needed.
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Affiliation(s)
- Carolina Rosadas
- Section of Virology, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Graham P. Taylor
- Section of Virology, Department of Infectious Disease, Imperial College London, London, United Kingdom
- National Centre for Human Retrovirology, Division of Medicine and Integrated Care, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- *Correspondence: Graham P. Taylor
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12
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Einsiedel L, Pham H, Talukder MR, Taylor K, Wilson K, Kaldor J, Gessain A, Woodman R. Very high prevalence of infection with the human T cell leukaemia virus type 1c in remote Australian Aboriginal communities: Results of a large cross-sectional community survey. PLoS Negl Trop Dis 2021; 15:e0009915. [PMID: 34879069 PMCID: PMC8654171 DOI: 10.1371/journal.pntd.0009915] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/14/2021] [Indexed: 11/18/2022] Open
Abstract
Infection with the human T cell leukaemia virus type 1 (HTLV-1) subtype C is endemic among Aboriginal people in central Australia. To provide insights into the risk factors for transmission, we conducted the first large-scale, community-based prevalence study in seven remote Aboriginal communities. Residents >2 years old were invited to participate in the study between August 2014 and June 2018. HTLV-1 infection was defined as a positive western blot (WB) test or a positive HTLV-1 PCR. 720 community residents participated in the study (children <15 years, 142; adults, 578). Prevalences for children and adults were 3.5% (5/142) and 36.8% (213/578), respectively, reaching 49.3% (106/215) for those older than 45 years. A wide range of proviral loads were measured for both asymptomatic and symptomatic participants with no difference within groups according to age or gender; however, median PVL was 1.34 log10 higher for symptomatic participants. The adult prevalence of HTLV-1 infection in central Australia is the highest reported worldwide. Sexual contact is likely to be the predominant mode of transmission.
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Affiliation(s)
- Lloyd Einsiedel
- Baker Heart and Diabetes Institute, Alice Springs, Northern Territory, Australia
- * E-mail:
| | - Hai Pham
- Baker Heart and Diabetes Institute, Alice Springs, Northern Territory, Australia
| | | | - Kerry Taylor
- Poche Centre for Indigenous Health and Wellbeing, Alice Springs, Northern Territory, Australia
| | - Kim Wilson
- National Serology Reference Laboratory, Melbourne, Australia
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
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Cooper-Beknazarova M, White M, Whiley H, Gray DJ, Mutombo PN, Bradbury R, McManus D, Gordon C, Judd J, Ross KE. Strongyloidiasis does not discriminate: nor should the screening and treatment. Intern Med J 2021; 51:2160-2161. [PMID: 34939286 DOI: 10.1111/imj.15579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Meruyert Cooper-Beknazarova
- Environmental Health, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Mae White
- Environmental Health, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Harriet Whiley
- Environmental Health, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Polydor N Mutombo
- School of Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Richard Bradbury
- School of Science, Psychology and Sport, Federation University, Ballarat, Victoria, Australia
| | - Don McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Catherine Gordon
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Jenni Judd
- School of Health Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Kirstin E Ross
- Environmental Health, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
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14
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McCallum GB, Oguoma VM, Versteegh LA, Wilson CA, Bauert P, Spain B, Chang AB. Comparison of Profiles of First Nations and Non-First Nations Children With Bronchiectasis Over Two 5-Year Periods in the Northern Territory, Australia. Chest 2021; 160:1200-1210. [PMID: 33964302 DOI: 10.1016/j.chest.2021.04.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/11/2021] [Accepted: 04/16/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although the burden of bronchiectasis is recognized globally, pediatric data are limited, particularly on trends over the years. Also, no published data exists regarding whether vitamin D deficiency or insufficiency and human T-cell lymphotropic virus type 1 (HTLV-1) infection, both found to be related to severe bronchiectasis in First Nations adults, also are important in children with bronchiectasis. RESEARCH QUESTION Among children with bronchiectasis, (1) have the clinical and BAL profiles changed between two 5-year periods (period 1, 2007-2011; period 2, 2012-2016) and (b) are vitamin D deficiency or insufficiency, HTLV-1 infection, or both associated with radiologic severity of bronchiectasis? STUDY DESIGN AND METHODS We analyzed the data from children with bronchiectasis prospectively enrolled at Royal Darwin Hospital, Australia, at the first diagnosis; that is, no child was included in both periods. Data collected include demographics, BAL, bloods, and high-resolution CT scan of the chest evaluated using the Bhalla and modified Bhalla scores. RESULTS The median age of the 299 children was 2.2 years (interquartile range, 1.5-3.7 years). One hundred sixty-eight (56%) were male and most were First Nations (92%). Overall, bronchiectasis was high over time, particularly among First Nations children. In the later period, numbers of non-First Nations children more than tripled, but did not reach statistical significance. In period 2 compared with period 1, fewer First Nations children demonstrated chronic cough (period 1, 61%; period 2, 47%; P = .03), were younger, First Nations children were less likely to have received azithromycin (period 1, 42%; period 2, 21%; P < .001), and the BAL fluid of First Nations children showed lower Haemophilus influenzae and Moraxella catarrhalis infection. HTLV-1 infection was not detected, and vitamin D deficiency or insufficiency did not correlate with severity of bronchiectasis. INTERPRETATION Bronchiectasis remains high particularly among First Nations children. Important changes in their profiles that arguably reflect improvements were present, but overall, the profiles remained similar. Although vitamin D deficiency was uncommon, its role in children with bronchiectasis requires further evaluation. HTLV-1 infection was nonexistent and is unlikely to play any role in First Nations children with bronchiectasis.
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Affiliation(s)
- Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT.
| | - Victor M Oguoma
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT; Health Research Institute, University of Canberra, Canberra, ACT
| | - Lesley A Versteegh
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT
| | - Cate A Wilson
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT
| | - Paul Bauert
- Department of Paediatrics, Royal Darwin Hospital, Darwin, NT
| | - Brian Spain
- Department of Anaesthetics, Royal Darwin Hospital, Darwin, NT
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
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15
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Becherer L, Hess JF, Frischmann S, Bakheit M, Nitschko H, Stinco S, Zitz F, Hofer H, Porro G, Hausladen F, Stock K, Drossart D, Wurm H, Kuhn H, Huber D, Hutzenlaub T, Paust N, Keller M, Strohmeier O, Wadle S, Borst N, Zengerle R, von Stetten F. Point-of-Care System for HTLV-1 Proviral Load Quantification by Digital Mediator Displacement LAMP. MICROMACHINES 2021; 12:mi12020159. [PMID: 33562822 PMCID: PMC7915047 DOI: 10.3390/mi12020159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 01/09/2023]
Abstract
This paper presents a universal point-of-care system for fully automated quantification of human T-cell lymphotropic virus type 1 (HTLV-1) proviral load, including genomic RNA, based on digital reverse RNA transcription and c-DNA amplification by MD LAMP (mediator displacement loop-mediated isothermal amplification). A disposable microfluidic LabDisk with pre-stored reagents performs automated nucleic acid extraction, reaction setup, emulsification, reverse transcription, digital DNA amplification, and quantitative fluorogenic endpoint detection with universal reporter molecules. Automated nucleic acid extraction from a suspension of HTLV-1-infected CD4+ T-lymphocytes (MT-2 cells) yielded 8 ± 7 viral nucleic acid copies per MT-2 cell, very similar to the manual reference extraction (7 ± 2 nucleic acid copies). Fully automated sample processing from whole blood spiked with MT-2 cells showed a comparable result of 7 ± 3 copies per MT-2 cell after a run time of two hours and 10 min.
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Affiliation(s)
- Lisa Becherer
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - Jacob Friedrich Hess
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | | | | | - Hans Nitschko
- Department of Virology, Pettenkoferstraße 9a, Max von Pettenkofer-Institute, 80336 Munich, Germany
| | - Silvina Stinco
- Department of Virology, Pettenkoferstraße 9a, Max von Pettenkofer-Institute, 80336 Munich, Germany
| | - Friedrich Zitz
- E.L.T. Kunststofftechnik & Werkzeugbau GmbH, Weidenweg 339, 8240 Friedberg, Austria
| | - Hannes Hofer
- E.L.T. Kunststofftechnik & Werkzeugbau GmbH, Weidenweg 339, 8240 Friedberg, Austria
| | - Giampiero Porro
- Datamed srl, Via Achille Grandi 4/6, 20068 Peschiera Borromeo MI, Italy
| | - Florian Hausladen
- Institut für Lasertechnologien in der Medizin und Meßtechnik, University of Ulm, Helmholtzstraße 12, 89081 Ulm, Germany
| | - Karl Stock
- Institut für Lasertechnologien in der Medizin und Meßtechnik, University of Ulm, Helmholtzstraße 12, 89081 Ulm, Germany
| | - Dominik Drossart
- Institut für Lasertechnologien in der Medizin und Meßtechnik, University of Ulm, Helmholtzstraße 12, 89081 Ulm, Germany
| | - Holger Wurm
- Institut für Lasertechnologien in der Medizin und Meßtechnik, University of Ulm, Helmholtzstraße 12, 89081 Ulm, Germany
| | - Hanna Kuhn
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- NB Technologies GmbH, Ludwig-Erhard-Allee 2, 53175 Bonn, Germany
| | - Dominik Huber
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - Tobias Hutzenlaub
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - Nils Paust
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - Mark Keller
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Spindiag GmbH, Engesserstraße 4a, 79108 Freiburg, Germany
| | - Oliver Strohmeier
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Spindiag GmbH, Engesserstraße 4a, 79108 Freiburg, Germany
| | - Simon Wadle
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Volpi AG, Wiesenstrasse 33, 8952 Schlieren, Switzerland
| | - Nadine Borst
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - Roland Zengerle
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
| | - Felix von Stetten
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
- Laboratory for MEMS Applications, IMTEK-Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany
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Einsiedel L, Chiong F, Jersmann H, Taylor GP. Human T-cell leukaemia virus type 1 associated pulmonary disease: clinical and pathological features of an under-recognised complication of HTLV-1 infection. Retrovirology 2021; 18:1. [PMID: 33407607 PMCID: PMC7789585 DOI: 10.1186/s12977-020-00543-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/13/2020] [Accepted: 10/28/2020] [Indexed: 12/14/2022] Open
Abstract
The lung is one of several organs that can be affected by HTLV-1 mediated inflammation. Pulmonary inflammation associated with HTLV-1 infection involves the interstitium, airways and alveoli, resulting in several clinical entities including interstitial pneumonias, bronchiolitis and alveolitis, depending on which structures are most affected. Augmentation of the inflammatory effects of HTLV-1 infected lymphocytes by recruitment of other inflammatory cells in a positive feedback loop is likely to underlie the pathogenesis of HTLV-1 associated pulmonary disease, as has been proposed for HTLV-1 associated myelopathy. In contrast to the conclusions of early case series, HTLV-1 associated pulmonary disease can be associated with significant parenchymal damage, which may progress to bronchiectasis where this involves the airways. Based on our current understanding of HTLV-1 associated pulmonary disease, diagnostic criteria are proposed.
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Affiliation(s)
- Lloyd Einsiedel
- Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, 0870, Australia.
| | - Fabian Chiong
- Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, 0870, Australia
| | - Hubertus Jersmann
- Department of Respiratory Medicine, Faculty of Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - Graham P Taylor
- Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
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Gordon CA, Shield JM, Bradbury RS, Muhi S, Page W, Judd JA, Lee R, Biggs BA, Ross K, Kurscheid J, Gray DJ, McManus DP. HTLV-I and Strongyloides in Australia: The worm lurking beneath. ADVANCES IN PARASITOLOGY 2021; 111:119-201. [PMID: 33482974 DOI: 10.1016/bs.apar.2020.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Strongyloidiasis and HTLV-I (human T-lymphotropic virus-1) are important infections that are endemic in many countries around the world with an estimated 370 million infected with Strongyloides stercoralis alone, and 5-10 million with HTVL-I. Co-infections with these pathogens are associated with significant morbidity and can be fatal. HTLV-I infects T-cells thus causing dysregulation of the immune system which has been linked to dissemination and hyperinfection of S. stercoralis leading to bacterial sepsis which can result in death. Both of these pathogens are endemic in Australia primarily in remote communities in Queensland, the Northern Territory, and Western Australia. Other cases in Australia have occurred in immigrants and refugees, returned travellers, and Australian Defence Force personnel. HTLV-I infection is lifelong with no known cure. Strongyloidiasis is a long-term chronic disease that can remain latent for decades, as shown by infections diagnosed in prisoners of war from World War II and the Vietnam War testing positive decades after they returned from these conflicts. This review aims to shed light on concomitant infections of HTLV-I with S. stercoralis primarily in Australia but in the global context as well.
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Affiliation(s)
- Catherine A Gordon
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
| | - Jennifer M Shield
- Department of Pharmacy and Biomedical Sciences, La Trobe University, Bendigo, VIC, Australia; Department of Medicine, The Peter Doherty Institute for Infection and Immunity, University of Melbourne and the Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Richard S Bradbury
- School of Health and Life Sciences, Federation University, Berwick, VIC, Australia
| | - Stephen Muhi
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wendy Page
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Jenni A Judd
- School of Health Medical and Applied Sciences, Central Queensland University, Bundaberg, QLD, Australia; Centre for Indigenous Health Equity Research, Central Queensland University, Bundaberg, QLD, Australia
| | - Rogan Lee
- Westmead Clinical School, The University of Sydney, Westmead, NSW, Australia
| | - Beverley-Ann Biggs
- Department of Medicine, The Peter Doherty Institute for Infection and Immunity, University of Melbourne and the Royal Melbourne Hospital, Melbourne, VIC, Australia; Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kirstin Ross
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Johanna Kurscheid
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Donald P McManus
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
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18
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Crusted scabies; a 2-year prospective study from the Northern Territory of Australia. PLoS Negl Trop Dis 2020; 14:e0008994. [PMID: 33338053 PMCID: PMC7781478 DOI: 10.1371/journal.pntd.0008994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/04/2021] [Accepted: 11/19/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Scabies is listed as a neglected tropical disease by the World Health Organization. Crusted scabies affects vulnerable and immunosuppressed individuals and is highly contagious because of the enormous number of Sarcoptes scabiei mites present in the hyperkeratotic skin. Undiagnosed and untreated crusted scabies cases can result in outbreaks of scabies in residential facilities and can also undermine the success of scabies mass drug administration programs. METHODS AND PRINCIPAL FINDINGS Crusted scabies became a formally notifiable disease in the Northern Territory of Australia in 2016. We conducted a 2-year prospective study of crusted scabies cases notified between March 2016 and February 2018, with subsequent follow up for 22 months. Demographics, clinical and laboratory data, treatment and outcomes were analysed, with cases classified by severity of disease. Over the 2-year study period, 80 patients had 92 episodes of crusted scabies; 35 (38%) were Grade 1 crusted scabies, 36 (39%) Grade 2 and 21 (23%) Grade 3. Median age was 47 years, 47 (59%) were female, 76 (95%) Indigenous Australians and 57 (71%) from remote Indigenous communities. Half the patients were diabetic and 18 (23%) were on dialysis for end-stage kidney failure. Thirteen (16%) patients had no comorbidities, and these were more likely to have Grade 3 disease. Eosinophilia was present in 60% and high immunoglobulin E in 94%. Bacteremia occurred in 11 episodes resulting in one fatality with methicillin-susceptible Staphylococcus aureus bacteremia. Two other deaths occurred during admission and 10 others died subsequent to discharge consequent to comorbidities. Treatment generally followed the recommended guidelines, with 3, 5 or 7 doses of oral ivermectin depending on the documented grade of crusted scabies, together with daily alternating topical scabicides and topical keratolytic cream. While response to this therapy was usually excellent, there were 33 episodes of recurrent crusted scabies with the majority attributed to new infection subsequent to return to a scabies-endemic community. CONCLUSIONS Crusted scabies can be successfully treated with aggressive guideline-based therapy, but high mortality remains from underlying comorbidities. Reinfection on return to community is common while scabies remains endemic.
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Al Sharif S, Pinto DO, Mensah GA, Dehbandi F, Khatkar P, Kim Y, Branscome H, Kashanchi F. Extracellular Vesicles in HTLV-1 Communication: The Story of an Invisible Messenger. Viruses 2020; 12:E1422. [PMID: 33322043 PMCID: PMC7763366 DOI: 10.3390/v12121422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 02/08/2023] Open
Abstract
Human T-cell lymphotropic virus type 1 (HTLV-1) infects 5-10 million people worldwide and is the causative agent of adult T-cell leukemia/lymphoma (ATLL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) as well as other inflammatory diseases. A major concern is that the most majority of individuals with HTLV-1 are asymptomatic carriers and that there is limited global attention by health care officials, setting up potential conditions for increased viral spread. HTLV-1 transmission occurs primarily through sexual intercourse, blood transfusion, intravenous drug usage, and breast feeding. Currently, there is no cure for HTLV-1 infection and only limited treatment options exist, such as class I interferons (IFN) and Zidovudine (AZT), with poor prognosis. Recently, small membrane-bound structures, known as extracellular vesicles (EVs), have received increased attention due to their potential to carry viral cargo (RNA and proteins) in multiple pathogenic infections (i.e., human immunodeficiency virus type I (HIV-1), Zika virus, and HTLV-1). In the case of HTLV-1, EVs isolated from the peripheral blood and cerebral spinal fluid (CSF) of HAM/TSP patients contained the viral transactivator protein Tax. Additionally, EVs derived from HTLV-1-infected cells (HTLV-1 EVs) promote functional effects such as cell aggregation which enhance viral spread. In this review, we present current knowledge surrounding EVs and their potential role as immune-modulating agents in cancer and other infectious diseases such as HTLV-1 and HIV-1. We discuss various features of EVs that make them prime targets for possible vehicles of future diagnostics and therapies.
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Affiliation(s)
| | | | | | | | | | | | | | - Fatah Kashanchi
- Laboratory of Molecular Virology, George Mason University, Manassas, VA 20110, USA; (S.A.S.); (D.O.P.); (G.A.M.); (F.D.); (P.K.); (Y.K.); (H.B.)
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20
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Kardani K, Basimi P, Fekri M, Bolhassani A. Antiviral therapy for the sexually transmitted viruses: recent updates on vaccine development. Expert Rev Clin Pharmacol 2020; 13:1001-1046. [PMID: 32838584 DOI: 10.1080/17512433.2020.1814743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The sexually transmitted infections (STIs) caused by viruses including human T cell leukemia virus type-1 (HTLV-1), human immunodeficiency virus-1 (HIV-1), human simplex virus-2 (HSV-2), hepatitis C virus (HCV), hepatitis B virus (HBV), and human papillomavirus (HPV) are major public health issues. These infections can cause cancer or result in long-term health problems. Due to high prevalence of STIs, a safe and effective vaccine is required to overcome these fatal viruses. AREAS COVERED This review includes a comprehensive overview of the literatures relevant to vaccine development against the sexually transmitted viruses (STVs) using PubMed and Sciencedirect electronic search engines. Herein, we discuss the efforts directed toward development of effective vaccines using different laboratory animal models including mice, guinea pig or non-human primates in preclinical trials, and human in clinical trials with different phases. EXPERT OPINION There is no effective FDA approved vaccine against the sexually transmitted viruses (STVs) except for HBV and HPV as prophylactic vaccines. Many attempts are underway to develop vaccines against these viruses. There are several approaches for improving prophylactic or therapeutic vaccines such as heterologous prime/boost immunization, delivery system, administration route, adjuvants, etc. In this line, further studies can be helpful for understanding the immunobiology of STVs in human. Moreover, development of more relevant animal models is a worthy goal to induce effective immune responses in humans.
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Affiliation(s)
- Kimia Kardani
- Department of Hepatitis and AIDS, Pasteur Institute of Iran , Tehran, Iran
| | - Parya Basimi
- Department of Hepatitis and AIDS, Pasteur Institute of Iran , Tehran, Iran
| | - Mehrshad Fekri
- Department of Hepatitis and AIDS, Pasteur Institute of Iran , Tehran, Iran
| | - Azam Bolhassani
- Department of Hepatitis and AIDS, Pasteur Institute of Iran , Tehran, Iran
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21
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Hirons A, Khoury G, Purcell DFJ. Human T-cell lymphotropic virus type-1: a lifelong persistent infection, yet never truly silent. THE LANCET. INFECTIOUS DISEASES 2020; 21:e2-e10. [PMID: 32986997 DOI: 10.1016/s1473-3099(20)30328-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/06/2020] [Accepted: 04/16/2020] [Indexed: 12/12/2022]
Abstract
Human T-cell lymphotropic virus type-1 (HTLV-1) has a large global burden and in some key communities, such as Indigenous Australians living in remote areas, greater than 45% of people are infected. Despite HTLV-1 causing serious malignancy and myelopathic paraparesis, and a significant association with a range of inflammatory comorbidities and secondary infections that shorten lifespan, few biomedical interventions are available. HTLV-1 starkly contrasts with other blood-borne sexually transmitted viral infections, such as, HIV, hepatitis B virus, and hepatitis C virus, with no antiviral treatments that reduce virus-infected cells, no rapid diagnostics or biomarker assays suitable for use in remote settings, and no effective vaccine. We review how the replication strategies and molecular properties of HTLV-1 establish a long-term stealthy viral pathogenesis through a fine-tuned balance of persistence, immune cell dysfunction, and proliferation of proviral infected cells that collectively present robust barriers to treatment and prevention. An understanding of the nature of the HTLV-1 provirus and opposing actions of viral-coded negative-sense HBZ and positive-sense regulatory proteins Tax, p12 and its cleaved product p8, and p30, is needed to improve the biomedical tools for preventing transmission and improving the long-term health of people with this lifelong infection.
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Affiliation(s)
- Ashley Hirons
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Georges Khoury
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Damian F J Purcell
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia.
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22
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Einsiedel L, Pham H, Talukder MRR, Liddle J, Taylor K, Wilson K, Jersmann H, Gessain A, Woodman R, Kaldor J. Pulmonary Disease Is Associated With Human T-Cell Leukemia Virus Type 1c Infection: A Cross-sectional Survey in Remote Aboriginal Communities. Clin Infect Dis 2020; 73:e1498-e1506. [DOI: 10.1093/cid/ciaa1401] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The human T-cell leukemia virus type 1 (HTLV-1) subtype c is endemic to central Australia. We report the first large-scale, community-based, health survey of HTLV-1 and its disease associations in this setting.
Methods
Aboriginal community residents aged >2 years in 7 remote communities were invited to do a health survey that included a questionnaire, spirometry, and clinical examination by a physician blinded to HTLV-1 status, clinical records, and spirometry results. Blood was drawn for HTLV-1 serology and proviral load (PVL). Pulmonary disease was assessed clinically and spirometrically and, where records were available, radiologically after the clinical assessment. Associations between specific diseases and HTLV-1 status were determined using logistic regression, adjusting for available confounders.
Results
Overall, 579 residents (164 children aged 3–17 years; 415 adults) were examined (37.7% of the estimated resident population). HTLV-1 prevalences for children and adults were 6.1% and 39.3%, respectively. No associations were found between HTLV-1 and any assessed clinical condition among children. Chronic pulmonary disease and gait abnormalities were more common among adults with HTLV-1 infection. Adjusted odds ratios among participants with PVL ≥1000 per 105 peripheral blood leukocytes were 7.08 (95% confidence interval [CI], 2.67–18.74; P < .001), 9.81 (95% CI, 3.52–27.35; P < .001), and 14.4 (95% CI, 4.99–41.69; P < .001) for clinically defined chronic pulmonary disease, moderate-severe expiratory airflow limitation, and radiologically determined bronchiectasis/bronchiolitis, respectively, and 5.21 (95% CI, 1.50–18.07; P = .009) for gait abnormalities.
Conclusions
In the first study of HTLV-1 disease associations based on community recruitment and blinded assessment, HTLV-1 infection was strongly associated with pulmonary disease and gait abnormalities.
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Affiliation(s)
- Lloyd Einsiedel
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, Australia
| | - Hai Pham
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, Australia
| | | | - Joel Liddle
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, Australia
| | - Kerry Taylor
- Poche Centre for Indigenous Health and Wellbeing, Alice Springs, Australia
| | - Kim Wilson
- National Serology Reference Laboratory, Melbourne, Australia
| | | | - Antoine Gessain
- Oncogenic virus epidemiology and pathophysiology Unit, Institut Pasteur, Paris, France
| | | | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
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Benencio P, Fraile Gonzalez SA, Ducasa N, Page K, Berini CA, Biglione MM. HLA-B*35 as a new marker for susceptibility to human T-cell lymphotropic virus type 1 (HTLV-1) Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) in patients living in Argentina. Retrovirology 2020; 17:29. [PMID: 32883310 PMCID: PMC7469403 DOI: 10.1186/s12977-020-00536-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/19/2020] [Indexed: 11/21/2022] Open
Abstract
Background Human T-cell lymphotropic virus type 1 (HTLV-1) is the etiological agent of HTLV associated myelopathy/ Tropical Spastic Paraparesis (HAM/TSP) and Adult T cell leukemia/lymphoma (ATLL), in around 2–5% of the infected individuals. Host genetic background might play a role in disease progression. Several previous studies across many countries report HLA haplotype to be one such factor. Here, we sequenced HLA-A, -B and -C of 66 individuals by Sequence-Based Typing (SBT), and compared the frequency of different alleles among ATLL patients, HAM/TSP patients, asymptomatic carriers and non-infected individuals living in Argentina. Results The frequency of HLA-A, -B and -C alleles largely matched that of the general population in Argentina. We identified HLA-A*02, HLA-B*35 and HLA-C*07 as associated to protection from ATLL (p = 0.031), susceptibility to HAM/TSP (p < 0.001) and susceptibility to ATLL (p = 0.017), respectively. We also found a strong correlation between high proviral load (PVL) and disease (p = 0.008), but were unable to identify any particular allele associated with high or low PVL. Conclusions We have found HLA-A*02, HLA-B*35 and HLA-C*07 to be associated to protection from ATLL (HLA-A*02) and susceptibility to HAM/TSP (HLA-B*35) or to ATLL (HLA-C*07), respectively. Whereas HLA-A*02 protection from ATLL has already been extensively described in other regions of the world, this is the first report that links HLA-B*35 and an increased susceptibility to HAM/TSP. As for HLA-C*07 it has previously been associated to susceptibility to HAM/TSP in other countries but in our population it has been linked to ATLL.
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Affiliation(s)
- Paula Benencio
- CONICET- Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Paraguay 2155, C1121ABG, Ciudad Autónoma de Buenos Aires, Argentina
| | - Sindy A Fraile Gonzalez
- CONICET- Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Paraguay 2155, C1121ABG, Ciudad Autónoma de Buenos Aires, Argentina
| | - Nicolás Ducasa
- CONICET- Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Paraguay 2155, C1121ABG, Ciudad Autónoma de Buenos Aires, Argentina
| | - Kimberly Page
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.,The University of New Mexico, Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Carolina A Berini
- CONICET- Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Paraguay 2155, C1121ABG, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Mirna M Biglione
- CONICET- Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Paraguay 2155, C1121ABG, Ciudad Autónoma de Buenos Aires, Argentina
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Santana GO, Libório AM, Galvão AV, Pondé MP, Sá KN. Signs, meanings and practices of people living with human t-cell lymphotropic virus type 1 or tropical spastic myelopathy. J Patient Rep Outcomes 2020; 4:31. [PMID: 32367401 PMCID: PMC7198688 DOI: 10.1186/s41687-020-00198-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 04/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background Human T-cell lymphotropic virus type 1 (HTLV-1) spreads silently in the world’s population and causes several syndromes. Among these, HTLV-1 associated myelopathy, also called tropical spastic paraparesis (HAM/TSP), affects the nervous system. It causes sensorimotor losses, spasticity, muscle weakness, voiding and sexual dysfunction, pain, and balance disorders. There is limited knowledge of the feelings, experiences, and coping mechanisms associated with this neglected disease. The objective of the present qualitative study was to investigate the signs, meanings, and practices of people with HAM/TSP, through narratives obtained from focus groups and individual semi-structured face-to-face interviews. Results Thirty-eight individuals diagnosed with HAM/TSP participated in the study. The following categories and subcategories emerged from the participants: Signs—physical signs, symptoms, and discovery of the disease; Meanings—reaction to diagnosis and knowledge of disease, fears, and expectations; Practices—daily life, leisure, religious, and treatment activities. Conclusions People with HAM/TSP suffer from symptoms that limit their social participation, and they are affected by complex and multidimensional feelings. This awareness can contribute to the implementation of public policies—focused on the real perspective of these patients—that provide more directed, empathic, and harmonious care for these individuals.
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Affiliation(s)
| | - Ana Mary Libório
- Department of Post Graduate, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Ana Verena Galvão
- Multidisciplinary Reference Center for Assistance and Research for Family and Patients with HTLV the Assisting Teaching the Bahia School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Milena Pereira Pondé
- Department of Post Graduate, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Katia Nunes Sá
- Department of Post Graduate, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
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25
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Enose-Akahata Y, Jacobson S. Immunovirological markers in HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Retrovirology 2019; 16:35. [PMID: 31783764 PMCID: PMC6884770 DOI: 10.1186/s12977-019-0499-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/23/2019] [Indexed: 02/06/2023] Open
Abstract
Human T cell lymphotropic virus 1 (HTLV-1) is a human retrovirus and infects approximately 10–20 million people worldwide. While the majority of infected people are asymptomatic carriers of HTLV-1, only 4% of infected people develop HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). HAM/TSP is a chronic, progressive, neurological disease which usually progresses slowly without remission, and is characterized by perivascular inflammatory infiltrates in chronic inflammatory lesions of the central nervous system (CNS), primarily affecting the spinal cord. A high HTLV-1 proviral load, high levels of antibodies against HTLV-1 antigens, and elevated concentration of proteins are detected in cerebrospinal fluid (CSF) of HAM/TSP patients. These chronically activated immune responses against HTLV-1 and infiltration of inflammatory cells including HTLV-1 infected cells into the CNS contribute to clinical disability and underlie the pathogenesis of HAM/TSP. Since the disease development of HAM/TSP mainly occurs in adults, with a mean age at onset of 40–50 years, it is important for HTLV-1-infected carriers and HAM/TSP patients to be monitored throughout the disease process. Recent advances in technologies and findings provide new insights to virological and immunological aspects in both the CNS as well as in peripheral blood. In this review, we focus on understanding the inflammatory milieu in the CNS and discuss the immunopathogenic process in HTLV-1-associated neurologic diseases.
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Affiliation(s)
- Yoshimi Enose-Akahata
- Viral Immunology Section, National Institute of Neurological, Disorders and Stroke, National Institutes of Health, 9000 Rockville Pike, Building 10 Room 5C-103, Bethesda, MD, USA
| | - Steven Jacobson
- Viral Immunology Section, National Institute of Neurological, Disorders and Stroke, National Institutes of Health, 9000 Rockville Pike, Building 10 Room 5C-103, Bethesda, MD, USA.
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26
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Dementia in Aboriginal people in Residential Aged Care Facilities in Alice Springs: A Descriptive Study. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AbstractBackground:A high prevalence of dementia among Aboriginal and Torres Strait Islanders has been reported but knowledge of underlying causes and associations remains limited.Objective:To identify the prevalence of factors that may be associated with the categories of Major neurocognitive disorders (Major NCDs) in Aboriginal people living in residential aged care facilities in Alice Springs in the Northern Territory (NT).Design and Setting:This descriptive cross-sectional study analysed clinical file and cognitive assessment data of participants who were identified as having cognitive impairment between January and June 2016.Method:Screening for the presence of cognitive impairment using the Kimberley Indigenous Cognitive Assessment (KICA) was undertaken and 58 of 84 Aboriginal people were admitted to the study. Using a clinical file audit, diagnoses of Major NCDs consistent with the DSM-5 classification were made and the prevalence of factors possibly associated with these diagnoses described.Results:Fifty of the 58 participants were diagnosed with a Major NCD. The most frequent diagnoses were Major NCD due to vascular disease (30%), Major NCD due to Alzheimer’s Disease (26%) and Major NCD due to brain injury (20%). Hypertension, Type 2 Diabetes Mellitus and alcohol misuse were commonly reported together with hypothyroidism, hypoglycaemia and vitamin D deficiency.Conclusion(s):This study identified possible associations with Major NCDs in this population as well as a different spread of Major NCD diagnoses to previous studies in Aboriginal populations. There is a need for further research to understand the causes of dementia in Australian Aboriginal people and to use this information to appropriately tailor treatment and prevention programmes.
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27
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Barski MS, Minnell JJ, Maertens GN. Inhibition of HTLV-1 Infection by HIV-1 First- and Second-Generation Integrase Strand Transfer Inhibitors. Front Microbiol 2019; 10:1877. [PMID: 31474960 PMCID: PMC6705210 DOI: 10.3389/fmicb.2019.01877] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/30/2019] [Indexed: 12/21/2022] Open
Abstract
More than 10 million people worldwide are infected with the retrovirus human T-cell lymphotropic virus type 1 (HTLV-1). Infection phenotypes can range from asymptomatic to severe adult T-cell leukemia/lymphoma (ATLL) and HTLV-1-associated myelopathy. HTLV-1, like human immunodeficiency virus type 1 (HIV-1), is a blood-borne pathogen and viral infection happens in a similar fashion, with the major mode of transmission through breastfeeding. There is a strong correlation between time of infection and disease development, with a higher incidence of ATLL in patients infected during childhood. There is no successful therapeutic or preventative regimen for HTLV-1. It is therefore essential to develop therapies to inhibit transmission or block the onset/development of HTLV-1 associated diseases. Recently, we have seen the overwhelming success of integrase strand transfer inhibitors (INSTIs) in the treatment of HIV-1. Previously, raltegravir was shown to inhibit HTLV-1 infection. Here, we tested FDA-approved and two Phase II HIV-1 INSTIs in vitro and in a cell-to-cell infection model and show that they are highly active in blocking HTLV-1 infection, with bictegravir (EC50 = 0.30 ± 0.17 nM) performing best overall. INSTIs, in particular bictegravir, are more potent in blocking HTLV-1 transmission than tenofovir disproxil fumarate (TDF), an RT inhibitor. Our data suggest that HIV-1 INSTIs could present a good clinical strategy in HTLV-1 management and justifies the inclusion of INSTIs in clinical trials.
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Affiliation(s)
- Michał S Barski
- Division of Infectious Diseases, Section of Molecular Virology, Department of Medicine, St Mary's Hospital, Imperial College London, London, United Kingdom
| | - Jordan J Minnell
- Division of Infectious Diseases, Section of Molecular Virology, Department of Medicine, St Mary's Hospital, Imperial College London, London, United Kingdom
| | - Goedele N Maertens
- Division of Infectious Diseases, Section of Molecular Virology, Department of Medicine, St Mary's Hospital, Imperial College London, London, United Kingdom
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Talukder MRR, Walley R, Pham H, Schinke S, Woodman R, Wilson K, Sajiv C, Einsiedel L. Higher human T‐cell leukaemia virus type 1 (HTLV‐1) proviral load is associated with end‐stage kidney disease in Indigenous Australians: Results of a case‐control study in central Australia. J Med Virol 2019; 91:1866-1872. [DOI: 10.1002/jmv.25532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/11/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Mohammad Radwanur R. Talukder
- Aboriginal Health, Baker Heart and Diabetes InstituteAlice Springs Hospital Alice Springs Northern Territory Australia
| | - Rebecca Walley
- Department of MedicineAlice Springs Hospital Northern Territory Australia
| | - Hai Pham
- Aboriginal Health, Baker Heart and Diabetes InstituteAlice Springs Hospital Alice Springs Northern Territory Australia
| | - Shane Schinke
- Aboriginal Health, Baker Heart and Diabetes InstituteAlice Springs Hospital Alice Springs Northern Territory Australia
| | - Richard Woodman
- Flinders Centre for Epidemiology and BiostatisticsFlinders University Adelaide Australia
| | - Kim Wilson
- NRL TestingNational Serology Reference Laboratory Melbourne Victoria Australia
| | - Cherian Sajiv
- Central Australia Renal ServicesAlice Springs Hospital Alice Springs Northern Territory Australia
| | - Lloyd Einsiedel
- Aboriginal Health, Baker Heart and Diabetes InstituteAlice Springs Hospital Alice Springs Northern Territory Australia
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Acuna-Villaorduna A, Gonzalez-Lugo J, Ye BH, Adrianzen Herrera DA, Sica RA, Shah U, Shah N, Kornblum N, Braunschweig I, Derman O, Mantzaris I, Shastri A, Wang Y, Verma A, Zalta B, Janakiram M. High prevalence of pulmonary findings in computed tomographies of HTLV-1-infected patients with and without adult-T cell leukemia/lymphoma - implications for staging. Leuk Lymphoma 2019; 60:3272-3276. [PMID: 31204876 DOI: 10.1080/10428194.2019.1627543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Lung involvement has been reported in HTLV-1 carriers and in patients with ATLL. Whether there are differences in the pattern of lung involvement between ATLL and HTLV carriers in North American patients is unknown. We aimed to compare CT pulmonary findings among patients with HTLV-1 infection with and without ATLL. Among 140 patients with HTLV-1 diagnosis, 97 had CT chest available. Of these, 72 (74.2%) had ATLL and 25 (25.8%) did not have ATLL. CT chest abnormalities were present in 90 (92.8%) participants (94.4% in ATLL; 88% in non-ATLL). Higher rates of lymphadenopathy (69.4% versus 24%, p < .01) and lower rates of bronchiectasis (25% versus 48%, p = .04) were seen in ATLL compared to non-ATLL. Our study supports that staging of lung involvement in ATLL should consider HTLV-associated pulmonary findings as not all CT chest abnormalities necessarily represent malignant infiltration.
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Affiliation(s)
| | | | - B Hilda Ye
- Yeshiva University Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | - Urvi Shah
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nishi Shah
- Montefiore Hospital and Medical Center, Bronx, NY, USA
| | - Noah Kornblum
- Department of Oncology, Montefiore Medical Center, Bronx, NY, USA
| | | | - Olga Derman
- Department of Oncology, Montefiore Medical Center, Bronx, NY, USA
| | | | - Aditi Shastri
- Department of Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Yanhua Wang
- Department of Pathology, Montefiore Medical Center, Bronx, NY, USA
| | - Amit Verma
- Department of Oncology, Montefiore Einstein Center for Cancer Care, Bronx, NY, USA
| | | | - Murali Janakiram
- Department of Oncology, Montefiore Medical Center, Bronx, NY, USA
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30
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Nozuma S, Jacobson S. Neuroimmunology of Human T-Lymphotropic Virus Type 1-Associated Myelopathy/Tropical Spastic Paraparesis. Front Microbiol 2019; 10:885. [PMID: 31105674 PMCID: PMC6492533 DOI: 10.3389/fmicb.2019.00885] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/05/2019] [Indexed: 12/14/2022] Open
Abstract
Human T-lymphotropic virus type 1 (HTLV-1) is the etiologic agent of both adult T-cell leukemia/lymphoma and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). HAM/TSP is clinically characterized by chronic progressive spastic paraparesis, urinary incontinence, and mild sensory disturbance. Given its well-characterized clinical presentation and pathophysiology, which is similar to the progressive forms of multiple sclerosis (MS), HAM/TSP is an ideal system to better understand other neuroimmunological disorders such as MS. Since the discovery of HAM/TSP, large numbers of clinical, virological, molecular, and immunological studies have been published. The host-virus interaction and host immune response play an important role for the development with HAM/TSP. HTLV-1-infected circulating T-cells invade the central nervous system (CNS) and cause an immunopathogenic response against virus and possibly components of the CNS. Neural damage and subsequent degeneration can cause severe disability in patients with HAM/TSP. Little progress has been made in the discovery of objective biomarkers for grading stages and predicting progression of disease and the development of molecular targeted therapy based on the underlying pathological mechanisms. We review the recent understanding of immunopathological mechanism of HAM/TSP and discuss the unmet need for research on this disease.
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Affiliation(s)
- Satoshi Nozuma
- Viral Immunology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Steven Jacobson
- Viral Immunology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
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Abstract
It has been nearly 40 years since human T-cell leukemia virus-1 (HTLV-1), the first oncogenic retrovirus in humans and the first demonstrable cause of cancer by an infectious agent, was discovered. Studies indicate that HTLV-1 is arguably one of the most carcinogenic agents to humans. In addition, HTLV-1 causes a diverse array of diseases, including myelopathy and immunodeficiency, which cause morbidity and mortality to many people in the world, including the indigenous population in Australia, a fact that was emphasized only recently. HTLV-1 can be transmitted by infected lymphocytes, from mother to child via breast feeding, by sex, by blood transfusion, and by organ transplant. Therefore, the prevention of HTLV-1 infection is possible but such action has been taken in only a limited part of the world. However, until now it has not been listed by the World Health Organization as a sexually transmitted organism nor, oddly, recognized as an oncogenic virus by the recent list of the National Cancer Institute/National Institutes of Health. Such underestimation of HTLV-1 by health agencies has led to a remarkable lack of funding supporting research and development of treatments and vaccines, causing HTLV-1 to remain a global threat. Nonetheless, there are emerging novel therapeutic and prevention strategies which will help people who have diseases caused by HTLV-1. In this review, we present a brief historic overview of the key events in HTLV-1 research, including its pivotal role in generating ideas of a retrovirus cause of AIDS and in several essential technologies applicable to the discovery of HIV and the unraveling of its genes and their function. This is followed by the status of HTLV-1 research and the preventive and therapeutic developments of today. We also discuss pending issues and remaining challenges to enable the eradication of HTLV-1 in the future.
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Affiliation(s)
- Yutaka Tagaya
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Masao Matsuoka
- Department of Hematology, Rheumatology and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Kumamoto, 860-0811, Japan
| | - Robert Gallo
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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Turpin J, Yurick D, Khoury G, Pham H, Locarnini S, Melamed A, Witkover A, Wilson K, Purcell D, Bangham CRM, Einsiedel L. Impact of Hepatitis B Virus Coinfection on Human T-Lymphotropic Virus Type 1 Clonality in an Indigenous Population of Central Australia. J Infect Dis 2019; 219:562-567. [PMID: 30307560 PMCID: PMC6350946 DOI: 10.1093/infdis/jiy546] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/02/2018] [Indexed: 12/19/2022] Open
Abstract
The prevalence of human T-cell lymphotropic virus type 1 (HTLV-1) and hepatitis B virus (HBV) coinfection is high in certain Indigenous Australian populations, but its impact on HTLV-1 has not been described. We compared 2 groups of Indigenous adults infected with HTLV-1, either alone or coinfected with HBV. The 2 groups had a similar HTLV-1 proviral load, but there was a significant increase in clonal expansion of HTLV-1-infected lymphocytes in coinfected asymptomatic individuals. The degree of clonal expansion was correlated with the titer of HBV surface antigen. We conclude that HTLV-1/HBV coinfection may predispose to HTLV-1-associated malignant disease.
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Affiliation(s)
- Jocelyn Turpin
- Section of Virology, Division of Infectious Diseases, Imperial College, London, United Kingdom
| | - David Yurick
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria
| | - Georges Khoury
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria
| | - Hai Pham
- Baker Heart and Diabetes Institute Central Australia, Alice Springs Hospital, Northern Territory, Melbourne, Victoria, Australia
| | - Stephen Locarnini
- Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, Victoria, Australia
| | - Anat Melamed
- Section of Virology, Division of Infectious Diseases, Imperial College, London, United Kingdom
| | - Aviva Witkover
- Section of Virology, Division of Infectious Diseases, Imperial College, London, United Kingdom
| | - Kim Wilson
- National Serological Reference Laboratory, Melbourne, Victoria, Australia
| | - Damian Purcell
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria
| | - Charles R M Bangham
- Section of Virology, Division of Infectious Diseases, Imperial College, London, United Kingdom
| | - Lloyd Einsiedel
- Baker Heart and Diabetes Institute Central Australia, Alice Springs Hospital, Northern Territory, Melbourne, Victoria, Australia
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Smith S, Russell D, Horne P, Hanson J. HTLV-1 is rare in Far North Queensland despite a significant burden of classically associated diseases. Pathology 2018; 51:91-94. [PMID: 30503217 DOI: 10.1016/j.pathol.2018.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/03/2018] [Accepted: 10/18/2018] [Indexed: 01/14/2023]
Abstract
Human T-lymphotropic virus type 1 (HTLV-1) is hyperendemic amongst Indigenous Australians living in Central Australia. The epidemiology of the disease is poorly defined in other parts of Australia, despite a high prevalence of classically associated conditions. All HTLV-1 serology tests requested through public health facilities in Far North Queensland (FNQ) from January 1999 to December 2016 were reviewed. The person's age, sex, ethnicity, location, rationale for testing and result were recorded. There were 444 tests performed in 409 people; 217 (53%) were male; 171 (42%) identified as Indigenous Australians. Testing increased over time and was performed throughout the region, suggesting increasing awareness of the disease. Testing occurred in patients with haematological, neurological, dermatological and respiratory complaints, but only four (1%) had proven infection. Three of these individuals were in the same family and two were asymptomatic. One of the two symptomatic seropostive individuals had recurrent scabies infection, the other T-cell lymphoma. HTLV-1 infection is extremely uncommon in FNQ. The high rates of bronchiectasis and other associated conditions that are seen in the region are more likely to be addressed by public health policies focusing on the socioeconomic determinants of health.
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Affiliation(s)
- Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Qld, Australia; James Cook University, Cairns, Qld, Australia.
| | - Darren Russell
- James Cook University, Cairns, Qld, Australia; Cairns Sexual Health Service, Cairns North, Qld, Australia; Melbourne School of Population and Global Health, Melbourne University, Carlton, Vic, Australia
| | - Peter Horne
- Tropical and Public Health Services, Cairns, Qld, Australia
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Qld, Australia; The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
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Nayar S, Pawar B, Einsiedel L, Fernandes D, George P, Thomas S, Sajiv C. Isolated Neurogenic Bladder Associated With Human T-Lymphotropic Virus Type 1 Infection in a Renal Transplant Patient From Central Australia: A Case Report. Transplant Proc 2018; 50:3940-3942. [PMID: 30577291 DOI: 10.1016/j.transproceed.2018.08.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/23/2018] [Accepted: 08/29/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Human T-lymphotropic virus type 1 (HTLV-1) is endemic amongst the Aborigines of the Northern Territory of Australia. HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) has been associated with this infection. In general population, isolated neurogenic bladder dysfunction in HTLV-1-infected individuals without HAM/TSP has been reported, and the HTLV-1 proviral load has been found to be higher in such patients compared with asymptomatic carriers. In solid organ transplantation, few cases of HAM/TSP have been reported worldwide, but not an isolated neurogenic bladder. CASE A 50-year-old indigenous women from Alice Springs with end stage renal disease secondary to diabetic nephropathy with no prior history of bladder dysfunction received a cadaveric renal allograft following which she developed recurrent urinary tract infections. The recipient was seropositive for HTLV-1 infection. HTLV-1 status of donor was not checked. Urodynamic studies revealed stress incontinence and detrusor overactivity without urethral intrinsic sphincter deficiency. She had no features of myelopathy. There was elevation of the serum and cerebrospinal fluid HTLV-1 proviral load. The magnetic resonance imaging myelogram was normal. Pyelonephritis was diagnosed based on clinical features, positive cultures, and renal allograft biopsy. Continuous suprapubic catheter drainage helped preventing further episodes of allograft pyelonephritis in spite of chronic colonization of the urinary tract. CONCLUSION Isolated bladder dysfunction is a rare manifestation of HTLV-1 infection and is probably associated with high proviral loads. This may adversely affect renal allograft and patient outcomes.
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Affiliation(s)
- S Nayar
- Central Australian Renal Services, Alice Springs Hospital, Northern Territory, Australia.
| | - B Pawar
- Central Australian Renal Services, Alice Springs Hospital, Northern Territory, Australia
| | - L Einsiedel
- Flinders University/Northern Territory Rural Clinical School, Alice Springs Hospital, Northern Territory, Australia
| | - D Fernandes
- Central Australian Renal Services, Alice Springs Hospital, Northern Territory, Australia
| | - P George
- Central Australian Renal Services, Alice Springs Hospital, Northern Territory, Australia
| | - S Thomas
- Central Australian Renal Services, Alice Springs Hospital, Northern Territory, Australia
| | - C Sajiv
- Central Australian Renal Services, Alice Springs Hospital, Northern Territory, Australia
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Mulherkar R, Karabudak A, Ginwala R, Huang X, Rowan A, Philip R, Murphy EL, Clements D, Ndhlovu LC, Khan ZK, Jain P. In vivo and in vitro immunogenicity of novel MHC class I presented epitopes to confer protective immunity against chronic HTLV-1 infection. Vaccine 2018; 36:5046-5057. [PMID: 30005946 PMCID: PMC6091894 DOI: 10.1016/j.vaccine.2018.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/29/2018] [Accepted: 07/01/2018] [Indexed: 12/21/2022]
Abstract
Human T-cell leukemia virus type 1 (HTLV-1) has infected as many as 10 million people worldwide. While 90% are asymptomatic, 5% develop severe diseases including adult T-cell leukemia/lymphoka (ATLL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). No vaccine against HTLV-1 exists, and screening programs are not universal. However, patients with chronic HTLV-1 infection have high frequencies of HTLV-1-activated CD8+ T cells, and the two main HLA alleles (A2, A24) are present in 88% of infected individuals. We thus utilized an immunoproteomics approach to characterize MHC-I restricted epitopes presented by HLA-A2+, A24+ MT-2 and SLB-1 cell lines. Unlike traditional motif prediction algorithms, this approach identifies epitopes associated with cytotoxic T-cell responses in their naturally processed forms, minimizing differences in antigen processing and protein expression levels. Out of nine identified peptides, we confirmed six novel MHC-I restricted epitopes that were capable of binding HLA-A2 and HLA-A24 alleles and used in vitro and in vivo methods to generate CD8+ T cells specific for each of these peptides. MagPix MILLIPLEX data showed that in vitro generated epitope-specific CD8+ T cells secreted IFN-ɣ, granzyme B, MIP-1α, TNF-α, perforin and IL-10 when cultured in the presence of MT-2 cell line. Degranulation assay confirmed cytotoxic response through surface expression of CD107 on CD8+ T cells when cultured with MT-2 cells. A CD8+ T-cell killing assay indicated significant antiviral activity of CD8+ T cells specific against all identified peptides. In vivo generated CD8+ T cells similarly demonstrated immunogenicity on ELISpot, CD107 degranulation assay, and MagPix MILLIPLEX analysis. These epitopes are thus candidates for a therapeutic peptide-based vaccine against HTLV-1, and our results provide preclinical data for the advancement of such a vaccine.
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Affiliation(s)
- Ria Mulherkar
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Aykan Karabudak
- Immunotope, Inc., Pennsylvania Institute for Biotechnology, Doylestown, PA, USA
| | - Rashida Ginwala
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Xiaofang Huang
- Immunotope, Inc., Pennsylvania Institute for Biotechnology, Doylestown, PA, USA
| | - Aileen Rowan
- Department of Medicine, Imperial College, London, UK
| | - Ramila Philip
- Immunotope, Inc., Pennsylvania Institute for Biotechnology, Doylestown, PA, USA
| | - Edward L. Murphy
- Department of Medicine and Department of Laboratory Medicine, University of California at San Francisco
- Blood Systems Research Institute San Francisco, CA, USA
| | - Danielle Clements
- Department of Tropical Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Lishomwa C. Ndhlovu
- Department of Tropical Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Zafar K. Khan
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Pooja Jain
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
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Wilson A, Fearon D. Paediatric Strongyloidiasis in Central Australia. Trop Med Infect Dis 2018; 3:E64. [PMID: 30274460 PMCID: PMC6073483 DOI: 10.3390/tropicalmed3020064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/06/2018] [Accepted: 06/06/2018] [Indexed: 11/24/2022] Open
Abstract
Few published studies are available describing the prevalence of paediatric strongyloidiasis in endemic areas within Australia. This literature review and exploratory clinical audit presents the first seroprevalence data for paediatric patients in Central Australia. A total of 16.1% (30/186) of paediatric inpatients tested for Strongyloides stercoralis in 2016 were seropositive (95% CI: 11.5% to 22.1%). Eosinophilia of unknown aetiology was the most common indication for testing (91.9%). Seropositive patients were significantly more likely to reside in communities outside of Alice Springs (p = 0.02). Seropositive patients were noted to have higher mean eosinophil counts with a mean difference of 0.86 × 10⁸/L (95% CI: 0.56 to 1.16, p < 0.0001), although the limited utility of eosinophilia as a surrogate marker of strongyloidiasis has been described previously. All seropositive patients were Indigenous. There was no significant difference in ages between groups. There was a male predominance in the seropositive group, although this was not significant (p = 0.12). Twelve patients had known human T-lymphotropic virus 1 (HTLV-1) status and all were seronegative. Further research describing the epidemiology of strongyloidiasis in Central Australia is required.
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Affiliation(s)
- Angela Wilson
- BBioMedSci MBBS Hons, Paediatric Senior Registrar, Department of Paediatrics, Alice Springs Hospital, P.O. Box 2234, Alice Springs NT 0871, Australia.
| | - Deborah Fearon
- FRACP, Head of Department, Department of Paediatrics, Alice Springs Hospital, P.O. Box 2234, Alice Springs NT 0871, Australia.
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Beknazarova M, Whiley H, Judd JA, Shield J, Page W, Miller A, Whittaker M, Ross K. Argument for Inclusion of Strongyloidiasis in the Australian National Notifiable Disease List. Trop Med Infect Dis 2018; 3:E61. [PMID: 30274457 PMCID: PMC6073110 DOI: 10.3390/tropicalmed3020061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 05/23/2018] [Accepted: 05/31/2018] [Indexed: 11/25/2022] Open
Abstract
Strongyloidiasis is an infection caused by the helminth, Strongyloides stercoralis. Up to 370 million people are infected with the parasite globally, and it has remained endemic in the Indigenous Australian population for many decades. Strongyloidiasis has been also reported in other Australian populations. Ignorance of this disease has caused unnecessary costs to the government health system, and been detrimental to the Australian people's health. This manuscript addresses the 12 criteria required for a disease to be included in the Australian National Notifiable Disease List (NNDL) under the National Health Security Act 2007 (Commonwealth). There are six main arguments that provide compelling justification for strongyloidiasis to be made nationally notifiable and added to the Australian NNDL. These are: The disease is important to Indigenous health, and closing the health inequity gap between Indigenous and non-Indigenous Australians is a priority; a public health response is required to detect cases of strongyloidiasis and to establish the true incidence and prevalence of the disease; there is no alternative national surveillance system to gather data on the disease; there are preventive measures with high efficacy and low side effects; data collection is feasible as cases are definable by microscopy, PCR, or serological diagnostics; and achievement of the Sustainable Development Goal (SDG) # 6 on clean water and sanitation.
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Affiliation(s)
- Meruyert Beknazarova
- College of Science and Engineering, Flinders University, Bedford Park, SA 5042, Australia.
| | - Harriet Whiley
- College of Science and Engineering, Flinders University, Bedford Park, SA 5042, Australia.
| | - Jenni A Judd
- School of Health Medical and Applied Sciences, Centre of Indigenous Health Equity Research, Central Queensland University, Bundaberg, QLD 4670, Australia.
| | - Jennifer Shield
- Department of Pharmacy and Applied Science, La Trobe University, Bendigo, VIC 3552, Australia.
| | - Wendy Page
- Miwatj Health Aboriginal Corporation, Nhulunbuy, NT 0881, Australia.
- Public Health and Tropical Medicine, James Cook University, Cairns, QLD 4870, Australia.
| | - Adrian Miller
- Indigenous Research Unit, Griffith University, Nathan, QLD 4111, Australia.
| | - Maxine Whittaker
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia.
| | - Kirstin Ross
- College of Science and Engineering, Flinders University, Bedford Park, SA 5042, Australia.
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Olindo S, Jeannin S, Saint-Vil M, Signate A, Edimonana-Kaptue M, Joux J, Merle H, Richard P, Granjeaud S, Cabre P, Smadja D, Cesaire R, Lezin A. Temporal trends in Human T-Lymphotropic virus 1 (HTLV-1) associated myelopathy/tropical spastic paraparesis (HAM/TSP) incidence in Martinique over 25 years (1986-2010). PLoS Negl Trop Dis 2018; 12:e0006304. [PMID: 29554087 PMCID: PMC5875895 DOI: 10.1371/journal.pntd.0006304] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 03/29/2018] [Accepted: 02/06/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Human T-lymphotropic virus type 1 (HTLV-1) has been discovered in 1980 and has been linked to tropical spastic paraparesis (HAM/TSP) in 1985 in Martinique. There is no data on HAM/TSP incidence trends. We report, in the present work, the temporal trends incidence of HAM/TSP in Martinique over 25 years. METHODS Martinique is a Caribbean French West Indies island deserved by a unique Neurology Department involved in HAM/TSP diagnosis and management. A registry has been set up since 1986 and patients diagnosed for a HAM/TSP were prospectively registered. Only patients with a definite HAM/TSP onset between 1986 and 2010 were included in the present study. The 25-year study time was stratified in five-year periods. Crude incidence rates with 95% confidence interval (95%CI) were calculated using Poisson distribution for each period. Age-standardized rates were calculated using the direct method and the Martinique population census of 1990 as reference. Standardized incidence rate ratios with 95% CIs and P trends were assessed from simple Poisson regression models. Number of HTLV-1 infection among first-time blood donors was retrospectively collected from the central computer data system of the Martinique blood bank. The HTLV-1 seroprevalence into this population has been calculated for four 5-year periods between 1996 and 2015. RESULTS Overall, 153 patients were identified (mean age at onset, 53+/-13.1 years; female:male ratio, 4:1). Crude HAM/TSP incidence rates per 100,000 per 5 years (95%CI) in 1986-1990, 1991-1995, 1996-2000, 2001-2005 and 2006-2010 periods were 10.01 (6.78-13.28), 13.02 (9.34-16.70), 11.54 (8.13-14.95), 4.27 (2.24-6.28) and 2.03 (0.62-3.43). Age-standardized 5-year incidence rates significantly decreased by 69% and 87% in 2001-2005 and 2006-2010 study periods. Patients characteristics did not differ regarding 1986-2000 and 2001-2010 onset periods. Between 1996-2000 and 2011-2015 study periods, the HTLV-1 seroprevalence significantly decreased by 63%. CONCLUSION Martinique faces a sudden and rapid decline of HAM/TSP incidence from 2001 in comparison to 1986-2000 periods. Reduction of HTLV-1 seroprevalence, that may result from transmission prevention strategy, could account for HAM/TSP incidence decrease.
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Affiliation(s)
- Stephane Olindo
- Department of Neurology, University Hospital of Bordeaux, Bordeaux, France
- * E-mail:
| | - Severine Jeannin
- Department of Neurology, University Hospital of Martinique, Martinique, France
| | - Martine Saint-Vil
- Department of Neurology, University Hospital of Martinique, Martinique, France
| | - Aissatou Signate
- Department of Neurology, University Hospital of Martinique, Martinique, France
| | | | - Julien Joux
- Department of Neurology, University Hospital of Martinique, Martinique, France
| | - Harold Merle
- Department of Ophtalmology, University Hospital of Martinique, Martinique, France
| | - Pascale Richard
- Etablissement Français du Sang de Martinique, Martinique, France
| | - Samuel Granjeaud
- Aix-Marseille University, CNRS, INSERM, Institut Paoli Calmettes, CRCM, CIBI Plateform, Marseille France
| | - Philippe Cabre
- Department of Neurology, University Hospital of Martinique, Martinique, France
| | - Didier Smadja
- Department of Neurology, Hospital of Sud-Francilien, Corbeil-Essonnes, France
| | - Raymond Cesaire
- Department of Virology, University Hospital of Martinique, Martinique, France and EA 4537, Université des Antilles et de la Guyane, Martinique, France
| | - Agnes Lezin
- Department of Virology, University Hospital of Martinique, Martinique, France and EA 4537, Université des Antilles et de la Guyane, Martinique, France
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Einsiedel L, Pham H, Wilson K, Walley R, Turpin J, Bangham C, Gessain A, Woodman RJ. Human T-Lymphotropic Virus type 1c subtype proviral loads, chronic lung disease and survival in a prospective cohort of Indigenous Australians. PLoS Negl Trop Dis 2018. [PMID: 29529032 PMCID: PMC5874075 DOI: 10.1371/journal.pntd.0006281] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The Human T-Lymphotropic Virus type 1c subtype (HTLV-1c) is highly endemic to central Australia where the most frequent complication of HTLV-1 infection in Indigenous Australians is bronchiectasis. We carried out a prospective study to quantify the prognosis of HTLV-1c infection and chronic lung disease and the risk of death according to the HTLV-1c proviral load (pVL). Methodology/Principal findings 840 Indigenous adults (discharge diagnosis of bronchiectasis, 154) were recruited to a hospital-based prospective cohort. Baseline HTLV-1c pVL were determined and the results of chest computed tomography and clinical details reviewed. The odds of an association between HTLV-1 infection and bronchiectasis or bronchitis/bronchiolitis were calculated, and the impact of HTLV-1c pVL on the risk of death was measured. Radiologically defined bronchiectasis and bronchitis/bronchiolitis were significantly more common among HTLV-1-infected subjects (adjusted odds ratio = 2.9; 95% CI, 2.0, 4.3). Median HTLV-1c pVL for subjects with airways inflammation was 16-fold higher than that of asymptomatic subjects. There were 151 deaths during 2,140 person-years of follow-up (maximum follow-up 8.13 years). Mortality rates were higher among subjects with HTLV-1c pVL ≥1000 copies per 105 peripheral blood leukocytes (log-rank χ2 (2df) = 6.63, p = 0.036) compared to those with lower HTLV-1c pVL or uninfected subjects. Excess mortality was largely due to bronchiectasis-related deaths (adjusted HR 4.31; 95% CI, 1.78, 10.42 versus uninfected). Conclusion/Significance Higher HTLV-1c pVL was strongly associated with radiologically defined airways inflammation and with death due to complications of bronchiectasis. An increased risk of death due to an HTLV-1 associated inflammatory disease has not been demonstrated previously. Our findings indicate that mortality associated with HTLV-1c infection may be higher than has been previously appreciated. Further prospective studies are needed to determine whether these results can be generalized to other HTLV-1 endemic areas. The Human T-Lymphotropic Virus type 1 (HTLV-1) infects up to 20 million people worldwide who predominantly reside in resource-limited areas. The virus is associated with a haematological malignancy (adult T-cell leukaemia/lymphoma, ATL), and inflammatory diseases involving organ systems including the spinal cord, eyes and lungs. Determining the outcomes of infection in most HTLV-1 endemic areas is extremely difficult; however, the virus is highly endemic to central Australia where the Indigenous population has access to sophisticated medical facilities. We prospectively followed a large hospital-based cohort of Indigenous Australian adults that was well characterized with regard to base-line comorbid conditions, HTLV-1 serostatus and HTLV-1 proviral load (pVL). A higher baseline HTLV-1 pVL was strongly associated with an increased risk of airway inflammation (bronchitis/bronchiolitis and bronchiectasis) and death, which most often resulted from complications of bronchiectasis. Increased mortality due to an HTLV-1-associated inflammatory condition has not been demonstrated previously. The morbidity and mortality associated with HTLV-1 infection may therefore be substantially higher than has been assumed from an analysis of cohorts of subjects with adult T-cell leukaemia or HTLV-1-associated myelopathy. These findings have important implications for epidemiological research and for determining health care priorities in resource-limited settings.
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Affiliation(s)
- Lloyd Einsiedel
- Aboriginal Health Domain, Baker Heart and Diabetes Institute central Australia, Alice Springs Hospital, Alice Springs, Australia
- * E-mail:
| | - Hai Pham
- Aboriginal Health Domain, Baker Heart and Diabetes Institute central Australia, Alice Springs Hospital, Alice Springs, Australia
| | - Kim Wilson
- National Serology Reference Laboratory, Melbourne, Australia
| | - Rebecca Walley
- Flinders University/Northern Territory Rural Clinical School, Alice Springs Hospital, Alice Springs, Australia
| | - Jocelyn Turpin
- Section of Virology, Division of Infectious Diseases, Department of Medicine, Imperial College London, Norfolk Place, London, United Kingdom
| | - Charles Bangham
- Section of Virology, Division of Infectious Diseases, Department of Medicine, Imperial College London, Norfolk Place, London, United Kingdom
| | - Antoine Gessain
- Institut Pasteur, Unité d’Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, Paris, France, CNRS UMR 3569
| | - Richard J. Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, Australia
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Highlights from the HTLV-1 symposium at the 2017 Australasian HIV and AIDS Conference held jointly with the 2017 Australasian Sexual Health Conference, November 2017, Canberra, Australia. J Virus Erad 2018; 4:48-50. [PMID: 29568554 PMCID: PMC5851185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We are pleased to report on the inaugural HTLV-1 symposium at the 2017 Australasian HIV and AIDS Conference joint with 2017 Australasian Sexual Health Conference in Canberra, Australia. Our understanding of HTLV-1 epidemiology, pathogenesis, laboratory diagnostics and treatment options for HTLV-1 diseases has advanced tremendously over the last 40 years. However, the awareness of healthcare providers and the general population about HTLV-1, and the effective promotion and implementation of HTLV-1 transmission-prevention strategies, lag behind current knowledge. Here we present a summary of the symposium, plenary and poster presentations on HTLV-1.
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Key Words
- HTLV-1, HTLV-1-associated myelopathy/tropical spastic paraparesis, HAM/TSP, ATL, adult T cell leukaemia/lymphoma, human T leukaemic virus type 1, bronchiectasis, bronchiolitis, mortality, Australia, sexual transmission, treatment, service provision, patient feedback, serology
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Highlights from the HTLV-1 symposium at the 2017 Australasian HIV and AIDS Conference held jointly with the 2017 Australasian Sexual Health Conference, November 2017, Canberra, Australia. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30242-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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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.
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Affiliation(s)
- Charles R M Bangham
- Division of Infectious Diseases, Faculty of Medicine, Imperial College, London W2 1PG, United Kingdom;
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Chew R, Henderson T, Aujla J, Whist E, Einsiedel L. Turning a blind eye: HTLV-1-associated uveitis in Indigenous adults from Central Australia. Int Ophthalmol 2017; 38:2159-2162. [PMID: 28755019 DOI: 10.1007/s10792-017-0659-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 07/17/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE We describe the first two cases of HTLV-1 associated uveitis to be associated with HTLV-1c subtype infection. METHODS Case report. RESULTS Uveitis was demonstrated in two Indigenous Australian men, both of whom had high HTLV-1c proviral loads in peripheral blood. Visual outcomes were poor in each case. CONCLUSION Clinicians should be aware of HTLV-1c infection as a cause of uveitis in Australia, and HTLV-1 serology should be included in the basic uveitis work-up in HTLV-1-endemic areas.
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Affiliation(s)
- Rusheng Chew
- Department of Infectious Diseases, Alice Springs Hospital, PO Box 2234, Alice Springs, NT, 0871, Australia.,Barwon Health, Geelong, VIC, Australia.,Mayne Medical School, University of Queensland, Brisbane, QLD, Australia
| | - Timothy Henderson
- Department of Ophthalmology, Alice Springs Hospital, Alice Springs, NT, Australia
| | - Jaskirat Aujla
- Department of Ophthalmology, Alice Springs Hospital, Alice Springs, NT, Australia
| | - Eline Whist
- Department of Ophthalmology, Alice Springs Hospital, Alice Springs, NT, Australia
| | - Lloyd Einsiedel
- Department of Infectious Diseases, Alice Springs Hospital, PO Box 2234, Alice Springs, NT, 0871, Australia. .,Baker IDI Heart and Diabetes Institute Central Australia, Alice Springs, NT, Australia.
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Kruavit A, Fox M, Pearson R, Heraganahally S. Chronic respiratory disease in the regional and remote population of the Northern Territory Top End: A perspective from the specialist respiratory outreach service. Aust J Rural Health 2017; 25:275-284. [PMID: 28618108 DOI: 10.1111/ajr.12349] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To study the demographic, rates and types of chronic respiratory conditions in Indigenous and non-Indigenous patients in regional and remote communities of Northern Territory Top End, who were referred to the specialist respiratory outreach service. DESIGN A retrospective, observational study over a 2 years period. SETTING Remote community health clinics within the Northern Territory Top End visited by the specialist respiratory outreach team. PARTICIPANTS Only patients referred to respiratory specialist outreach team were included. There were 444 participants, with 210 males and 234 females. In total, 79.3% were Indigenous. MAIN OUTCOME MEASURES The rates of chronic respiratory disease diagnoses and smoking status within the different communities and health district regions. RESULTS Chronic obstructive pulmonary disease (COPD) was the most common primary respiratory condition in our cohort of patients (50.5%) followed by sleep apnoea in (14.2%), bronchiectasis in (11.6%), asthma (11%), interstitial lung disease (2.5%), nodule/cancer (1.8%) sarcoidosis (0.2%) and others (9.2%). COPD, smoking status and bronchiectasis was more frequently noted among the Indigenous patients compared to non-Indigenous patients (56.3% versus 28.3%, P < 0.001), (52.6% versus 25.0%, P < 0.001), and (12.5% versus 3.3%, P = 0.01) respectively. Obstructive sleep apnoea was more commonly diagnosed in non-Indigenous patients. CONCLUSION Indigenous patients of the remote and rural communities of the Top End have significantly higher rates of smoking and COPD compared to non-Indigenous patients. Bronchiectasis is also more common among Indigenous patients. Further efforts are warranted to develop strategies to address the disparity and optimise the respiratory outreach service to this population.
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Affiliation(s)
- Anuk Kruavit
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Melissa Fox
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Rebecca Pearson
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Einsiedel LJ, Pham H, Woodman RJ, Pepperill C, Taylor KA. The prevalence and clinical associations of HTLV-1 infection in a remote Indigenous community. Med J Aust 2017; 205:305-9. [PMID: 27681971 DOI: 10.5694/mja16.00285] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/28/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Hospital and laboratory data indicate that human T-lymphotropic virus type 1 (HTLV-1) is endemic to central Australia, but no community-based studies of its prevalence or disease burden have been reported. We determined the prevalence rates of HTLV-1 infection and of HTLV-1-associated diseases in a remote Indigenous community. SETTING A remote Northern Territory community. DESIGN All residents were asked to complete a health survey and offered a limited clinical examination, together with serological tests for HTLV-1 and Strongyloides, and HTLV-1 proviral load (PVL) assessment. MAIN OUTCOME MEASURES HTLV-1 seropositivity rates; HTLV-1 PVL (copies/105 peripheral blood leucocytes [PBL]); presentation with HTLV-1-related clinical disease. RESULTS HTLV-1 serostatus was determined for 97 of 138 residents (70%). The prevalence of HTLV-1 infection was significantly higher among adults (30 of 74 people tested) than children (1 of 23; P = 0.001). Nine of 30 HTLV-1-positive adults had a clinical syndrome that was potentially attributable to HTLV-1 infection (chronic lung disease, seven; symptomatic strongyloidiasis, two). The median HTLV-1 PVL was significantly higher for adults with chronic lung disease than for those who were asymptomatic (chronic lung disease, 649 copies/105 PBL [IQR, 162-2220]; asymptomatic adults, 40 copies/105 PBL [IQR, 0.9-229]; P = 0.017). Ten of 72 adults tested were seropositive for Strongyloides (six of 28 HTLV-1-positive participants and four of 44 HTLV-1-negative participants; P = 0.17), as were three of 15 children tested; the three children were HTLV-1-negative. CONCLUSION The prevalence of HTLV-1 infection and the rate of disease potentially attributable to HTLV-1 were high among adults in this remote community.
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Affiliation(s)
- Lloyd J Einsiedel
- Northern Territory Rural Clinical School, Flinders University, Alice Springs, NT
| | - Hai Pham
- Baker IDI Heart and Diabetes Institute, Alice Springs, NT
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, SA
| | | | - Kerry A Taylor
- Poche Centre for Indigenous Health, Flinders University, Alice Springs, NT
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Marr I, Davies J, Baird RW. Hepatitis B virus and human T-cell lymphotropic virus type 1 co-infection in the Northern Territory, Australia. Int J Infect Dis 2017; 58:90-95. [PMID: 28315754 DOI: 10.1016/j.ijid.2017.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To establish the relationship between hepatitis B virus (HBV) and human T-cell lymphotropic virus type 1 (HTLV-1) serological markers in the Northern Territory, Australia. METHODS A retrospective serological study of patients presenting to public healthcare facilities in the Northern Territory between 2008 and 2015 was performed in order to determine the presence and relationships of serological markers of HBV and HTLV-1. RESULTS Seven hundred and forty individual patients were found to be serologically positive for HTLV-1 in the Northern Territory over the 8-year period. Hepatitis B results were available for 521 of these patients. Hepatitis B surface antigen (HBsAg) positivity was demonstrated in 15.9% (83/521) of this cohort, which was significantly different to the HTLV-1-negative group (3.7%, 125/3354) (p<0.001). Excluding individuals with isolated hepatitis B surface antibody (anti-HBs), those in the HTLV-1-positive group had a higher HBV exposure history (67.5%, 352/521) when compared to HTLV-1-negative individuals (37.8%, 1259/3354) (p<0.001). HTLV-1-positive individuals had a lower prevalence of HBV combined anti-HBs and hepatitis B core antibody (anti-HBc) positive markers compared to those who were HTLV-1-negative (56.3% (198/352) versus 73.8% (937/1269), respectively; p<0.001). CONCLUSIONS A significantly higher prevalence rate of HBV was found in HTLV-1-positive individuals from the Northern Territory. When considering the higher exposure to HBV in HTLV-1-positive individuals, the clearance of HBV appears lower than in those individuals testing HTLV-1-negative. A lower prevalence of clearance in HTVL-1-positive individuals than in HTLV-1-negative individuals, as signified by formation of HBVcAb and HBVsAb in HTVL-1 positive individual's may equate to higher prevalence of ongoing coinfection.
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Affiliation(s)
- Ian Marr
- Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia; Territory Pathology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
| | - Jane Davies
- Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia; Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Rob W Baird
- Territory Pathology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Shah K, Ferastraoaru D, Jariwala S. Eosinophilia associated with Strongyloides infection, severe asthma, and central bronchiectasis. Ann Allergy Asthma Immunol 2017; 118:510-511. [PMID: 28254204 DOI: 10.1016/j.anai.2017.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Kishan Shah
- Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
| | - Denisa Ferastraoaru
- Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sunit Jariwala
- Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Rivera-Caldón CC, López-Valencia D, Zamora-Bastidas TO, Dueñas-Cuéllar RA, Mora-Obando DL. Infección por el virus linfotrópico humano de células T tipo 1 (HTLV-1) y paraparesia espástica. Avances y diagnóstico 35 años después de su descubrimiento. IATREIA 2017. [DOI: 10.17533/udea.iatreia.v30n2a04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Einsiedel L, Woodman RJ, Flynn M, Wilson K, Cassar O, Gessain A. Human T-Lymphotropic Virus type 1 infection in an Indigenous Australian population: epidemiological insights from a hospital-based cohort study. BMC Public Health 2016; 16:787. [PMID: 27526923 PMCID: PMC4986258 DOI: 10.1186/s12889-016-3366-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 07/23/2016] [Indexed: 11/17/2022] Open
Abstract
Background The Human T Lymphotropic Virus type 1 (HTLV-1) subtype C is endemic to central Australia where each of the major sequelae of HTLV-1 infection has been documented in the socially disadvantaged Indigenous population. Nevertheless, available epidemiological information relating to HTLV-1c infection is very limited, risk factors for transmission are unknown and no coordinated program has been implemented to reduce transmission among Indigenous Australians. Identifying risk factors for HTLV-1 infection is essential to direct strategies that could control HTLV-1 transmission. Methods Risk factors for HTLV-1 infection were retrospectively determined for a cohort of Indigenous Australians who were tested for HTLV-1 at Alice Springs Hospital (ASH), 1st January 2000 to 30th June 2013. Demographic details were obtained from the ASH patient management database and the results of tests for sexually transmitted infections (STI) were obtained from the ASH pathology database. Results Among 1889 Indigenous patients whose HTLV-1 serostatus was known, 635 (33.6 %) were HTLV-1 Western blot positive. Only one of 77 (1.3 %) children tested was HTLV-1 infected. Thereafter, rates progressively increased with age (15–29 years, 17.3 %; 30–49 years, 36.2 %; 50–64 years, 41.7 %) reaching 48.5 % among men aged 50–64 years. In a multivariable model, increasing age (OR, 1.04; 95 % CI, 1.03–1.04), male gender (OR, 1.41; 95 % CI, 1.08–1.85), residence in the south (OR, 10.7; 95 % CI, 7.4–15.6) or west (OR, 4.4; 95 % CI, 3.1–6.3) of central Australia and previous STI (OR, 1.42; 95 % CI, 1.04–1.95) were associated with HTLV-1 infection. Infection was acquired by three of 351 adults who were tested more than once during the study period (seroconversion rate, 0.24 (95 % CI = 0.18–2.48) per 100 person-years). Conclusions This study confirms that HTLV-1 is highly endemic to central Australia. Although childhood infection was documented, HTLV-1 infection in adults was closely associated with increasing age, male gender and STI history. Multiple modes of transmission are therefore likely to contribute to high rates of HTLV-1 infection in the Indigenous Australian population. Future strategies to control HTLV-1 transmission in this population require careful community engagement, cultural understanding and Indigenous leadership.
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Affiliation(s)
- Lloyd Einsiedel
- Flinders University/Northern Territory Rural Clinical School, Alice Springs Hospital, Rubuntja Building, 0870, Northern Territory, Australia. .,Aboriginal Health Unit, BakerIDI,central Australia, Alice Springs Hospital, 0870, Northern Territory, Australia.
| | - Richard J Woodman
- Flinders University/Northern Territory Rural Clinical School, Alice Springs Hospital, Rubuntja Building, 0870, Northern Territory, Australia
| | - Maria Flynn
- Flinders University/Northern Territory Rural Clinical School, Alice Springs Hospital, Rubuntja Building, 0870, Northern Territory, Australia
| | - Kim Wilson
- National Serological Reference Laboratory, Melbourne, Australia
| | - Olivier Cassar
- Institut Pasteur, Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, F-75015, Paris, France.,CNRS, UMR 3569, 28 Rue du Dr. Roux, F-75015, Paris, France
| | - Antoine Gessain
- Institut Pasteur, Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, F-75015, Paris, France.,CNRS, UMR 3569, 28 Rue du Dr. Roux, F-75015, Paris, France
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Higher HTLV-1c proviral loads are associated with blood stream infections in an Indigenous Australian population. J Clin Virol 2016; 78:93-8. [DOI: 10.1016/j.jcv.2016.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 01/08/2023]
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