Human T cell lymphotropic virus type 1 infection among men who have sex with men in Central Brazil

ABSTRACT Human T cell lymphotropic virus type 1 (HTLV-1) was the first retrovirus discovered in humans and is endemic in several parts of the world. Because of risk behaviors, mainly sexual, men who have sex with men (MSM) are at high risk of acquiring HTLV-1 infection. A cross-sectional study was performed to estimate the prevalence of HTLV-1 infection, to characterize genetically HTLV-1 sequences and to identify risk behaviors associated with this infection among MSM in Central Brazil. A total of 430 MSM were enrolled in this study and three were shown to be HTLV-1 infected, prevalence of 0.7% (95% confidence interval: 0.4-0.9). Phylogenetic analysis showed that all HTLV-1 positive samples belonged to Cosmopolitan subtype Transcontinental subgroup A. Although the prevalence rate of HTLV-1 infection found in this study was similar to that observed among Brazilian blood donors, additional HTLV-1 preventive interventions need to be further implemented because this population is engaged in high-risk sexual behavior.

Human T-cell lymphotropic virus-1 infection: three infected generations in the same family

Abstract The human T-cell lymphotropic virus-1 (HTLV-1) affects worldwide population; the estimated number of currently infected individuals is 10-20 million. In this report, we describe the clinical findings of three family members with vertical transmission of HTLV-1. This case report highlights the importance of healthcare providers who have optimal knowledge about HTLV-1 including its transmission and pertinent attributes, and who are able to provide affected individuals with adequate information regarding their condition.

Serological and virological evaluation of human T-lymphotropic virus type 1 infection in family groups from Tumaco, Colombia / Evaluación serológica y virológica de la infección por el virus linfotrópico de células T humanas de tipo 1 en grupos familiares de Tumaco, Colombia

Introduction: To date there has been no statistical evaluation of the profiles of immunoglobulin classes and viral replication as variables in the study of HTLV-1 infection and circulation among families in virus-endemic areas of Colombia. Objective: To evaluate the correlation of several immunological and molecular characteristics with the transmission and circulation of HTLV-1 among families in the town of Tumaco. Materials and methods: Plasma levels of HTLV-1 specific immunoglobulin classes IgG, IgM and IgA1, as well as IgG and sIgA in oral fluids, were calculated for 32 members of 10 family groups from Tumaco in which the mother and at least one child were infected with the virus. Levels of the different immunoglobulin classes were correlated with viral RNA circulating in plasma or oral fluids and the proviral burden as detected by RT-PCR. Results: Significant differences were determined between mothers and carrier children for immunoglobulin levels (p=0.037) and proviral burden (p=0.002). The overall estimate of IgG in plasma and sIgA in oral fluids could be correlated with the circulation of free viral RNA in both fluids and high proviral burden, and associated with HAM/TSP mothers. The detection of anti- tax IgG in plasma revealed differences between HAM/TSP mothers and their offspring. Conclusion: The study of immunological and molecular variables permitted the analysis of HTLV-1 circulation among families of Tumaco. The strong correlation between levels of IgM specific for the virus and viral RNA circulating in fluids indirectly confirmed the transmission of HTLV-1 among families.

Introducción. Todavía no hay una evaluación estadística de los perfiles de las clases de inmuno- globulina s y la replicación viral, como variables para estudiar la infección y la circulació n del HTLV-1 en familias de zonas endémicas en Colombia. Objetivo. Evaluar la correlación de varias características inmunológicas y moleculares, con la transmisión y circulación del virus en familias del municipio de Tumaco. Materiales y métodos. Se calcularon los niveles de IgG, IgM e IgA1 en plasma, e IgG y IgA secretoria en fluido oral, de 32 miembros de 10 grupos familiares de Tumaco, en los que la madre y, al menos, un hijo estaban infectados con el virus. La concentración de las diferentes clases de inmunoglobulinas se pudo correlacionar con la circulación de ARN viral libre en plasma y fluido oral, y la carga proviral, según su detección mediante reacción en cadena de la polimerasa de transcripción inversa. Resultados. Se encontraron diferencias significativas en los niveles de inmunoglobulinas (p=0,037) y en la carga proviral (p=0,002) entre madres e hijos portadores. La estimación total de IgG en plasma e IgA secretoria en fluido oral, se pudo correlacionar con la circulación de ARN viral libre en ambos fluidos y una alta carga proviral, y se asoció con las madres paraparesia espástica tropical o mielopatía asociada con el HTLV-1. La detección en plasma de IgG anti-Tax reveló diferencias entre ellas y sus hijos. Conclusión. El estudio de las variables inmunológicas y moleculares permitió analizar la circulación del HTLV-1 en familias de Tumaco. La fuerte asociación entre los niveles de IgM específica para el virus y el ARN viral circulante en los fluidos y la carga proviral, confirmó indirectamente la transmisión intrafamiliar del virus.

Sexual transmission of human T-cell lymphotropic virus type 1

Human T-cell lymphotropic virus type 1 (HTLV-1) is endemic in many parts of the world and is primarily transmitted through sexual intercourse or from mother to child. Sexual transmission occurs more efficiently from men to women than women to men and might be enhanced by sexually transmitted diseases that cause ulcers and result in mucosal ruptures, such as syphilis, herpes simplex type 2 (HSV-2), and chancroid. Other sexually transmitted diseases might result in the recruitment of inflammatory cells and could increase the risk of HTLV-1 acquisition and transmission. Additionally, factors that are associated with higher transmission risks include the presence of antibodies against the viral oncoprotein Tax (anti-Tax), a higher proviral load in peripheral blood lymphocytes, and increased cervicovaginal or seminal secretions. Seminal fluid has been reported to increase HTLV replication and transmission, whereas male circumcision and neutralizing antibodies might have a protective effect. Recently, free virions were discovered in plasma, which reveals a possible new mode of HTLV replication. It is unclear how this discovery might affect the routes of HTLV transmission, particularly sexual transmission, because HTLV transmission rates are significantly higher from men to women than women to men.

Mielopatia sinalizando o diagnóstico tardio da infecçãopor HtlV: um relato de caso / Myelopathy signaling the late diagnosis of HIV infection: a case report

A infecção pelo vírus T-linfotrópico humano (HTLV) caracteriza-se como uma doença sexualmente transmissível (DST), que pode também ser adquirida pelas vias parenteral e vertical. Subdivide-se em dois tipos: o HTLV-I, relacionado com doenças como mielopatia associada a HTLV/paraparesia espástica tropical (HAM/TSP) e a leucemia/linfoma de células T do adulto (ATL). Já o HTLV-II ainda não foi correlacionado cientificamente com nenhuma patologia na atualidade. Seu diagnóstico é realizado pela triagem sorológica para a detecção de anticorpo anti-HTLV-I/II, sendo o exame confirmatório o western blot. Neste contexto, o objetivo do presente estudo foi descrever um relato de caso em que a mielopatia foi a manifestação clínica sinalizadora da infecção pelo HTLV, em consequência do diagnóstico tardio da infecção por este patógeno, na qual a paciente apresentou os sintomas, progrediu lentamente e recebeu o diagnóstico apenas no último estágio da patologia (HAM/TSP), quando se tornou cadeirante. Embora a paciente realize na atualidade a terapêutica proposta e o acompanhamento ambulatorial segundo o protocolo estabelecido para o manejo desta infecção viral, membros de sua família também foram avaliados e diagnosticados e apenas um se apresentou positivo para a infecção. Este estudo visa demonstrar a importância do rastreio laboratorial para a infecção pelo HTLV, na mesma dimensão do diagnóstico da sífilis e do HIV, de modo que o mesmo não ocorra de forma tardia, quando associado a suas manifestações clínicas nos pacientes ou a infecções oportunistas relacionadas.

The human T-lymphotropic virus (HTLV) is characterized as a sexually transmitted disease (STD), it can also be transmitted by parenteral and vertical routes. It is subdivided into two types: the HTLV-I related diseases such as myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T-cell leukemia/lymphoma (ATL). HTLV-II has not been scientifically correlated with pathology yet. This diagnosis is made by serological screening for detection of HTLV antibody, and the western blot confirmatory test. In this context, the objective of this study was to describe a case in which myelopathy was signaling to the clinical manifestation of HTLV, as a result of delayed diagnosis of infection by this pathogen in which the patient had symptoms progressed slowly and received diagnosis only in the last stage of pathology (HAM/TSP), becoming a wheelchair user. Although nowadays the patient performs the therapeutic proposed and outpatient treatment according to the established protocol for the management of this viral infection, members of her family were also diagnosed and only one had a positive diagnosis of infection. This study aims to demonstrate the importance of laboratory screening for HTLV infection, in the same dimension of the diagnosis of syphilis and HIV, so that it does not occur so late, when it is associated to clinical manifestations in patients or related opportunistic infections

Detección de virus linfotrópico de células T humano-I/II en pacientes con enfermedades de transmisión sexual de Santiago / Human T-lymphotropic virus I/II detection in Chilean patients from Sexually Transmitted Diseases clinics

Background: The human T-lymphotropic virus I (HTLV-I) causes spastic para-paresis and adult T-cell leukemia/lymphoma. It can be sexually transmitted and is highly prevalent in Central and South America. Aim: To study HTLV-I/IIprevalence in serum samples obtained from two Sexually Transmitted Diseases (STD) clinics. Material and Methods: Two hundred serum samples were randomly chosen from two reference STD centers of Santiago. The presence of specific HTLV I/II antibodies was detected by indirect immunofluorescence. Results: The analyzed samples came from participants aged 14 to 70 years. Forty nine percent were women and 76% were heterosexual. Only one of the 200 samples was positive (0.5%) and it came from a 70 year-old woman, housewife, with a stable single partner, a history of recurrent genital ulcers, VDRL (-) and positive serology for herpes simplex virus. Conclusions: The prevalence of HTLV-I found in this group is similar to that demonstrated in other populations in Chile, except for aboriginal populations, and similar to international STD studies. Our data is consistent with the low transmissibility by sexual contact.

Infecções pelo vírus linfotrópico humano (HTLV) / Infections by human lymphotropic virus (HTLV)

No presente artigo são revistos os aspectos clínicos das infecções pelo HTLV-I e HTLV-II.

In the present paper the clinical aspects of HTLV-I and HTLV-II infections are reviewed.

Transmisión vertical de HTLV-1 en el Perú / Vertical transmission of HTLV-1 in Peru

La infección por el virus linfotrópico humano de células T tipo 1 (HTLV-1) ha sido descrita en muchas áreas del mundo, como en los países del Caribe, Japón, África, Oceanía y en Sudamérica. En la presente revisión definimos la endemicidad del HTLV-1 en el país, planteando cuatro criterios epidemiológicos. Luego discutimos el tema central de la revisión: la transmisión vertical del HTLV-1, que en nuestro país sería uno de los principales mecanismos de transmisión. Dentro del desarrollo de este aspecto en particular, presentamos una estimación de la tasa de transmisión vertical y los factores de riesgo asociados con la transmisión vertical sobre la base de una revisión exhaustiva de estudios nacionales y extranjeros. Con esta revisión pretendemos dar una primera aproximación al estudio de la trasmisión vertical de HTLV-1, un aspecto poco estudiado en nuestro medio.

Human type 1 T-cell lymphotropic virus (HTLV-1) infection has been described in many areas of the world, including Caribbean countries, Japan, Africa, Oceania and South America. In this review we define the endemicity of HTLV-1 in the country proposing four epidemiological criteria. Then we discuss the core subject of the review, which is the vertical transmission of HTLV-1. This mechanism is one of the main forms of transmission in our country. Within the development of this particular topic, we present an estimated rate of vertical transmission and the risk factors associated to vertical transmission based on an exhaustive review of the national and international literature. This review pretends to provide a first approach to the vertical transmission of HTLV-1, an aspect poorly studied in our country.

Geographic distribution of human T-lymphotropic virus types 1 and 2 among mothers of newborns tested during neonatal screening, Minas Gerais, Brazil / Distribución geográfica del virus linfotrópico de células T humanas tipos 1 y 2 en madres de recién nacidos estudiados en el tamizaje neonatal en Minas Gerais, Brasil

OBJECTIVE: To evaluate the geographic distribution of human T-lymphotropic virus types 1 and 2 (HTLV-1/2) in the State of Minas Gerais, Brazil, in puerperal women whose newborns were tested for HTLV-1/2 during neonatal screening, and to overlap seropositivity with social and economic status determinants. METHODS: During September-November 2007, the dry-blood samples taken from newborns on filter paper for routine screening were also tested for maternal IgG anti-HTLV-1/2 antibodies. For reactive samples, the mothers of the newborns had blood drawn to test for these viruses. RESULTS: The study analyzed 55 293 specimens taken from newborns. Of these, 52 (9.4 per 10 000) were reactive and 42 mothers (7.6 per 10 000) were confirmed with HTLV-1/2 infection. HTLV-1/2 geographic distribution was heterogeneous, with a tendency to be higher in the North and North-East parts of Minas Gerais. The highest rates of seropositivity were observed in Vale do Mucuri (55.9 per 10 000) and in Jequitinhonha (16.0 per 10 000), overlapping with the State's worst social and economic indicators. CONCLUSIONS: To our knowledge this was the first time that neonatal screening for HTLV-1/2 was performed in Brazil. This model could be used in other areas with high HTLV-1/2 prevalence rates. The detection of carrier mothers can enable intervention measures, such as providing infant formula to newborns, to be implemented expeditiously to reduce vertical transmission.

OBJETIVOS: Evaluar la distribución geográfica del virus linfotrópico de células T humanas tipos 1 y 2 (HTLV-1/2) en el estado de Minas Gerais (Brasil), en mujeres puérperas en cuyos recién nacidos se analizó la presencia del HTLV-1/2 durante las pruebas neonatales de detección sistemática, y superponer la seropositividad con determinantes del estado socioeconómico. MÉTODOS: Entre septiembre y noviembre de 2007, en las muestras de sangre seca extraída a los recién nacidos en papel de filtro para un tamizaje sistemático, se analizaron también los anticuerpos maternos de tipo IgG anti-HTLV-1/2. En el caso de las muestras reactivas, se extrajo la sangre de las madres de los recién nacidos para realizar pruebas de detección de estos virus. RESULTADOS: En el estudio se analizaron 55 293 muestras extraídas de los recién nacidos. De estas, 52 (9,4 por 10 000) fueron reactivas y en 42 madres (7,6 por 10 000) se confirmó la infección por el HTLV-1/2. La distribución geográfica del HTLV-1/2 fue heterogénea, con una tendencia a ser mayor en el norte y el noreste de Minas Gerais. Las tasas más elevadas de seropositividad se observaron en Vale do Mucuri (55,9 por 10 000) y en Jequitinhonha (16,0 por 10 000), superponiéndose con los peores indicadores socioeconómicos del estado. CONCLUSIONES: Esta fue la primera vez que se realizó un tamizaje neonatal para el HTLV-1/2 en Brasil. Este modelo podría usarse en otras regiones con tasas de prevalencia altas del HTLV-1/2. La detección de las madres portadoras puede permitir la aplicación rápida de medidas de intervención, como por ejemplo, el suministro de leche maternizada a los recién nacidos, a fin de reducir la transmisión vertical.

HTLV-1 related knowledge, attitude and behaviour patterns among mothers who participated in the Jamaica breastfeeding intervention study (1996-2000) / Conocimientos, actitudes y patrones de conducta en relación con el VLHT-1 entre las madres que participaron en el estudio de intervención de la lactancia materna en Jamaica - JBI (1996-2000)

Human T-cell Lymphotropic Virus type-1 (HTLV-1), the first human retrovirus associated with a malignant disease, is endemic in Jamaica. Vertical transmission and sexual intercourse are the major routes of transmission. Women are at greater risk of contracting the virus as it is more efficiently transmitted from male to female than in the reverse. Prevention of transmission is best achieved by health education on safe practices. The study aims to document the knowledge, attitude and behaviour pattern (KABP) of a group of women five years after they had participated in a mother-to-child transmission of HTLV- 1 risk reduction study. A cross-sectional study was conducted using a 46-point structured intervieweradministered questionnaire to capture data from 88 mothers. Overall knowledge scores were computed and four rating categories created. There were large deficiencies in the knowledge and practice of women at risk of being infected with HTLV-1. Only 58% knew that HTLV-1 is sexually transmitted. A minority was aware of HTLV-1 associated diseases: Adult T-cell lymphoma/leukaemia (ATL) -30.7%; Tropical Spastic Paraparesis (TSP) -42%; Infective dermatitis-42%). Ten (11.4%) believed that HTLV-1 infection can cause HIV/AIDS and only 33% knew that there was no cure for the virus. Most women (88.6%) continued to have unprotected sex. Controlling HTLV-1 spread must be based on interrupting transmission. In Jamaica, donated blood is screened for HTLV-1 and sharing of infected needle is an insignificant mode of transmission. However, although safe practices in breastfeeding and sexual intercourse are proven ways to reduce HTLV-1 transmission, these data show that knowledge and safe practices among those at risk may not be retained and health education will need to be sustained.

El virus linfotrópico de células T humanas de Tipo 1 (VLHT-1) - el primer retrovirus humano asociado con una enfermedad maligna - es endémico en Jamaica La transmisión vertical y las relaciones sexuales, son las principales vías de transmisión. Las mujeres tienen un mayor riesgo de contraer el virus, ya que este se transmite más eficientemente del varón a la hembra que a la inversa. La prevención de la transmisión se logra mejor por la educación de salud en las prácticas seguras. El estudio tiene por objetivo documentar los conocimientos, actitudes y patrones de conducta (KABP) de un grupo de mujeres cinco años después de haber participado en un estudio de la reducción del riesgo de la transmisión madre a hijo del HTLV. Se llevó a cabo un estudio transversal usando un cuestionario de 46 puntos aplicado por un administrador para recoger datos de 88 madres. Se computaron laspuntuaciones sobre los conocimientos generales y se crearon cuatro categorías globales y cuatro categorías de clasificación. Hubo grandes deficiencias de conocimientos y práctica entre las mujeres con riesgo de ser infectadas por HTLV-1. Sólo el 58% sabían que el HTLV-1 se transmite sexualmente. Una minoría tenía conciencia de las enfermedades asociadas con el HTLV-1: leucemia/linfoma de células T de adulto (TSP) LTA-30.7%; paraparesia espástica tropical PET-42%; y dermatitis infecciosa-42%. Diez (11.4%) creían que la infección por HTLV-1 puede causar VIH/SIDA, y solamente el 33% sabía que no hay cura para ese virus. La mayoría de las mujeres (88.6%) continuó teniendo sexo sin protección. El control de la propagación del HTVL-1 tiene que basarse en acciones encaminadas a interrumpir su transmisión. En Jamaica, la sangre obtenida mediante donaciones es sometida a examen en busca del HTLV-1 y el compartir una aguja infectada es un modo insignificante de transmisión. Sin embargo, aunque las prácticas seguras en la lactancia materna y las relaciones sexuales son formas probadas de reducir la transmisión de HTLV-1, estos datos muestran que la atención para garantizar el conocimiento y las prácticas seguras entre aquéllos en riesgo no pueden ser interrumpida, y es por ello necesario mantener la educación para la salud.

O vírus linfotrópico de células T humanos tipo 1 (HTLV-1): quando suspeitar da infecção?: [revisão] / Human T cell lymphotropic virus (HTLV)1: when should infection be suspected?: [review]

A infecção pelo vírus linfotrópico de células T humanas (HTLV) ocorre há milhares de anos. No entanto, o conhecimento sobre a sua patogênese é recente. Esse vírus é endêmico em várias regiões do mundo. No Brasil encontra-se presente em todos os estados, com prevalências variadas, sendo estimado cerca de 2,5 milhões de infectados. Fatores genéticos e imunológicos do hospedeiro são os principais responsáveis pelas manifestações clínicas associadas, que podem ser divididas em três categorias: neoplásicas, inflamatórias e infecciosas. Destacam-se a mielopatia associada ao HTLV (HAM/TSP) e a leucemia/linfoma de células T do adulto (ATLL) como as primeiras doenças associadas a esse retrovírus. Posteriormente, inúmeras outras doenças têm sido correlacionadas a esse vírus. Esta revisão atualiza conhecimentos epidemiológicos, fisiopatológicos, terapêuticos e principalmente diagnósticos do HTLV. O objetivo é permitir a suspeita etiológica do HTLV em suas diversas manifestações clínicas, hoje pouco correlacionadas com este agente.

Human T Lymphotropic Virus (HTLV) infection has occurred for thousands of years. However, knowledge about this pathogenesis is recent. This virus is endemic worldwide. In Brazil it is present throughout the country , with different prevalence and about 2 5 million infected. Genetic and immunologic characteristics of the host are chiefly responsible for clinically associated manifestations which may be: neoplasic, inflammatory and infectious diseases. HTLV associated myelopathy (TSP/ HAM) and adult T cell leukemia/lymphoma (ATL) stand out as the first diseases associated to this retrovirus. Further, several diseases have been correlated to this virus. This review updates epidemiologic, physiopathologic, therapeutic and diagnostic knowledge of HTLV. The purose is to orient suspicion of HTLV etiology and several clinically associated manifestations, which currenty are seldom correlated with this virus.

HTLV- I infection is not associated with a higher risk of death in peruvian HIV-infected patients / A infecção pelo HTLV- I não está associada a maior risco de morte em pacientes peruanos infectados pelo HIV

Limited and contradictory information exists regarding the prognosis of HIV/HTLV-I co-infection. Our goal was to estimate the effect of HTLV-I infection on mortality in HIV-infected patients at a HIV reference center in Peru. We studied a retrospective cohort of HIV-infected patients, who were exposed or unexposed to HTLV-I. Exposed patients were Western Blot (WB) positive for both retroviruses. Unexposed patients were WB positive for HIV, and had least one negative EIA for HTLV-I. These were selected among patients who entered our Program immediately before and after each exposed patient, between January 1990 and June 2004. Survival time was considered between the diagnosis of exposure to HTLV-I and death or censoring. Confounding variables were age, gender, baseline HIV clinical stage, baseline CD4+ T cell count, and antiretroviral therapy. We studied 50 exposed, and 100 unexposed patients. Exposed patients had a shorter survival compared to unexposed patients [median survival: 47 months (95 percent CI: 17-77) vs. 85 months (95 percent CI: 70-100), unadjusted p = 0.06]. Exposed patients had a higher rate of mortality compared to unexposed patients (HIV/HTLV-I (24/50 [48 percent]) vs. HIV only (37/100 [37 percent]), univariable p = 0.2]. HTLV-I exposure was not associated to a higher risk of death in the adjusted analysis: HR: 1.2 (0.4-3.5). AIDS clinical stage and lack of antiretroviral therapy were associated to a higher risk of dying. In conclusions, HTLV-I infection was not associated with a higher risk of death in Peruvian HIV-infected patients. Advanced HIV infection and lack of antiretroviral therapy may explain the excess of mortality in this population.

Existe informação limitada e contraditória sobre o prognóstico da co-infecção pelo Vírus da Imunodeficiência Humana Tipo 1 (HIV-1) e Vírus Linfotrópico de Células T Humanas Tipo I (HTLV-I). Nosso objetivo foi estimar o efeito da infecção pelo HTLV-I na mortalidade de pacientes infectados pelo HIV-1 em Centro de Referência de HIV no Peru. Trata-se de uma coorte retrospectiva de pacientes infectados pelo HIV, expostos ou não expostos ao HTLV-I. Os pacientes expostos tiveram resultados positivos no Western Blot (WB) para ambos retrovírus. Os pacientes não expostos tiveram resultados positivos para o HIV-1 e pelo menos um teste de EIA negativo para o HTLV-I. Esses pacientes foram selecionados entre aqueles que entraram no nosso Programa imediatamente antes ou depois de cada paciente exposto, no período de janeiro de 1990 a junho de 2004. O tempo de sobrevida foi considerado entre o diagnóstico da exposição ao HTLV-I e a morte. As variáveis de confusão foram: idade, gênero, estágio clínico basal da infecção pelo HIV-1, contagem basal de células CD4, e terapia anti-retroviral. Estudamos 50 pacientes expostos e 100 não expostos. Os pacientes expostos tiveram menor sobrevida quando comparados aos não expostos [mediana de sobrevida: 47 meses (95 por cento IC: 17-77) versus 85 meses (70-100), p não ajustado < 0.06]. Os pacientes expostos tiveram maior risco de morte quando comparados aos não expostos (HIV-1/HTLV-I (24/50 [48 por cento]) versus HIV-1 só (37/100 [37 por cento]) p univariado = 0.2). A exposição ao HTLV-I não foi associada a maior risco de morte na análise ajustada: HR: 1.2 (0.4-3.5). O estágio clínico da infecção pelo HIV-1 e a ausência de terapia anti-retroviral foram associados a maior risco de morte. Em conclusão, a infecção pelo HTLV-I não foi associada a maior risco de morte em pacientes peruanos infectados pelo HIV-1. A infecção avançada pelo HIV-1 e a falta de terapia anti-retroviral podem explicar o excesso de mortalidade ...

Prevalence and risk factors for HIV, syphilis, hepatitis B, hepatitis C, and HTLV-I/II infection in low-income postpartum and pregnant women in Greater Metropolitan Vitória, Espírito Santo State, Brazil / Prevalência e fatores de risco para a infecção por HIV, sífilis, hepatite B, hepatite C e HTLV-I/II em parturientes e gestantes de baixa renda atendidas na Região Metropolitana de Vitória, Espírito Santo, Brasil

Sexually transmitted infections during pregnancy pose a major risk to the fetus due to vertical transmission. The study's objective was to determine the prevalence of HIV, syphilis, hepatitis B and C, and HTLV-I/II infection among low-income postpartum and pregnant women treated in Greater Metropolitan Vitória, Espírito Santo State, Brazil, and the risk factors associated with these infections. A cross-sectional study was conducted from February to October 1999 assessing postpartum and pregnant women from the maternity ward of the Vitória Mercy Hospital and the Carapina Outpatient Referral Unit in the Municipality of Serra, respectively. Patients were systematically interviewed and had blood samples drawn for serological tests (HIV 1&2, VDRL, HbsAg, anti-HCV, and HTLV-I/II). A total of 534 patients (332 postpartum and 202 pregnant women) were assessed. Seroprevalence rates for the target infections in postpartum and pregnant women and the overall sample were as follows, respectively: HIV 0.9 percent, 0 percent, and 0.6 percent; syphilis 2.1 percent, 3.6 percent, and 2.7 percent; HBV 1.2 percent, 1 percent, and 1.1 percent; HCV 1.8 percent, 0.6 percent, and 1.4 percent; and HTLV-I/II 1.7 percent, 0.6 percent, and 1.3 percent. Factors associated with the various infections are presented and analyzed in light of other research findings from the literature.

A ocorrência de doenças sexualmente transmissíveis durante a gravidez representa risco aumentado de morbidade e mortalidade para o feto e neonato em virtude da transmissão vertical. O objetivo deste estudo foi identificar a prevalência da infecção por HIV, sífilis, hepatites B e C e por HTLV-I/II em parturientes e gestantes de baixa renda da Região Metropolitana de Vitória, Espírito Santo, Brasil, e avaliar fatores de risco associados a essas infecções. Foi realizado estudo de corte transversal de fevereiro a outubro de 1999, avaliando 534 pacientes (332 parturientes e 202 gestantes). Todas as participantes foram submetidas a entrevista semi-estruturada, após a qual foi coletada uma amostra de sangue para realização de testes sorológicos (HIV 1 e 2, VDRL, HbsAg, anti-HCV e HTLV-I/II). A soroprevalência das infecções estudadas entre as parturientes, as gestantes e no total da amostra foi, respectivamente: HIV 0,9 por cento, 0 por cento e 0,6 por cento; sífilis 2,1 por cento, 3,6 por cento e 2,7 por cento; HBV 1,2 por cento, 1 por cento e 1,1 por cento; HCV 1,8 por cento, 0,6 por cento e 1,4 por cento e HTV-I/II 1,7 por cento, 0,6 por cento e 1,3 por cento. Os fatores associados às infecções avaliadas são descritos e analisados à luz de achados de outros investigadores.

Frequent HTLV-1 infection in the offspring of Peruvian women with HTLV-1-associated myelopathy/tropical spastic paraparesis or strongyloidiasis

OBJECTIVES: To describe the frequency of HTLV-1 infection among offspring of mothers who had presented with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), strongyloidiasis, or asymptomatic HTLV-1 infection, and to identify factors associated with HTLV-1 infection. METHODS: In a descriptive study, records were reviewed of HTLV-1-positive women and their offspring who had been tested for HTLV infection at a public hospital in Lima, Peru, from 1989 to 2003. Sons and daughters of women who had presented with strongyloidiasis, HAM/TSP, or asymptomatic infection were eligible for this study. RESULTS: Three hundred seventy subjects were included: 279 were the offspring of 104 mothers presenting with HAM/TSP, 58 were the offspring of 22 mothers with strongyloidiasis, and 33 were the offspring of 26 asymptomatic mothers. Mean age of the offspring at the time of testing was 26 years (standard deviation 12). Nineteen percent of the offspring tested positive for HTLV-1: 6 percent (2/33) of those with asymptomatic mothers, 19 percent (52/279) among the offspring of mothers with HAM/TSP, and 31 percent (18/58) among the offspring of mothers presenting with strongyloidiasis On multiple logistic regression analysis, three factors were significantly associated with HTLV-1: (a) duration of breast-feeding (odds ratio [OR] = 15.1; [4.2-54.1] for 12 to 24 months versus less than 6 months breast-feeding); (b) clinical condition of the mother (OR = 8.3 [1.0-65.3] for HAM/TSP and OR = 11.5 [1.4-98.4] for strongyloidiasis in comparison with offspring of asymptomatic mothers); and (c) transfusion history (OR = 5.5 [2.0-15.2]). CONCLUSIONS: In addition to known risk factors for HTLV-1 transmission (duration of breast-feeding and history of blood transfusion), maternal HAM/TSP and strongyloidiasis were associated with seropositivity among offspring of HTLV-1-infected mothers.

OBJETIVOS: Describir la frecuencia de la infección por HTLV-1 en los hijos e hijas de madres diagnosticadas con mielopatía/paraparesia espástica tropical asociada con el HTLV-1 (M/PET-HTLV-1), estrongiloidiasis o infección asintomática por HTLV-1, e identificar los factores asociados con la infección por HTLV-1. MÉTODOS: Para este estudio descriptivo se revisaron los registros de mujeres positivas a HTLV-1 y de sus hijos evaluados con pruebas para la infección por HTLV en un hospital público de Lima, Perú, entre 1989 y 2003. Eran elegibles para este estudio los hijos y las hijas de las mujeres que se presentaron con estrongiloidiasis, M/PET-HTLV-1 o infección asintomática. RESULTADOS: En el estudio participaron 370 personas: 279 hijos de 104 madres con M/PET-HTLV-1, 58 hijos de 22 madres con estrongiloidiasis y 33 hijos de 26 madres asintomáticas. La edad promedio de los participantes en el momento de su prueba para HTLV era de 26 años (desviación estándar: 12 años). De las personas estudiadas, 19 por ciento resultaron positivas a la infección por HTLV-1: 6 por ciento (2/33) de los hijos de madres asintomáticas, 19 por ciento (52/279) de los hijos de madres con M/PET-HTLV-1 y 31 por ciento (18/58) de los hijos de madres con estrongiloidiasis. Según el análisis de regresión logística múltiple, tres factores se asociaron significativamente con la infección por HTLV-1: a) duración de la lactancia materna por 12_24 meses (razón de posibilidades [odds ratio, OR] = 15,1; intervalo de confianza de 95 por ciento [IC95 por ciento]: 4,2 a 54,1, frente a la lactancia materna por menos de 6 meses); b) que la madre presentara M/PET-HTLV-1 o estrongiloidiasis (OR = 8,3; IC95 por ciento: 1,0 a 65,3 y OR = 11,5; IC95 por ciento: 1,4 a 98,4, respectivamente, en comparación con los hijos de madres asintomáticas); y c) los antecedentes de haber recibido una transfusión sanguínea (OR = 5,5; IC95 por ciento: 2,0 a 15,2). CONCLUSIONES: Además de los factores...

Efeitos de compostos quinolínicos sobre a infecção pelo HTLV-I, ex-vivo / Effects of compounds quinolínicos on infection with HTLV-I, ex-vivo

No Brasil, a prevalência do HTLV-I é particularmente elevada em Salvador, onde cerca de 2 por cento da população encontra-se infectada. Uma das características imunológicas da infecção pelo HTLV-I é a presença de linfoproliferação espontânea dos linfócitos de indivíduos infectados. Este fenômeno pode ter papel importante no desenvolvimento das doenças associadas ao HTLV. Recentemente, compostos quinolínicos sintetizados a partir de molécula isolada da planta Galipea longiflora, foram descritos como capazes de diminuir a proliferação espontânea em linhagens celulares transformadas pelo HTLV-1. Neste estudo avaliamos a capacidade de 22 compostos quinolínicos sintéticos em inibir a proliferação espontânea em PBMC de indivíduos infectados pelo HTLV-1 e os efeitos destes sobre o perfil de secreção de citocinas, a carga proviral e a indução da apoptose. Identificamos 15 compostos não tóxicos. Destes, 4 compostos (BS74, MDS14, MDS22 e MHM22) inibiram acima de 80 por cento a proliferação espontânea em PBMC de indivíduos infectados pelo HTLV em presença de concentração modo-dependente dos compostos uinolínicos (100 a 0,8 /-lM). Em presença do composto MDS14, a proporção de células T CD4+ e T CD8+ produtoras de IL-10 foi superior em relação ao controle (p= 0,05 e p= 0,04, respectivamente). O composto MHM22 diminuiu na carga proviral em 40 por cento (p= 0,027). O composto BS74 foi capaz de induzir a apoptose em PBMC de indivíduos infectados pelo HTLV-1 (p= 0,01) Nossos resultados reforçam que alguns compostos quinolínicos diminuem a proliferação espontânea em PBMC de indivíduos infectados pelo HTLV-1. Além disso, estes compostos quinolínicos foram capazes de diminuir a carga proviral e induzir a apoptose de linfócitos. Entretanto, é necessário investigar mecanismos de ação destes compostos sobre os parâmetros avaliados.