HTLV-2 infection in Manaus, Brazil: first description of HTLV-2c subtype in an urban area of the Western Amazon region

Abstract INTRODUCTION: We investigated the prevalence of human T-cell lymphotropic virus types 1 and 2 (HTLV-1/2) infection in patients with hematological diseases from the western Amazon region of Brazil. METHODS: Samples from 306 patients were submitted for the molecular diagnosis of HTLV-1/2 infection by real time PCR (qPCR), with amplification, sequencing, and phylogenetic analysis of the long terminal repeat (LTR) region. RESULTS: A 29-year-old male carrier of sickle cell anemia with a history of multiple blood transfusions was diagnosed with the HTLV-2c subtype. CONCLUSIONS: This study describes the first known occurrence of HTLV-2c in the urban area of Brazil's western Amazon region.

Laboratory diagnosis of human T-lymphotropic virus in Brazil: assays, flowcharts, challenges, and perspectives

Abstract INTRODUCTION We present a data analysis and review of recent studies regarding the laboratory diagnosis of human T-lymphotropic virus 1 and 2 (HTLV-1/2) infections in Brazil. METHODS Target populations, available diagnostic serological assays (screening and complementary tests), molecular assays (in-house), causes of false-positive and false-negative results, and flowcharts were analyzed. RESULTS A table presents the target populations, two diagnostic flowcharts (depending on laboratory infrastructure and study population), and recent research that may improve how HTLV-1/2 is diagnosed in Brazil. CONCLUSIONS: Our results support the implementation of public policies to reduce HTLV-1/2 transmission and its associated diseases.

Prevalence of infection by human T Cell lymphotropic viruses (HTLV-1/2) in adult population in Vitoria-ES

ABSTRACT Introduction: Brazil has a high number of HTLV-1/2 infections which are unequally distributed in the country. Most prevalence studies have focused on specific populations, such as blood donors and pregnant women. Some areas, for example the state of Bahia, have robust information about HTLV-1/2 infection, however there is no information available about this infection in the general population of Vitoria, Espírito Santo, Brazil. Objective: To determine the prevalence of HTLV-1/2 infection in adults from the municipality of Vitoria, ES. Methods: A cross sectional study was performed from September 2010 to December 2011, in individuals of both sexes, aged 18 or older living in Vitoria-ES. Venous blood samples were collected and tested for anti-HTLV-1/2 antibodies by chemiluminescent immunoassay (CMIA). Individuals with CMIA reactive results were submitted to a new blood collection for retesting by CMIA, followed by PCR to confirm infection and discriminate the viral type. Results: From 1502 tested samples, eight were reactive in CMIA and all were confirmed by PCR. Therefore, the prevalence of HTLV-1/2 was 0.53% (8/1502, 95% CI: 0.2-1.0%). The infection rate was 0.7% in men (5/711, 95% CI: 0.17-1.51%), and 0.38% in women (3/791, 95% CI: 0 -0.81%). Conclusions: The prevalence of HTLV-1/2 infection was 0.53% (8/1502; 95% CI: 0.2 -0.9%). Confirmatory test using real-time PCR (qPCR) identified seven individuals positive for HTLV-1 and one for HTLV-2. Considering the risk of infected individuals to develop high morbidity and mortality diseases, it would be important to implement public health policies aimed at stopping transmission of these viruses in this municipality. 2021 Sociedade Brasileira de Infectologia. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license

Specificity of HTLV screening tests and its impact on health care program costs: The perspective of antenatal screening in Brazil

Abstract INTRODUCTION: Brazil ranks first in the number of HTLV-1/-2-infected individuals worldwide. The high morbidity and mortality of HTLV-1-associated diseases, especially following infection in infancy, requires strong action to reduce vertical transmission. METHODS: To facilitate the appraisal of the implementation of the HTLV antenatal screening program by the Brazilian Ministry of Health, we determined the costs in distinct scenarios according to HTLV seroprevalence, specificity of the screening test, and type of confirmatory test. RESULTS: HTLV antenatal screening would cost R$ 55,777,012-R$ 77,082,123/year. Screening assays with high specificity reduce the need and cost of confirmatory assays by up to 25%. CONCLUSIONS: Careful selection of the screening assay is required to optimize the program.

Line immunoassay for confirmation and discrimination of human t-cell lymphotropic virus infections in inconclusive western blot serum samples from Brazil

Difficulties in confirming and discriminating human T-cell lymphotropic virus type 1 (HTLV-1) and HTLV-2 infections by serological Western blot (WB) assays (HTLV Blot 2.4; MP Biomedicals) have been reported in Brazil, mainly in HIV/AIDS patients, with a large number of WB-indeterminate and WB-positive but HTLV-untypeable results. Nonetheless, a line immunoassay (LIA) (INNO-LIA HTLV-I/II; Fujirebio) provided enhanced specificity and sensitivity for confirming HTLV-1/2 infections. To add information concerning the improved ability of the LIA in relation to WB when applied to samples of individuals from different risk groups from Brazil, we performed the present study. Three groups were analyzed group 1 (G1), with 62 samples from HIV/AIDS patients from São Paulo, SP (48 WB indeterminate and 14 HTLV untypeable); group 2 (G2), with 24 samples from patients with hepatitis B or hepatitis C from São Paulo (21 WB indeterminate and 3 HTLV untypeable; 17 HIV seropositive); and group 3 (G3), with 25 samples from an HTLV outpatient clinic in Salvador, Bahia (16 WB indeterminate and 9 HTLV untypeable; all HIV seronegative). Overall, the LIA confirmed HTLV-1/2 infection (HTLV-1, HTLV-2, or HTLV) in 66.1% (G1), 83.3% (G2), and 76.0% (G3) of samples. Interestingly, the majority of WB-indeterminate results were confirmed by the LIA as being HTLV-2 positive in G1 and G2 but not in G3, in which the samples were defined as being HTLV-1 or HTLV positive. These results agree with the virus types that circulate in such patients of different regions in Brazil and emphasize that the LIA is the bes

Comparative performances of serologic and molecular assays for detecting human T lymphotropic virus type 1 and type 2 (HTLV-1 and HTLV-2) in patients infected with human immunodeficiency virus type 1 (HIV-1)

ABSTRACT The present study evaluated several techniques currently available (commercial kits and in-house assays) for diagnosing human T lymphotropic viruses types 1 and 2 in two groups of patients enrolled at HIV/AIDS specialized care services in São Paulo: Group 1 (G1), n = 1608, 1237 male/371 female, median age 44.3 years old, majority using highly active antiretroviral therapy (HAART); G2, n = 1383, 930 male/453 female, median age of 35.6 years old, majority HAART naïve. Enzyme immunoassays [(EIA) Murex and Gold ELISA] were employed for human T lymphotropic viruses types 1 and 2 screening; Western blotting (WB), INNO-LIA (LIA), real-time PCR pol (qPCR), and nested-PCR-RFLP (tax) were used to confirm infection. Samples were considered human T lymphotropic viruses types 1 and 2 positive when there was reactivity using at least one of the four confirmatory assays. By serological screening, 127/2991 samples were positive or borderline, and human T lymphotropic virus infection was confirmed in 108 samples (three EIA-borderline): 56 human T lymphotropic virus type 1 [G1 (27) + G2 (29)]; 45 human T lymphotropic virus type 2 [G1 (21) + G2 (24)]; one human T lymphotropic virus type 1 + human T lymphotropic virus type 2 (G2); six human T lymphotropic virus [G1 (2) + G2 (4)]. Although there were differences in group characteristics, human T lymphotropic viruses types 1 and 2 prevalence was similar [3.1% (G1) and 4.2% (G2), p = 0.113]. The overall sensitivities of LIA, WB, qPCR, and PCR-RFLP were 97.2%, 82.4%, 68.9%, and 68.4%, respectively, with some differences among groups, likely due to the stage of human T lymphotropic virus infection and/or HAART duration. Indeterminate immunoblotting results were detected in G2, possibly due to the seroconversion period. Negative results in molecular assays could be explained by the use of HAART, the occurrence of defective provirus and/or the low circulating proviral load. In conclusion, when determining the human T lymphotropic virus infection, the findings highlight that there is a need to consider the blood samples with borderline results in screening assays. Of all the tested assays, LIA was the assay of choice for detecting human T lymphotropic virus type 1 and human T lymphotropic virus type 2 in human immunodeficiency virus type 1-infected patients.

Short communication: failures in detecting HTLV-1 and HTLV-2 in patients infected with HIV-1

Changes in retrovirus acquisition/transmission behaviors have been reported in Brazil, with a concerning increase in HIV-1-infected individuals aged 15-39 years. In São Paulo, HIV-1/HTLV-1 and HIV-1/HTLV-2 coinfections have been associated with intravenous drug use and failure to detect HTLV-1/2 (human T cell lymphotropic virus types 1 and 2) with immunosuppression and the use of highly active antiretroviral therapy (HAART). Negative results for HTLV serologic [western blotting (WB)] and molecular [real-time PCR pol (qPCR)] confirmatory assays have been reported, whereas the best sensitivity has been found for INNO-LIA (LIA). In this study, we expand our previous data by analyzing a group of young patients (n = 1,383; median age 35.6 years) who recently acquired HIV by sexual contact, the majority of whom were HAART naïve, and comparing the performances of four HTLV confirmatory assays LIA, WB, qPCR, and PCR-RFLP (tax). We confirmed HTLV infection in 58 (4.2%) blood samples 29 HTLV-1, 24 HTLV-2, 1 HTLV-1+HTLV-2, and 4 HTLV. LIA, WB, qPCR, and PCR-RFLP sensitivities were 94.8%, 82.8%, 79.2%, and 74.5%, respectively. Associations of HTLV infection with female gender (OR = 2.28, 1.31-4.00) and age >40 years (p < .0001) were detected. The results confirm the low sensitivities of molecular assays and the best performance of LIA in detecting HTLV-1/2 in such patients. We hypothesize that the negative PCR results are due to the presence of defective provirus and/or low proviral load circulating in such patients, with inconclusive WB coinciding with the seroconversion period. Corroborating the associations obtained, repeated exposure is required for HTLV sexual transmission/acquisition, which is more efficient from male to female

Comparação de testes laboratoriais para o diagnóstico de infecção por vírus linfotrópicos de células T humanas do tipo 1 (HTLV-1)e tipo 2 (HTLV-2) em pacientes infectados por HIV-1 / Comparison of laboratorial tests for the diagnosis of human T-lymphotropic virus type 1 (HTLV-1) and type 2 (HTLV-2) in HIV-1 infected patients

O presente estudo pesquisou o melhor algoritmo de testes laboratoriais para efetuar o diagnóstico de infecção por vírus linfotrópicos de células T humanas dos tipos 1 (HTLV-1) e 2 (HTLV-2) em pacientes HIV-1 positivos. Amostras de sangue de 1.608 pacientes do CRT DST/Aids-SP foram analisadas quanto à presença de anticorpos específicos usando-se dois ensaios de triagem (EIA Murex HTLV-I+II e Gold ELISA HTLV-I/II), dois confirmatórios [HTLV Blot 2.4 (Western Blot – WB) e INNO-LIA HTLV I/II (Line ImmunoAssay - LIA)] e um molecular (PCR em tempo real pol). Na triagem foram detectados 51(Murex) e 49 (Gold ELISA) soros reagentes. Pelo WB, 23 soros confirmaram infecção por HTLV-1, 12 HTLV-2, seis HTLV e nove apresentaram perfis indeterminados. O LIA detectou 24 soros HTLV-1 positivos, 20 HTLV-2 e seis HTLV. A PCR evidenciou segmento pol de HTLV-1 em 18 e HTLV-2 em 12 amostras de sangue. Pelos testes confirmatórios, em 50 pacientes foi confirmada a infecção por HTLV: 25 HTLV-1 (1,55 %), 21 HTLV-2 (1,31 %) e quatro HTLV (0,25 %). As sensibilidades do LIA, WB e PCR foram de 96 %, 76 % e 60 %, respectivamente. Considerando-se apenas o custo, o melhor algoritmo diagnóstico para população infectada pelo HIV-1 foi o uso da PCR seguida do LIA...

Dried blood spot testing for the antenatal screening of HTLV, HIV, syphilis, toxoplasmosis and hepatitis B and C: prevalence, accuracy and operational aspects

Introduction: Screening for vertically transmitted infection is mandatory and must be conducted at the first prenatal consultation. The most vulnerable women's groups are those at the lowest socio-economic level. Dried blood spot testing on filter paper could represent a secure way to screen pregnant women in the prenatal period. Methods: A cross-sectional study was conducted between November 2009 and March 2010, in the Metropolitan Region of Salvador, Bahia, Brazil, to compare the accuracy of the dried blood spot in filter paper and venipuncture serological as screening methods for HIV, HTLV, VHB, VHC, Treponema pallidum, and Toxoplasma gondii during prenatal period. Results of the venous blood sample collected in tubes were considered the gold standard. Results: Serum samples and dried blood spot were obtained from 692 pregnant women aged between 14 and 42 years, with a median age of 26. Thirteen women were seropositive for T. gondii (1.88%; 95% CI: 0.60–2.71%), five for T. pallidum (0.72%; 95% CI: 0.15–1.61%), two for HBV (0.29%; 95% CI: 0.050.95%) and one for HTLV-1 (0.14%; 95% CI: 0.01–0.71%). No one was positive for HCV and HIV. The dried blood spot accuracy for syphilis and HTLV were 100% (95% CI: 99.25–100) and 100% (95% CI: 99.45–100%), respectively. The average time between blood collection and recording of the sample in the reference laboratory was 4.93 (3.82) days and between dried blood spot processing and active search for pregnant women was 3.44 (4.27) days. Conclusions: The use of dried blood spot may represent a secure way to expedite access to results of vertically transmitted diseases in the prenatal period, particularly in regions with scarce healthcare resources. .

Diagnóstico serológico de HTLV-1/2: combinación de técnicas de tamizaje para definir el estatus serológico en donantes de sangre / [Serological diagnosis of HTLV-1/2: combination of screening assays to define the serological status in blood donors].

Alternative algorithms were evaluated in order to reduce the number of false reactive results for antibodies against HTLV-1/2. From 20,210 samples tested, 0.37

(74/20,210) was reactive by ELISA Murex. Of these, 23 were confirmed as positive by the indirect immunofluorescence assay whereas 51 were negative, being the positive predictive value (PPV) 31.08

. From a combination of the ELISA Murex assay with the particle agglutination assay (PA) and ELISA MP, the following results were obtained: 26/74 were reactive by ELISA Murex and PA, PPV 88.5

and 32/74 were reactive by ELISA Murex and ELISA MP, PPV 71.8

. The ROC curve analysis determined that for an RP 4.74, the values for sensitivity, specificity, PPV and NPV by ELISA Murex were 100

, respectively. We propose that reactive samples by ELISA Murex with an RP d 4.74 should be retested in duplicate by PA, and the resulting concordantly nonreactive samples should be defined as negative for HTLV-1/2.

Descriptive study of HTLV infection in a population of pregnant women from the state of Pará, Northern Brazil / Estudo descritivo da infecção pelo HTLV em uma população de gestantes do Estado do Pará, norte do Brasil

INTRODUCTION: In Brazil, studies have shown that HTLV seroprevalence among pregnant women varies from 0 to 1.8%. However, this seroprevalence was unknown in the State of Pará, Brazil. The present study describes, for the first time, the HTLV seroprevalence among pregnant women from the State of Pará, Northern Brazil. METHODS: 13,382 pregnant women were submitted to HTLV screening during prenatal care, and those with non-seronegative results to anti-HTLV were submitted to Western blot (WB) test to confirm and separate HTLV-1 and HTLV-2 carriers. RESULTS: HTLV seroprevalence in the population of pregnant women was 0.3%, and HTLV-1 was identified in 95.3% of patients. The demographic profile of HTLV carriers was as follows: women with age between 20 and 40 years old (78.4%); residing in the metropolitan region of Belém, Pará (67.6%); and with educational level of high school (56.8%). Other variables related to infection were as follows: beginning of sexual intercourse between the age of 12 and 18 years old (64.9%) and have being breastfed for more than 6 months (51.4%). Most of the women studied had at least two previous pregnancies (35.1%) and no abortion (70.3%). Coinfections (syphilis and HIV) were found in 10.8% (4/37) of these pregnant women. CONCLUSIONS: Seroprevalence of HTLV infection in pregnant women assisted in basic health units from the State of Pará, Northern Brazil, was 0.3% similar to those described in other Brazilian studies. The variables related to infection were important indicators in identifying pregnant women with a higher tendency to HTLV seropositivity, being a strategy for disease control and prevention, avoiding vertical transmission.

INTRODUÇÃO: No Brasil, estudos mostram que a soroprevalência do HTLV entre gestantes varia de 0 a 1,8%. Contudo, esta soroprevalência era desconhecida no Estado do Pará, Brasil. O presente estudo descreve, pela primeira vez, a soroprevalência do HTLV entre gestantes do Estado do Pará, Norte do Brasil. MÉTODOS: 13,382 gestantes foram submetidas à triagem para HTLV durante o pré-natal, e aquelas com sorologia alterada para anti-HTLV foram submetidas ao teste de Western Blot (WB), para confirmar e discriminar portadoras do HTLV-1 e do HTLV-2. RESULTADOS: A soroprevalência do HTLV na população de gestantes foi de 0,3%, sendo o HTLV-1 identificado em 95,3% das pacientes. O perfil demográfico das portadoras do HTLV foi de: mulheres com idade entre 20-40 anos (78,4%); residentes na região metropolitana de Belém (67,6%) e com nível educacional igual ao ensino médio (56,8%). Outras variáveis relacionadas à infecção foram: início das relações sexuais compreendido entre 12-18 anos (64,9%), e ter sido aleitada mais de 6 meses (51,4%). A maior parte das mulheres estudadas teve ao menos duas gestações anteriores (35,1%); e nenhum aborto (70,3%). Co-infecções (sífilis e HIV) foram descritas em 10,8% (4/37) das gestantes. A soroprevalência da infecção pelo HTLV em gestantes atendidas em Unidades Básicas de Saúde do Estado do Pará, Norte do Brasil foi de 0,3% semelhante à descrita em outros estudos brasileiros. As variáveis relacionadas com a infecção são indicadores importantes na identificação de gestantes com maior tendência a soropositividade pelo HTLV, sendo uma estratégia de controle e prevenção, evitando a transmissão vertical.

HTLV-1/2 seroprevalence and coinfection rate in Brazilian first-time blood donors: an 11-year follow-up / Soroprevalência e taxa de coinfecção do HTLV-1/2 em doadores de sangue de primeira vez brasileiros: 11 anos de estudo

The seroprevalence and geographic distribution of HTLV-1/2 among blood donors are extremely important to transfusion services. We evaluated the seroprevalence of HTLV-1/2 infection among first-time blood donor candidates in Ribeirão Preto city and region. From January 2000 to December 2010, 1,038,489 blood donations were obtained and 301,470 were first-time blood donations. All samples were screened with serological tests for HTLV-1/2 using enzyme immunoassay (EIA). In addition, the frequency of coinfection with hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), Chagas disease (CD) and syphilis was also determined. In-house PCR was used as confirmatory test for HTLV-1/2. A total of 296 (0.1%) first-time donors were serologically reactive for HTLV-1/2. Confirmatory PCR of 63 samples showed that 28 were HTLV-1 positive, 13 HTLV-2 positive, 19 negative and three indeterminate. Regarding HTLV coinfection rates, the most prevalent was with HBV (51.3%) and HCV (35.9%), but coinfection with HIV, CD and syphilis was also detected. The real number of HTLV-infected individual and coinfection rate in the population is underestimated and epidemiological studies like ours are very informative.

A soroprevalência e a distribuição geográfica do HTLV-1/2 entre os doadores de sangue são extremamente importantes para os serviços de transfusão. Neste trabalho, foi determinada a soroprevalência da infecção pelo HTLV-1/2 entre os doadores de sangue de primeira vez da cidade de Ribeirão Preto e região. No período de Janeiro de 2000 a Dezembro de 2010, 1.038.489 doações de sangue foram obtidas sendo 301.470 doações de primeira vez. Todas as amostras foram avaliadas com testes sorológicos para HTLV-1/2 usando ensaio imunoenzimático (EIA). Adicionalmente, a frequência de coinfecção com o vírus da hepatite B (HBV), vírus da hepatite C (HCV), vírus da imunodeficiência humana (HIV), doença de Chagas (CD) e sífilis também foi determinada. Adicionalmente, foi utilizada uma reação de PCR in-house como teste confirmatório para HTLV-1/2. Um total de 296 (0,1%) doadores de primeira vez foram sorologicamente reativos para HTLV-1/2. O PCR confirmatório de 63 amostras mostrou que 28 eram HTLV-1 positivas, 13 HTLV-2 positivas, 19 negativas e três indeterminadas. Em relação às taxas de coinfecção com HTLV1/2, a maior prevalência foi com HBV (51,3%) e HCV (35,9%), mas a coinfecção com HIV, CD e sífilis também foram detectadas. O número real de indivíduos infectados pelo HTLV-1 e a taxa de coinfecção na população é subestimado e estudos epidemiológicos como esse são muito informativos.

High prevalence of HTLV-1 and 2 viruses in pregnant women in São Luis, state of Maranhão, Brazil / Alta prevalência dos vírus HTLV-1 e 2 em gestantes de São Luis, estado do Maranhão, Brasil

INTRODUCTION: Human T cell lymphotropic virus type 1 (HTLV-1) is endemic in the Caribbean, Japan, South America and regions of Africa. HTLV-2 is present in Native American populations and associated with IV drug use in Europe and North America. In Brazil, it is estimated that 1.5 million people are infected with HTLV-1/2. The study objective was to determine HTLV-1/2 prevalence in pregnant women in the prenatal care from three public services in São Luis, State of Maranhão, Brazil, and to counsel seropositive women to reduce viral transmission. METHODS: A cross-sectional study was conducted from February to December 2008; women with age of 18 to 45 years, with low risk for sexually transmitted disease (STD) were invited to participate. Blood samples were collected in filter paper, and HTLV-1/2 immunoenzymatic test (ELISA) was performed as a screening test. Women with reactive results were submitted to peripheral venous blood collection for ELISA repetition, followed by Western blot (WB) and real-time PCR to confirm and discriminate the infection between virus types 1 and 2. RESULTS: Of the 2,044 women tested, seven (0.3%) were ELISA reactive and confirmed positive (four were HTLV-1, and three were HTLV-2). All positive women were oriented not to breastfeed their newborns. CONCLUSIONS: This study showed that the virus is present in high prevalence in that population. Further studies covering other segments of the population are necessary to better characterize the presence of HTLV-1/2 in Maranhão and to elicit measures to prevent its spread.

INTRODUÇÃO: O vírus linfotrópico de células T humanas tipo 1 (HTLV-1) é endêmico no Caribe, Japão, América do sul e regiões da África. O HTLV-2 está presente em populações indígenas das Américas e usuários de drogas injetáveis na Europa e América do Norte. No Brasil, estimase que 1,5 milhões de pessoas estejam infectadas pelo HTLV-1/2. O objetivo deste estudo foi de determinar a prevalência do HTLV-1/2 em gestantes atendidas no pré-natal de três serviços públicos em São Luis, Maranhão, e orientar as mulheres soropositivas para reduzir a transmissão viral. MÉTODOS: Foi realizado um estudo transversal, de fevereiro a dezembro de 2008, com gestantes de 18 a 45 anos, com baixo risco de doença sexualmente transmissível (DST). Amostras de sangue foram coletadas em papel filtro e submetidas à técnica de ensaio imunoenzimático (ELISA) como teste de triagem para HTLV-1/2. As gestantes com resultado ELISA reativo foram submetidas à coleta de sangue venoso periférico para repetição do ELISA, seguido por WB e PCR em tempo real para confirmar e discriminar a infecção pelos tipos virais. RESULTADOS: Das 2.044 mulheres examinadas, sete (0.3%)tiveram resultados reativos e foram confirmadas soropositivas (quatro para HTLV-1 e três para HTLV-2). Todas as sete gestantes foram orientadas a não dar leite materno aos filhos. CONCLUSÕES: Este estudo mostrou que o HTLV-1/2 está presente em alta prevalência na população das mulheres grávidas estudadas. São necessários outros estudos contemplando diferentes segmentos populacionais para caracterizar a presença do HTLV-1/2 no Maranhão, e permitirmedidas preventivas contra a disseminação viral.

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.

Coinfection by HTLV-I/II is associated with an increased risk of strongyloidiasis and delay in starting antiretroviral therapy for AIDS patients

OBJECTIVE: To compare the clinical characteristics and outcomes of HIV-1-HTLV-1 coinfected patients, in Bahia, Brazil. METHODS: Retrospective, comparative study. RESULTS: Among a total of 123 consecutive HIV infected patients, 20 men (20.6 percent) and 6 women (23.1 percent) had detectable antibodies against HTLV-I/II. The major risk factor associated with coinfection by HTLV was intravenous drug use (57.7 percent of coinfected patient versus 9.2 percent of HTLV seronegative patients, p < 0.0001). Coinfected patients had higher absolute lymphocyte counts (1,921 + 762 versus 1,587 + 951, p = 0.03). Both groups of patients had similar means of CD4+ and CD8+ cell counts. However, among patients with AIDS CD4+ cell counts were significantly higher among those coinfected with HTLV-I/II (292 ± 92 cells/mm³, versus 140 ± 177cells/mm³, p = 0.36). The frequency and type of opportunistic infections were similar for both groups, but strongyloidiasis and encephalopathy were more frequently diagnosed in coinfected patients (p < 0.05). On the other hand, patients coinfected with HTLV-I/II received significantly less antiretroviral therapy than singly infected by HIV-1. CONCLUSION: Coinfection by HTLV-I/II is associated with an increased risk of strongyloidiasis for HIV patients. Higher CD4 count may lead to underestimation of immunodeficiency, and delay to initiate antiretroviral therapy.

Decline in prevalence and asymmetric distribution of human T cell lymphotropic virus 1 and 2 in blood donors, State of Minas Gerais, Brazil, 1993 to 2007 / Declínio na prevalência e distribuição assimétrica do vírus linfotrópico de células T humanas em doadores de sangue, Estado de Minas Gerais, Brasil, 1993 a 2007

INTRODUCTION: Human T cell lymphotropic virus types 1 and 2 (HTLV-1/2) are endemic in Brazil and are screened for in transfusion services since 1993. This study evaluated the evolution of the prevalence of HTLV-1 and 2 in blood donors of the Hemominas Foundation from 1993 to 2007, and its geographical distribution in State of Minas Gerais, Brazil. METHODS: The Hemominas Foundation is a centralized blood center in Minas Gerais, Brazil. The sources of data were the Hemominas Foundation Technical Bulletin and files from the centralized serological laboratory. Donors were tested in the period using enzyme linked immuno sorbent assays (ELISA), followed by Western blot, when repeatedly reactive. The data were analyzed by EPIINFO 6.2 and TABWIN 3.5 softwares. RESULTS: The average seroprevalence in the period 1993-2007 was 0.1 percent. A steady decline occurred from 0.4 percent in 1993 to below 0.1 percent in 2002 and later, with a transient peak of 0.5 percent in 1994. HTLV reactivity distribution was asymmetrical in the state, with regions of higher prevalence, interspersed with low prevalence areas. Comparison of positive and negative donors verified that increasing age was proportional to virus positivity. Odds ratio for age ranged from 1.43 (30 to 39 years-old) to 3.09 (50 to 65 years-old). Women had a greater chance of being positive (OR-1.64), as previously described. CONCLUSIONS: Possible explanations for HTLV-1/2 prevalence decline are the exclusion of positive donors from the donor pool, an increase in repeat donors and ELISA test improvement, with reduction in the number of false positive results.

INTRODUÇÃO: Os vírus linfotrópicos de células T humanas 1 e 2 (HTLV-1/2) são endêmicos no Brasil e são testados nos serviços de transfusão desde 1993. Este estudo avaliou a evolução da prevalência do HTLV-1 e 2 em doadores de sangue da Hemominas, de 1993 a 2007, bem como sua distribuição geográfica no Estado de Minas Gerais, Brasil. MÉTODOS: A Hemominas é um serviço transfusional centralizado em Minas Gerais, Brasil. As fontes de dados foram o Boletim Técnico da Fundação Hemominas, e os dados informatizados do laboratório central de sorologia. Os doadores foram testados no período utilizando ensaio enzimático (ELISA), seguido de Western blot, para confirmação, se repetidamente reagentes. Os dados foram analisados utilizando EPIINFO 6.2 e TABWIN 3.5. RESULTADOS: A prevalência media no período 1993-2007 foi de 0,1 por cento. Houve declínio contínuo de 0,4 por cento em 1993 para menos de 0,1 por cento de 2002 em diante, com um pico transitório de 0,5 por cento em 1994. A distribuição do HTLV foi assimétrica, com alternância de regiões de alta e baixa prevalências. A comparação entre doadores positivos e negativos mostrou que a idade aumenta a positividade para o vírus. A OR para idade variou de 1,43 (30 a 39 anos) a 3,09 (50 a 65 anos). As mulheres tiveram chance maior de ser positivas (OR-1,64), como descrito anteriormente. CONCLUSÕES: As possíveis explicações para o declínio do HTLV-1/2 foram a exclusão de doadores positivos, aumento nos doadores de repetição, e melhora nos testes de ELISA, com redução do número de testes falso positivos.

Declínio da prevalência do HTLV-1/2 em doadores de sangue do Hemocentro Regional da Cidade de Uberaba, Estado de Minas Gerais, 1995 a 2008 / Decline in the prevalence of HTLV-1/2 among blood donors at the Regional Blood Center of the City of Uberaba, State of Minas Gerais, from 1995 to 2008

INTRODUCÃO: Estudo retrospectivo com o objetivo de avaliar a prevalência e fatores associados à soropositividade para o HTLV-1/2, no período de 1995 a 2008, no Hemocentro Regional de Uberaba e descrever os doadores soropositivos quanto ao gênero, idade, estado civil, cor de pele e procedência. MÉTODOS: Foram realizados análise estatística descritiva, testes qui-quadrado e odds ratio para comparação de proporções e gráfico de dispersão com coeficiente de correlação linear. RESULTADOS: Dentre x doadores testados, foi encontrada a prevalência de sorologia positiva para o HTLV de 0,02 por cento e indeterminada de 0,09 por cento. Houve uma redução significativa da sorologia positiva para HTLV, no período de 2002 a 2008, em comparação ao período de 1995 a 2001. Dentre os soropositivos, observou predomínio significante no gênero feminino. CONCLUSÕES: Imputamos a queda gradativa de soropositividade no período à exclusão permanente dos doadores de repetição soropositivos e ao aprimoramento dos métodos de triagem clínica e dos testes sorológicos ao longo dos anos com reflexos positivos na segurança transfusional.

INTRODUCTION: A retrospective study was conducted in order to assess the prevalence and factors associated with seropositivity for HTLV-1/2 between 1995 and 2008 in Uberaba Regional Blood Center, and to describe the seropositive blood donors in relation to gender, age, marital status, skin color and origin. METHODS: Descriptive statistical analysis, chi-square tests and odds ratios were produced to compare proportions, along with scatter charts with linear correlation coefficients. RESULTS: Among the donors tested, the prevalence of seropositivity for HTLV was found to be 0.02 percent, with indeterminate results in 0.09 percent. There was a significant reduction in seropositivity for HTLV between 2002 and 2008, compared with the period from 1995 to 2001. Among the seropositive individuals, females were significantly predominant. CONCLUSIONS: The gradual decrease in seropositivity over this period was attributed to the permanent exclusion of seropositive repeat donors and improvement in the clinical screening methods and serological tests over the years, with a positive impact on transfusion safety.

Evaluation of the use of real-time PCR for human T cell lymphotropic virus 1 and 2 as a confirmatory test in screening for blood donors / Análise do uso da PCR em tempo real para HTLV-1 e 2 como teste confirmatório na triagem de doadores de sangue

INTRODUCTION: HTLV-1/2 screening among blood donors commonly utilizes an enzyme-linked immunosorbent assay (EIA), followed by a confirmatory method such as Western blot (WB) if the EIA is positive. However, this algorithm yields a high rate of inconclusive results, and is expensive. METHODS: Two qualitative real-time PCR assays were developed to detect HTLV-1 and 2, and a total of 318 samples were tested (152 blood donors, 108 asymptomatic carriers, 26 HAM/TSP patients and 30 seronegative individuals). RESULTS: The sensitivity and specificity of PCR in comparison with WB results were 99.4 percent and 98.5 percent, respectively. PCR tests were more efficient for identifying the virus type, detecting HTLV-2 infection and defining inconclusive cases. CONCLUSIONS: Because real-time PCR is sensitive and practical and costs much less than WB, this technique can be used as a confirmatory test for HTLV in blood banks, as a replacement for WB.

INTRODUÇÃO: A triagem para HTLV-1/2 em doadores de sangue geralmente utiliza imunoensaio enzimático, seguido de um método confirmatório como Western blot quando o EIA é positivo, mas este algoritmo mostra alta taxa de resultados inconclusivos, e elevado custo. MÉTODOS: Dois ensaios qualitativos de PCR em tempo real foram desenvolvidos para detectar HTLV-1 e 2 e um total de 318 amostras foram testadas por PCR (152 de doadores de sangue, 108 de portadores assintomáticos, 26 de pacientes HAM/TSP e 30 de indivíduos soronegativos). RESULTADOS: A sensibilidade e especificidade das PCR em relação aos resultados de WB foram de 99,4 por cento e 98,5 por cento, respectivamente. As PCR foram mais eficientes em identificar o tipo viral, a infecção pelo HTLV-2 e úteis para definir casos inconclusivos. CONCLUSÕES: Por serem sensíveis, práticas e de custo muito inferior ao do WB, as técnicas de PCR em tempo real podem ser usadas como teste confirmatório do HTLV em bancos de sangue, em substituição ao WB.

HTLV-1 and neurological conditions: when to suspect and when to order a diagnostic test for HTLV-1 infection? / Doenças neurológicas e infecção pelo HTLV-1: quando suspeitar e quando solicitar testes diagnósticos para a infecção pelo HTLV-1

HTLV-1 is a retrovirus associated with a myriad of clinical conditions, especially hematological and neurological ones. Regarding nervous system diseases, it is of utmost importance to select those cases in which HTLV-1 infection could really be associated. This is particularly true for patients from endemic areas and for HIV-infected patients and drug users, since that these groups are at a higher risk for HTLV infection. This caution in selecting neurological patients for HTLV diagnostic tests is justified by the fact that in some circumstances the seropositivity may merely represent an epiphenomenon. In this paper we enroll some neurological conditions that have been associated with HTLV-1/2 infection in the literature and discuss the real need for HTLV-1/2 diagnostic tests in each one. Because HIV/HTLV-co-infected patients seem to be at an increased risk for neurological diseases development, a special consideration about this matter is also made.

O HTLV-1 é um retrovírus associado tanto a doenças hematológicas quanto a doenças neurológicas. Em relação às doenças neurológicas, é fundamental que selecionemos aquelas em que de fato a infecção pelo HTLV-1 possa ser a causa. Isto é particularmente verdadeiro nos pacientes oriundos de áreas endêmicas e nos pacientes infectados pelo HIV e usuários de drogas, haja vista que estes grupos são de risco para infecção pelo HTLV. Este cuidado ao selecionarmos aquelas condições neurológicas que merecem ser investigadas com sorologia para o HTLV se justifica pelo fato de que nem sempre podemos afastar uma associação fortuita entre a infecção e a referida doença. Neste artigo, comentaremos sobre algumas condições neurológicas que podem estar associadas com a infecção pelo HTLV-1/2, discutindo a real necessidade de solicitar testes para o diagnóstico da infecção pelo HTLV-1/2 frente a elas. Uma breve consideração sobre a co-infecção HIV/HTLV será feita no final deste artigo tendo em vista que estes pacientes apresentam um risco aumentado para o desenvolvimento de doenças neurológicas.