O conhecimento dos profissionais da Atenção Básica em Saúde sobre o Vírus T-linfotrópico Humano / The knowledge of Primary Health Care professionals about the Human T-lymphotropic virus / El conocimiento de los profesionales de la Atención Primaria de Salud sobre el virus linfotrópico T humano

Objetivo: investigar o conhecimento de profissionais de saúde presentes em unidades básicas de saúde (UBS's) sobre o HTLV e as condutas tomadas em caso de infecção. Método:pesquisa quantitativa transversal de abordagem exploratória, sendo realizada por meio de entrevista, com preenchimento de formulário via Google Forms. Realizada em julho de 2023. Resultados:estudo composto por 33 profissionais de saúde, dentre os quais 39% afirmaram desconhecer o HTLV. Essa informação é preocupante, considerando que uma unidade de saúde representa a principal porta de entrada paraos indivíduos em busca de atendimento à saúde. A maioria expressiva, representando 70%, demonstrou conhecimento sobre os meios de prevenção da doença. Porém, a vacinação não foi identificada pela maioria como um método de prevenção, destacando uma percepção menos difundida sobre o papel da vacina nesse contexto. Conclusão:é crucial divulgar pesquisas sobre o tema, criando oportunidades estratégicas para aprimorar tanto a compreensão clínica quanto a empatia no atendimento aos portadores do HTLV, contribuindo assim para a melhoria do diagnóstico, tratamento e qualidade assistencia

Objective:To investigate the knowledge of health professionals present in primary health care units (BHUs) about HTLV and the procedures taken in case of infection. Method:cross-sectional quantitative research with an exploratory approach, carried out through interviews, filling out a form via Google Forms. Carried out in July 2023. Results:study composed of 33 health professionals, of which 39% said they were unaware of HTLV. This information is worrying, considering that a health unit represents the main gateway for individuals seeking health care. The significant majority, representing 70%, demonstrated knowledge about the means of preventing the disease. However, vaccination was not identified by the majority as a prevention method, highlighting a less widespread perception about the role of the vaccine in this context. Conclusion:it is crucial to disseminate research on the topic, creating strategic opportunities to improve both clinical understanding and empathy in the care of HTLV carriers, thus contributing to the improvement of diagnosis, treatment and quality of care.

Objective:To investigate the knowledge of health professionals present in primary health care units (BHUs) about HTLV and the procedures taken in case of infection. Method:cross-sectional quantitative research with an exploratory approach, carried out through interviews, filling out a form via Google Forms. Carried out in July 2023. Results:study composed of 33 health professionals, of which 39% said they were unaware of HTLV. This information is worrying, considering that a health unit represents the main gateway for individuals seeking health care. The significant majority, representing 70%, demonstrated knowledge about the means of preventing the disease. However, vaccination was not identified by the majority as a prevention method, highlighting a less widespread perception about the role of the vaccine in this context. Conclusion:it is crucial to disseminate research on the topic, creating strategic opportunities to improve both clinical understanding and empathy in the care of HTLV carriers, thus contributing to the improvement of diagnosis, treatment and quality of care.

Postural Adjustments in HTLV-1 Infected Patients during a Self-Initiated Perturbation.

BACKGROUND: Human T-cell lymphotropic virus type 1 (HTLV-1) infection can be associated with tropical spastic paraparesis (TSP/HAM), which causes neurological myelopathy and sensory and muscle tone alterations, leading to gait and balance impairments. Once trunk perturbation is predicted, the motor control system uses anticipatory and compensatory mechanisms to maintain balance by recruiting postural muscles and displacement of the body's center of mass. METHODS: Twenty-six participants (control or infected) had lower limb muscle onset and center of pressure (COP) displacements assessed prior to perturbation and throughout the entire movement. RESULTS: Semitendinosus (ST) showed delayed onset in the infected group compared to the control group. The percentage of trials with detectable anticipatory postural adjustment was also lower in infected groups in the tibialis anterior and ST. In addition, COP displacement in the infected group was delayed, had a smaller amplitude, and took longer to reach the maximum displacement. CONCLUSIONS: HTLV-1 infected patients have less efficient anticipatory adjustments and greater difficulty recovering their postural control during the compensatory phase. Clinical assessment of this population should consider postural stability during rehabilitation programs.

Virus linfotrópico humano de células T tipo 1 (HTLV-1) en el embarazo / Human lymphotropic virus in T-cell type 1 (HTLV-1) during pregnancy

El HTLV-1 es un retrovirus que afecta principalmente a los linfocitos T-CD4, causando enfermedades como paraparesia espástica o mielopatía, uveítis, dermatitis infecciosas, leucemia/linfoma de las células T del adulto, además de otras enfermedades. Causa una infección crónica de por vida en humanos y su transmisión ocurre a través de la lactancia materna, el contacto sexual y las transfusiones de sangre. En Chile actualmente ocupa el cuarto lugar en notificaciones entre el año 2014-2021, estimándose a nivel mundial más de 20 millones de portadores. El mayor riesgo de transmisión ocurre por lactancia mayor a seis meses y alta carga proviral y altos títulos de anticuerpos en la madre portadora. El objetivo consistió en analizar la situación de la portación del virus HTLV-1 durante el embarazo, determinando su prevalencia, vías de transmisión y complicaciones. Se realizó una revisión bibliográfica sistemática de artículos publicados en bases de datos científicas referidos al virus HTLV-1. Este virus está globalmente diseminado y se presenta en forma endémica en algunas regiones del mundo con prevalencias entre muy elevadas y bajas. En Chile la seroprevalencia en promedio es de 0,124% para HTLV-1. Esta infección no cuenta con tratamiento, solo se tratan los síntomas por lo que mientras esto no cambie, solo es factible reducir la transmisión, incidencia y la morbilidad del HTLV-1 incorporando medidas de control del virus en las intervenciones de control de enfermedades y estrategias de salud pública. La forma más eficiente de transmisión del virus madre-hijo es a través de la leche materna, es necesario implementar la detección prenatal de HTLV-1, en especial en las zonas endémicas, así como también asesorar a las madres HTVL-1 positivas sobre la lactancia materna.

HTLV-1 is a retrovirus that mainly affects CD4-T lymphocytes, causing diseases such as spastic paraparesis or myelopathy, uveitis, infectious dermatitis, adult T-cell leukemia/lymphoma, and other diseases. It causes a lifelong chronic infection in humans and its transmission occurs through breastfeeding, sexual contact and blood transfusions. In Chile, it currently ranks fourth in notifications between the years 2014-2021, with more than 20 million carriers being estimated worldwide. The greatest risk of transmission occurs by breastfeeding for more than six months and high proviral load and high antibody titers in the carrier mother. The objective consisted of analyzing the situation of the carriage of the HTLV-1 virus during pregnancy, determining its prevalence, transmission routes and complications. A systematic bibliographic review of articles published in scientific databases referring to the HTLV-1 virus was carried out. This virus is globally disseminated and occurs endemic in some regions of the world with prevalence between very high and low. In Chile, the average seroprevalence is 0.124% for HTLV-1. There is no treatment for this infection, only the symptoms are treated, so as long as this does not change, it is only feasible to reduce the transmission, incidence, and morbidity of HTLV-1 by incorporating virus control measures into disease control interventions and strategies. of public health. The most efficient form of mother-child transmission of the virus is through breast milk, it is necessary to implement prenatal screening for HTLV-1, especially in endemic areas, as well as counsel HTLV-1 positive mothers on breastfeeding

Hiperinfección por Strongyloides stercoralis en un paciente joven con infección por HTLV-1 y colitis ulcerativa / Strongyloides stercolaris hyperinfection in a young patient with HTLV-1 infection and ulcerative colitis

Resumen La estrongiloidiasis es una infección causada por el parásito Strongyloides stercoralis (SS) y se asocia con una alta mortalidad en pacientes inmunosuprimidos debido a una diseminación larvaria y síndrome de hiperinfección. El compromiso de la mucosa gástrica es raro, pero cuando se presenta se caracteriza por sangrado digestivo y emesis persistente. A continuación, se presenta el caso de un paciente de 27 años con síntomas gastrointestinales, antecedente de infección por el virus linfotrópico humano de células T tipo 1 (HTLV-1) y colitis ulcerativa, quien desarrolló síndrome de hiperinfección por SS. Se describe la presentación clínica, diagnóstico, tratamiento y complicaciones derivadas del cuadro infeccioso.

Abstract Strongyloidiasis is an infection caused by the parasite Strongyloides stercolaris (SS) and is associated with high mortality in immunosuppressed patients due to larval spread and hyperinfection syndrome. Gastric mucosal involvement is rare, but when it occurs, it is characterized by digestive bleeding and persistent emesis. The following is the case of a 27-year-old patient with gastrointestinal symptoms, a history of HTLV-1 infection and ulcerative colitis, who developed hyperinfection syndrome with SS. The clinical presentation, diagnosis, treatment and complications arising from the infectious disease are described.

Uncommon Association Between Diabetic Ketoacidosis, Thyrotoxicosis, Cutaneous Abscess and Acute Pericarditis in an Immunocompetent Patient: A Single Case Report and Literature Review.

INTRODUCTION: The typical factors precipitating diabetic ketoacidosis (DKA) include infections (30%), cessation of antidiabetic medication (20%), and a new diagnosis of diabetes (25%). The etiology remains unknown in 25% of cases. Less frequent causes cited in the literature include severe thyrotoxicosis and, infrequently, pericarditis. Few publications have described the role of human T lymphotropic virus type 1 (HTLV-1) in endocrine and metabolic disorders. Based on a clinical case associated with several endocrine and metabolic disorders, we suggest a potential role for HTLV-1, an endemic virus in the Amazonian area, and review the literature concerning the role of this virus in thyroiditis, pericarditis and diabetes mellitus. CASE REPORT: A fifty-year-old Surinamese woman without any medical history was admitted for diabetic ketoacidosis. No specific anti-pancreatic autoimmunity was observed, and the C-peptide level was low, indicating atypical type-1 diabetes mellitus. DKA was associated with thyrotoxicosis in the context of thyroiditis and complicated by nonbacterial pericarditis and a Staphylococcus aureus subcutaneous abscess. The patient was infected with HTLV-1. CONCLUSION: To our knowledge, this uncommon association is described for the first time. Few studies have analyzed the implications of HTLV-1 infection in thyroiditis and diabetes mellitus. We did not find any reports describing the association of pericarditis with HTLV-1 infection. Additional studies are necessary to understand the role of HTLV-1 in endocrine and cardiac disorders.

Characterization of cognitive performance and evaluation of quality of life among patients with HTLV-1.

OBJECTIVE: To characterize cognitive alterations among patients with HTLV-1, ascertain what is associated with these alterations and evaluate these patients' quality of life. PATIENTS AND METHODS: This was a cross-sectional study. Patients infected by HTLV-1 who were seen at the Oswaldo Cruz University Hospital from March 2014 to June 2015 were included in the study. A semi-structured questionnaire and the Mini-Mental State Examination, Color Trails Test, Wechsler Adult Intelligence Scale (WAIS-III), Hospital Anxiety and Depression Scale and Medical Outcomes Study 36-Item Short-Form Health Survey (SF36) were used. "Low IQ" scores were defined for WAIS-III as under 80 points. Results Fifty-five patients were evaluated: 26% presented altered MMSE, 38%, altered Color Trails Test; 10.9% presented low total IQ; 12.7%, low executive IQ; and 10.9%, low verbal IQ. There was no association between low total IQ and any characteristics of the patient or of the HTLV infection. Paraparesis and anxiety disorders were significantly associated with worse quality of life. CONCLUSION: High frequency of cognitive impairment was found in patients with HTLV, thus suggesting that these alterations are an important clinical manifestation of this virus.

Prevalence and risk factors for Human T-Lymphotropic Virus Type 1 (HTLV-1) among maintenance hemodialysis patients.

BACKGROUND: Infection with the human T-cell lymphotropic virus type 1 (HTLV-1), although asymptomatic in most cases, can lead to potentially grave consequences, such as adult T-cell leukemia-lymphoma and HTLV-1-associated myelopathy / tropical spastic paraparesis. Its prevalence varies widely across different populations and geographic regions. A population-based study in the city of Salvador, located in the Northeast region of Brazil, showed an overall prevalence of HTLV-1 seropositivity of 1.7%. Blood borne virus infections are recognized as important hazards for patients and staff in maintenance hemodialysis (MHD) units but most studies focus on hepatitis B, hepatitis C and human immunodeficiency viruses. There are scarce data about HTLV-1 infection in the MHD population. We aimed to determine the prevalence and risk factors for HTLV-1 infection among MHD patients in the city of Salvador-Bahia, Brazil. METHODS: We conducted a multi-center, cross-sectional study nested in a prospective cohort of MHD patients enrolled from four outpatient clinics. HTLV-1 screening was performed with ELISA and positive cases were confirmed by Western Blot. Factors associated with HTLV-1 seropositivity were identified by multivariable logistic regression. RESULTS: 605 patients were included in the study. The overall prevalence of HTLV-1 infection was 2.48% (15/605), which was similar to that of hepatitis B [1.98% (12/605)] and C [3.14% (19/605)] viruses in our sample. HTLV-1 seropositivity was positively associated with age [prevalence odds ratio (POR) 1.04; 95% confidence interval (CI) 1.01-1.08], unmarried status (POR 3.65; 95% CI 1.13-11.65), and history of blood transfusion (POR 3.35; 95% CI 1.01-11.13). CONCLUSIONS: The overall prevalence of HTLV-1 infection in a sample of MHD patients was similar to that of other viral infections, such as hepatitis B and C. Our data revealed that MHD patients who are older, unmarried or who have received blood transfusions are at higher risk for HTLV-1 infection.

Tuberculosis incidence in a cohort of individuals infected with human T-lymphotropic virus type 1 (HTLV-1) in Salvador, Brazil.

BACKGROUND: Few reports have investigated the association between human T-lymphotropic virus type 1 (HTLV-1) and tuberculosis (TB) in countries where both infections are endemic. This study estimates the incidence of TB in a cohort infected with HTLV-1, compared with non-infected individuals, over a ten-year period. METHODS: Retrospective cohort study involving the cross-matching of records of individuals for whom a HTLV serology was performed at a referral center for HTLV (CHTLV) with a database of TB cases from Sinan-the Information System on Diseases of Compulsory Declaration between 2002 and 2012. RESULTS: From a cohort of 6,495 individuals, 1,711 were infected with HTLV-1. A total of 73 TB cases occurred during the study period: 33 HTLV-1-infected patients and 40 uninfected individuals. The incidence density for TB in the HTLV-1 infected group was 3.3 person-years per 1,000 individuals and 1.1 person-years per 1,000 individuals in the group HTLV-1 uninfected group. The relative risk of developing TB in the group of patients infected with HTLV-1 was 2.6 (CI 95 % 1.6-4.2) in comparison with HTLV-1 uninfected group. Compared to individuals with isolated TB, those in the HTLV-1 infected group who had TB were older (p = 0.005) and had lower education levels (p = 0.02). No differences were observed with respect to the clinical/radiological presentation, nor in the outcome of TB and prevalence of HIV infection, when comparing among the HTLV-1-infected and uninfected groups. CONCLUSIONS: Patients infected with HTLV-1 are more susceptible to TB. The epidemiological characteristics of HTLV-1/TB subjects and those infected with TB overlap.

HTLV-1, Immune Response and Autoimmunity.

Human T-lymphotropic virus type-1 (HTLV-1) infection is associated with adult T-cell leukemia/lymphoma (ATL). Tropical spastic paraparesis/HTLV-1-associated myelopathy (PET/HAM) is involved in the development of autoimmune diseases including Rheumatoid Arthritis (RA), Systemic Lupus Erythematosus (SLE), and Sjögren's Syndrome (SS). The development of HTLV-1-driven autoimmunity is hypothesized to rely on molecular mimicry, because virus-like particles can trigger an inflammatory response. However, HTLV-1 modifies the behavior of CD4⁺ T cells on infection and alters their cytokine production. A previous study showed that in patients infected with HTLV-1, the activity of regulatory CD4⁺ T cells and their consequent expression of inflammatory and anti-inflammatory cytokines are altered. In this review, we discuss the mechanisms underlying changes in cytokine release leading to the loss of tolerance and development of autoimmunity.

Soroprevalência do vírus linfotrópico de células T humanas (HTLV) entre doadores de sangue em hemocentros de Maringá-Paraná e Boa Vista-Roraima / Seroprevalence of Human T Cell Lymphotropic Virus (HTLV) among blood donors in blood centers in Maringá-Paraná and Boa Vista-Roraima / La seroprevalencia del virus linfotrópico de células T humanas (HTLV) entre los donantes de sangre en los bancos de sangre de Maringá-Paraná y Boa Vista-Roraima

OBJETIVO: descrever a soroprevalência do vírus linfotrópico de células T humanas (HTLV) entre doadores de sangue em hemocentros nos municípios de Maringá-PR e Boa Vista-RR, Brasil. MÉTODO: estudo descritivo com dados secundários dos resultados de exames realizados em amostras de sangue de doações realizadas no período de 2001 a 2010 em Maringá, e de 2007 a 2010 em Boa Vista. RESULTADOS: foram estudadas 126.386 doações em Maringá e 50.855 em Boa Vista; considerando-se os registros de sorologia positiva para HTLV, foi possível constatar que em Maringá, entre 2007 e 2010, o número de casos permaneceu baixo e estável, enquanto em Boa Vista, ocorreu aumento de 1,6 para 11,2 casos positivos para cada 10 mil doações. CONCLUSÃO: evidenciou-se perfil epidemiológico distinto entre os doadores dos hemocentros nas duas cidades, sugerindo a necessidade de incremento das ações com enfoque mais regionalizado, para a prevenção da transmissão do HTLV no Brasil.

OBJECTIVE: to describe human T cell lymphotropic virus (HTLV) seroprevalence among blood donors at blood centers in Maringá-Paraná and Boa Vista-Roraima. METHODS: this was a descriptive study of secondary data of tests on blood samples from first time and loyal donors in Maringá (2001-2010) and Boa Vista (2007-2010). RESULTS: 126,386 blood donations were studied in Maringá and 50,855 in Boa Vista. Based on the records of positive serology for HTLV between 2007 and 2010, the number of cases in Maringá remained low and stable, while in Boa Vista it increased from 1.6 to 11.2 positive cases per 10,000 donations. CONCLUSION: this study showed a different epidemiological profile among donors in the two cities. This suggests the need to increase actions with a more regionalized approach to preventing HTLV virus transmission in Brazil.

OBJETIVO: evaluar la seroprevalencia de infección por el virus linfotrópico de células T humanas (HTLV) en donantes en los bancos de sangre de Maringá (PR) y Boa Vista (RR). MÉTODO: estudio descriptivo de los datos secundarios de laboratorio realizados con muestras de las donaciones de sangre entre 2001 y 2010 en la ciudad de Maringá y 2007-2010 en Boa vista. RESULTADOS: se estudiaron 126.386 donaciones en Maringá y 50.855 en Boa Vista; considerándose los registros de serología positiva para HTLV, se encontró que en Maringá entre los años 2007 a 2010, el núme ro de casos se mantuvo bajo y estable, mientras que en Boa Vista se incrementaron 1,6 a 11,2 casos positivos para cada 10 mil donaciones. CONCLUSIÓN: el presente estudio mostró diferencia epidemiológica entre las ciudades de Maringá y Boa Vista, lo que sugiere la necesidad de incrementar las acciones con enfoque más regional para prevenir la transmisión del virus HTLV en Brasil.

Human T-lymphotropic virus type 1 infection is frequent in rural communities of the southern Andes of Peru.

OBJECTIVES: To evaluate the presence of human T-lymphotropic virus type 1 (HTLV-1) infection in isolated rural communities in the southern Andes of Peru. METHODS: We conducted a cross-sectional study in five communities located in three provinces in Ayacucho, Peru. The five communities are located at >3000 meters above sea level and are mainly rural, and more than 85% of the population speaks Quechua. Volunteers aged 12 years and older were included. Clinical and epidemiological data were collected, along with a blood sample for serological testing. RESULTS: We included 397 participants; their median age was 41 years (interquartile range 31-57 years) and 69% were women. According to our definitions, 98% were of Quechua origin. HTLV-1 was diagnosed in 11 people: 0/164 in Cangallo, 3/154 (2%) in Vilcashuaman, and 8/79 (10%) in Parinacochas. There were no cases of HTLV-2. All the HTLV-1-positive participants were born in Ayacucho and were of Quechua origin; they ranged in age from 29 to 87 years (median 56 years) and 10/11 were women. Ten were apparently healthy, and one woman was diagnosed with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Three out of 11 had a family member with a lower limb impairment compatible with HAM/TSP. CONCLUSION: The fact that HTLV-1 infection was present in two out of three provinces suggests that HTLV-1 could be highly endemic in the southern Andes in the Quechua population.

Standardisation of Western blotting to detect HTLV-1 antibodies synthesised in the central nervous system of HAM/TSP patients

Intrathecal synthesis of human T-lymphotropic virus type 1 (HTLV-1) antibodies (Abs) represents conclusive evidence of a specific immune response in the central nervous system of HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients. Western blotting (WB) for HTLV Abs in serum is a confirmatory test for HTLV-1 infection. The aim of this study was to standardise the Western blot to demonstrate the intrathecal pattern of Abs against HTLV-1 proteins in HAM/TSP patients. Paired cerebrospinal fluid (CSF) and serum samples were selected from 20 patients with definite HAM/TSP, 19 HTLV-1 seronegative patients and two HTLV-1 patients without definite HAM/TSP. The presence of reactive bands of greater intensity in the CSF compared to serum (or bands in only the CSF) indicated the intrathecal synthesis of anti-HTLV-1 Abs. All definite HAM/TSP patients presented with an intrathecal synthesis of anti-HTLV-1 Abs; these Abs were not detected in the control patients. The most frequent intrathecal targets of anti-HTLV-1 Abs were GD21, rgp46-I and p24 and, to a lesser extent, p19, p26, p28, p32, p36, p53 gp21 and gp46. The intrathecal immune response against env (GD21 and rgp46-I) and gag (p24) proteins represents the most important humoral pattern in HAM/TSP. This response may be used as a diagnostic marker, considering the frequent association of intrathecal anti-HTLV-1 Ab synthesis with HAM/TSP and the pathogenesis of this neurological disease.

Vírus linfotrópicos de células T humanas dos tipos 1 e 2 (HTLV-1 e HTLV-2): estudo de segmentos do genoma proviral obtidos de pacientes com HIV/Aids de São Paulo e de Londrina e região / Human T-lymphotropic virus type 1 and 2 (HTLV-1 and HTLV-2): study on proviral genome segments obtained from patients with HIV/Aids from Sao Paulo and Londrina and vicinities

O Brasil é considerado o país com o maior número absoluto de indivíduos infectados pelos vírus linfotrópicos de células T humanas dos tipos 1 e 2 (HTLV-1 e HTLV2), perto de 2,5 milhões; além disso, é também considerado epidêmico para o HIV e, portanto, casos de coinfecção HIV/HTLV são frequentes no país. O presente trabalho efetuou o seqüenciamento das regiões LTR, env e tax do genoma proviral do HTLV-1 e do HTLV-2 isolados das amostras de sangue de pacientes coinfectados pelo HIV-1 de Londrina e região (n=34) e de São Paulo (n=20), para realizar a caracterização molecular e determinar subtipos virais. Foram utilizadas na análise das sequências as ferramentas Sequencher 4.7, BLAST, Genotyping-NCBI, Subtyping-REGA, BioEdit 7.0.5.3, ClustalW, GenBank, PAUP 4.0.b10, Modeltest 3.7, TreeView 1.6.6 e MEGA4. As diversas análises confirmaram como subtipos prevalentes o HTLV-1a, subgrupo Transcontinental A, e o HTLV-2a (variante -2c). Foram detectadas assinaturas moleculares nos isolados do Brasil. Detectou-se o genótipo brasileiro taxA para o HTLV-1 e para o HTLV-2 a Tax longa, a qual é característica da variante HTLV-2c. Houve também a confirmação da troca de aminoácido S1909P no env dos HTLV-2. Especulou-se sobre duas entradas do HTLV-1 no Brasil e sobre a disseminação do HTLV-2c em grupos distintos quanto ao comportamento de risco e região geográfica. O estabelecimento de métodos laboratoriais otimizados para isolados brasileiros de HTLV-1 e HTLV-2 possibilitou melhor compreensão da diversidade genômica e da origem e disseminação dos HTLVs em populações coinfectadas pelo HIV no Brasil

Brazil is considered the country with the major absolute number of individuals infected with human T-lymphotropic virus types 1 and 2 (HTLV-1 and HTLV-2), close to 2,500,000; moreover, it is also considered epidemic for HIV/Aids =and therefore HIV/HTLV coinfection is frequent in the country. This study aimed at sequencing the LTR, env and tax regions of the proviral genome of HTLV-1 and HTLV-2 isolated from blood samples obtained from patients coinfected with HIV-1 from Londrina and vicinities (n=34) and São Paulo (n=20), in order to perform the molecular characterization and viral subtyping. For sequences analysis, several bioinformatics tools were employed: Sequencher 4.7, BLAST, Genotyping-NCBI, Subtyping-REGA, BioEdit 7.0.5.3, ClustalW, GenBank, PAUP 4.0.b10, Modeltest 3.7, TreeView 1.6.6 and MEGA4. The results confirmed as prevalent the HTLV-1a subtype, the Transcontinental subgroup A, and the HTLV-2a (variant-2c). Molecular signatures characteristic of Brazilian isolates were detected: taxA Brazilian genotype in HTLV-1, and the long Tax which is characteristic of the HTLV-2c in HTLV-2. Also, it was confirmed the S1909P amino acid change in the env region of HTLV-2c. It was speculated on two entrances of HTLV-1 in Brazil, and on the spread of HTLV-2c in distinct groups related to risk factors and geographic region. The establishment and optimization of laboratory methods performed in this study allowed to get a better understanding on HTLVs genomic diversity, and to give insights on the origin and spread of HTLVs in populations coinfected with HIV in Brazil

Human T-Lymphotropic virus (HTLV) type I in vivo integration in oral keratinocytes

Although the infection of HTLV-1 to cell components of the mouth have been previously reported, there was not until this report, a detailed study to show the characteristics of such infection. From 14 Tropical Spastic Paraparesis/ HTLV-1-Associated Myelopathy (HAM/TSP) patients and 11 asymptomatic carrier individuals (AC) coming from HTLV-1 endemic areas of southwest Pacific of Colombia, infected oral mucosa cells were primary cultured during five days. These cell cultures were immunophenotyped by dual color fluorescence cell assortment using different lymphocyte CD markers and also were immunohistochemically processed using a polyclonal anti-keratin antibody. Five days old primary cultures were characterized as oral keratinocytes, whose phenotype was CD3- /CD4-/CD8-/CD19-/CD14-/CD45-/A575-keratin+. From DNA extracted of primary cultures LTR, pol, env and tax HTLV-1 proviral DNA regions were differentially amplified by PCR showing proviral integration. Using poly A+ RNA obtained of these primary cultures, we amplify by RT-PCR cDNA of tax and pol in 57.14 percent (8/14) HAM/TSP patients and 27.28 percent (3/11) AC. Tax and pol poly A+ RNA were expressed only in those sIgA positive subjects. Our results showed that proviral integration and viral gene expression in oral keratinocytes are associated with a HTLV-1 specific local mucosal immune response only in those HTLV-1 infected individuals with detectable levels of sIgA in their oral fluids. Altogether the results gave strong evidence that oral mucosa infection would be parte of the systemic spreading of HTLV-1 infection.

Human T-Lymphotropic Virus (HTLV) Type I in vivo Integration in Oral Keratinocytes.

Although the infection of HTLV-1 to cell components of the mouth have been previously reported, there was not until this report, a detailed study to show the characteristics of such infection. From 14 Tropical Spastic Paraparesis/HTLV-1-Associated Myelopathy (HAM/TSP) patients and 11 asymptomatic carrier individuals (AC) coming from HTLV-1 endemic areas of southwest Pacific of Colombia, infected oral mucosa cells were primary cultured during five days. These cell cultures were immunophenotyped by dual color fluorescence cell assortment using different lymphocyte CD markers and also were immunohistochemically processed using a polyclonal anti-keratin antibody. Five days old primary cultures were characterized as oral keratinocytes, whose phenotype was CD3- /CD4-/CD8-/CD19-/CD14-/CD45-/A575-keratin+. From DNA extracted of primary cultures LTR, pol, env and tax HTLV-1 proviral DNA regions were differentially amplified by PCR showing proviral integration. Using poly A+ RNA obtained of these primary cultures, we amplify by RT-PCR cDNA of tax and pol in 57.14% (8/14) HAM/TSP patients and 27.28% (3/11) AC. Tax and pol poly A+ RNA were expressed only in those sIgA positive subjects. Our results showed that proviral integration and viral gene expression in oral keratinocytes are associated with a HTLV-1 specific local mucosal immune response only in those HTLV-1 infected individuals with detectable levels of sIgA in their oral fluids. Altogether the results gave strong evidence that oral mucosa infection would be parte of the systemic spreading of HTLV-1 infection.

Human T-Lymphotropic virus (HTLV) type I in vivo integration in oral keratinocytes

Although the infection of HTLV-1 to cell components of the mouth have been previously reported, there was not until this report, a detailed study to show the characteristics of such infection. From 14 Tropical Spastic Paraparesis/ HTLV-1-Associated Myelopathy (HAM/TSP) patients and 11 asymptomatic carrier individuals (AC) coming from HTLV-1 endemic areas of southwest Pacific of Colombia, infected oral mucosa cells were primary cultured during five days. These cell cultures were immunophenotyped by dual color fluorescence cell assortment using different lymphocyte CD markers and also were immunohistochemically processed using a polyclonal anti-keratin antibody. Five days old primary cultures were characterized as oral keratinocytes, whose phenotype was CD3- /CD4-/CD8-/CD19-/CD14-/CD45-/A575-keratin+. From DNA extracted of primary cultures LTR, pol, env and tax HTLV-1 proviral DNA regions were differentially amplified by PCR showing proviral integration. Using poly A+ RNA obtained of these primary cultures, we amplify by RT-PCR cDNA of tax and pol in 57.14% (8/14) HAM/TSP patients and 27.28% (3/11) AC. Tax and pol poly A+ RNA were expressed only in those sIgA positive subjects. Our results showed that proviral integration and viral gene expression in oral keratinocytes are associated with a HTLV-1 specific local mucosal immune response only in those HTLV-1 infected individuals with detectable levels of sIgA in their oral fluids. Altogether the results gave strong evidence that oral mucosa infection would be parte of the systemic spreading of HTLV-1 infection.

Hepatitis C virus and human T-lymphotropic virus coinfection: epidemiological, clinical, laboratory and histopathological features / Coinfecção vírus da hepatite C-vírus linfotrópico de células T humanas: aspectos epidemiológicos, clínicos, laboratoriais e histopatológicos

Twenty-four hepatitis C virus patients coinfected with human T-lymphotropic virus type 1 were compared with six coinfected with HTLV-2 and 55 with HCV alone, regarding clinical, epidemiological, laboratory and histopathological data. Fischer's discriminant analysis was applied to define functions capable of differentiating between the study groups (HCV, HCV/HTLV-1 and HCV/HTLV-2). The discriminant accuracy was evaluated by cross-validation. Alcohol consumption, use of intravenous drugs or inhaled cocaine and sexual partnership with intravenous drug users were more frequent in the HCV/HTLV-2 group, whereas patients in the HCV group more often reported abdominal pain or a sexual partner with hepatitis. Coinfected patients presented higher platelet counts, but aminotransferase and gamma-glutamyl transpeptidase levels were higher among HCV-infected subjects. No significant difference between the groups was seen regarding liver histopathological findings. Through discriminant analysis, classification functions were defined, including sex, age group, intravenous drug use and sexual partner with hepatitis. Cross-validation revealed high discriminant accuracy for the HCV group.

Compararam-se 24 pacientes coinfectados pelos vírus da hepatite C/vírus linfotrópico de células T humanas do tipo 1 com 6 coinfectados por VHC/HTLV-2 e 55 infectados pelo VHC, no tocante a dados clínico-epidemiológicos, laboratoriais e histopatológicos. A análise discriminante de Fischer foi utilizada para definir funções capazes de diferenciar os grupos de estudo (VHC, VHC/HTLV-1 e VHC/HTLV-2). A acurácia discriminatória foi avaliada pelo por validação cruzada. O uso de álcool, drogas endovenosas, cocaína inalatória e a parceria sexual com UDEV foram mais freqüentes no grupo VHC/HTLV-2, enquanto queixa de dor abdominal e parceiro sexual com hepatite predominaram no grupo VHC. Os coinfectados apresentaram número maior de plaquetas, enquanto as aminotransferases e a gamaglutamiltranspeptidase foram mais altas no grupo VHC. Não houve diferença entre os grupos à análise histopatológica do fígado. Por análise discriminante definiram-se funções classificatórias, incluindo as variáveis sexo, faixa etária, uso de drogas endovenosas e parceiro sexual com hepatite, com acurácia discriminante alta para o grupo VHC.