Human T-cell leukemia virus type 1 infection among Japanese immigrants and their descendants living in Southeast Brazil: A call for preventive and control responses.

Larissa M Bandeira,Ana C P Vicente,Sabrina M S Weis-Torres,Grazielli R Rezende,Silvia N O Uehara,Marco A M Puga,Juliana Yamashiro,João A Domingos,Aluísio C Segurado,Murilo O Saito,Youko Nukui,Ana R C Motta-Castro,Osnei Okumoto,João R R Pinho,Gabriela A Cesar,Jorge Casseb,Tayana S O Tanaka,Rivaldo V Cunha,Graham P Taylor

doi:10.1371/journal.pntd.0009066

Abstract

Human T-cell leukemia virus type 1 (HTLV-1) has worldwide distribution and is considered endemic in southwestern Japan. HTLV-1 infection has been associated with adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) besides other diseases. This cross-sectional study aimed to investigate the prevalence, risk factors and molecular characterization of HTLV-1, among the world’s largest population of Japanese immigrants and their descendants outside of Japan, in São Paulo, Southeast Brazil, as well as to analyze the phylogenetic relationship among isolates of HTLV-1. From July to December 2017, 2,139 individuals from five Japanese associations were interviewed and submitted to blood collection. All serum samples were first tested for the presence of anti-HTLV-1/2 antibodies by ELISA and then peripheral blood from individuals with positive serological results were analyzed for the presence of HTLV-1 5’LTR proviral DNA. Partial sequencing of the 5’LTR region of HTLV-1 proviral DNA was performed by Sanger. The prevalence of HTLV-1 infection was 5.1% (CI 95%: 4.2–6.0). In the multiple logistic regression model, HTLV-1 infection was associated with age ≥ 45 years, female sex, being first and second-generation Japanese immigrants, and having sexual partners with history of blood transfusion. The phylogenetic analysis revealed that all HTLV-1 were classified as Cosmopolitan (1a) subtype. Of them, 47.8% were classified as Transcontinental (A) subgroup and 52.2% as belonging to the Japanese (B) subgroup. Although most HTLV-1-infected patients were asymptomatic (97.3%), blurred vision was associated with HTLV-1 infection. The high prevalence of HTLV-1 infection found in this studied population and especially the intra- and interfamily HTLV-1 transmission presents an urgent call for preventive and control responses of this infection in Brazil.

Highlights

What is the prevalence of Human T-cell leukemia virus type 1 (HTLV-1) among the largest world population of Japanese immigrants and their descendants outside Japan? There are approximately 1.5 million people of Japanese descent in Brazil and most of them living in São Paulo state, Southeast Brazil
The prevalence of 5.1% of HTLV-1 infection found in this study is higher than those observed in other studies conducted in HTLV-1 endemic areas and in specific groups at high risk from Brazil
The high prevalence of HTLV-1 infection found in this studied population presents an urgent call for preventive and control responses of this infection in Brazil

Summary

Introduction

Human T-cell leukemia virus type 1 (HTLV-1) has been associated with an aggressive malignant disease known as adult T-cell leukemia/lymphoma (ATL) and a chronic inflammatory neurological disease known as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) [1]. Inflammatory disorders such as uveitis, dermatitis, arthritis, myositis, and an immune-deficient state, resulting in bronchiectasis have been associated with this retrovirus [2]. The total number of HTLV-1 carriers in Japan was estimated to be 1.08 million with highly variable geographical distribution of HTLV-1 seroprevalence among blood donors [11]. Japan has been a leader in implementing several strategies to prevent new HTLV-1 infections, including antenatal HTLV-1 antibody screening, recommending seropositive mothers to refrain from breastfeeding, and screening all blood donors for HTLV-1 infection since 1986 [12]

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