Abstract
Human T-lymphotropic virus (HTLV) infection has been under enhanced surveillance in England and Wales since 2002, however, little is known about testing patterns. Using data from two surveillance systems held at Public Health England, we described HTLV antibody testing patterns between 2008 and 2013 and the demographic and clinical characteristics of persons diagnosed with HTLV in England and Wales between 2004 and 2013. An increase in HTLV testing was observed in England between 2008 and 2013 (3,581 to 7,130). Most tests (82%; 7,597/9,302) occurred within secondary care, 0.5% (48/9,302) of persons were reactive for HTLV antibodies and 0.3% (27/9,302) were confirmed positive. Increasing age and female sex were predictors of a reactive HTLV screen and confirmed diagnosis. Testing in primary care including sexual health and antenatal services was infrequent. Between 2004 and 2013, 858 people were diagnosed with HTLV, most of whom were female (65%; 549/851), of black Caribbean ethnicity (60%), not born in the United Kingdom (72%; 369/514) and asymptomatic at diagnosis (45%; 267/595). Despite increased testing, the epidemiology and clinical features of those diagnosed with HTLV have remained consistent. Apart from donor screening, testing for HTLV infection remains uncommon, except to diagnose associated disease.
Highlights
The human T-lymphotropic viruses (HTLV), discovered in the early 1980s [1,2], have infected an estimated 10 million people worldwide [3]
The majority of HTLV-1-infected individuals remain asymptomatic carriers, the other 10% will develop one or more of several diseases [5]: 2–6% will develop adult T-cell leukaemia/lymphoma (ATLL), a highly aggressive T-cell malignancy, while 2–3% develop a variety of chronic inflammatory syndromes, most notably HTLV-1-associated myelopathy (HAM)/tropical spastic paraparesis (TSP) [6]
Other symptoms associated with HTLV infection include uveitis, thyroiditis, alveolitis, polymyositis and an impairment of immunity most strikingly associated with risk of strongyloidiasis observed in those HTLV-1 carriers exposed to Strongyloides stercoralis
Summary
The human T-lymphotropic viruses (HTLV), discovered in the early 1980s [1,2], have infected an estimated 10 million people worldwide [3]. The distribution of infection varies, with seroprevalence among adults ranging between 0.1% and 30% [4]. In Europe and North America, HTLV-1 is predominately found among persons migrating from endemic areas, while HTLV-2 has been associated with injecting drug use [4]. The majority (ca 90%) of HTLV-1-infected individuals remain asymptomatic carriers, the other 10% will develop one or more of several diseases [5]: 2–6% will develop adult T-cell leukaemia/lymphoma (ATLL), a highly aggressive T-cell malignancy, while 2–3% develop a variety of chronic inflammatory syndromes, most notably HTLV-1-associated myelopathy (HAM)/tropical spastic paraparesis (TSP) [6]. There is no vaccine or effective treatment to reduce or eliminate HTLV viral load and treatments available for those who have malignant or inflammatory manifestations of HTLV infection are limited
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