Abstract
Mother-to-child transmission (MTCT) of Human T-cell lymphotropic virus type 1 (HTLV-1) causes lifelong infection. At least 5–10 million individuals worldwide are currently living with HTLV-1. Studies of regional variation are required to better understand the contribution of MTCT to the global burden of infection. Although most infected individuals remain asymptomatic ∼10% develop high morbidity, high mortality disease. Infection early in life is associated with a higher risk of disease development. Adult T-cell leukemia (ATL), which is caused by HTLV-1 and has a median survival of 8 months is linked to MTCT, indeed evidence of ATL following infection as an adult is sparse. Infective dermatitis also only occurs following neonatal infection. Whilst HTLV-1-associated myelopathy (HAM) follows sexual and iatrogenic infection approximately 30% of patients presenting with HAM/TSP acquired the infection through their mothers. HAM/TSP is a disabling neurodegenerative disease that greatly impact patient’s quality of life. To date there is no cure for HTLV-1 infection other than bone marrow transplantation for ATL nor any measure to prevent HTLV-1 associated diseases in an infected individual. In this context, prevention of MTCT is expected to contribute disproportionately to reducing both the incidence of HTLV-1 and the burden of HTLV-1 associated diseases. In order to successfully avoid HTLV-1 MTCT, it is important to understand all the variables involved in this route of infection. Questions remain regarding frequency and risk factors for in utero peri-partum transmission whilst little is known about the efficacy of pre-labor cesarean section to reduce these infections. Understanding the contribution of peripartum infection to the burden of disease will be important to gauge the risk-benefit of interventions in this area. Few studies have examined the impact of HTLV-1 infection on fertility or pregnancy outcomes nor the susceptibility of the mother to infection during pregnancy and lactation. Whilst breast-feeding is strongly associated with transmission and avoidance of breast-feeding a proven intervention little is known about the mechanism of transmission from the breast milk to the infant and there have been no clinical trials of antiretroviral therapy (ARV) to prevent this route of transmission.
Highlights
Human T-cell lymphotropic virus type 1 (HTLV-1) is a human retrovirus that is mostly transmitted through sexual intercourse and from mother-to-child
In a case-control study in Gabon of 45 HTLV-1 infected mothers each matched to two controls higher rates of preterm delivery (11% vs. 2.7%), complicated pregnancy (36.5% vs. 22%) and cesarean sections (8% vs. 3%) were observed in HTLV-1 infected women compared to the control group, but none of these differences were statistically significant (Ville et al, 1991)
While the production observed was parallel in PBMC and BMMC from the same patient, it did not correlate with maternal anti-HTLV-1 antibody titers, indicating that the cytotoxic T cell response could be more important than humoral response to control HTLV-1 load and, vertical transmission (Yoshinaga et al, 1995)
Summary
Human T-cell lymphotropic virus type 1 (HTLV-1) is a human retrovirus that is mostly transmitted through sexual intercourse and from mother-to-child. In a case-control study in Gabon of 45 HTLV-1 infected mothers each matched to two controls higher rates of preterm delivery (11% vs 2.7%), complicated pregnancy (36.5% vs 22%) and cesarean sections (8% vs 3%) were observed in HTLV-1 infected women compared to the control group, but none of these differences were statistically significant (Ville et al, 1991). In Brazil, HTLV screening in germinative cells donors and patients seeking for assisted reproduction is implemented (ANVISA, 2011) Another point that needs more attention is about the impact of HTLV-1 infection in the psychological health of pregnant women and parturient (Carneiro-Proietti et al, 2014).
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