HTLV-II Infection Research Articles

A novel high-performance rapid screening test for the detection of total HTLV-I and HTLV-II antibodies in HTLV-I/II infected patients

Rapid diagnosis of human T-cell lymphotropic virus (HTLV) type-I and -II infections are essential for timely and cost-effective disease interventions. MP Diagnostics ASSURE HTLV-I/II Rapid Test was developed for the rapid detection of anti-HTLV-I/II antibodies in patients’ serum, plasma, and whole blood specimens. ASSURE HTLV-I/II Rapid Test employed MP Biomedicals’ proprietary HTLV-I/II Trifusion recombinant antigen conjugated with gold nanoparticles and HTLV-I / HTLV-II recombinant antigens immobilized on the nitrocellulose membrane to detect total HTLV-I and HTLV-II antibodies. The overall performance of the ASSURE HTLV-I/II Rapid Test was found to be 99.42% sensitivity (95% Confidence Interval, 98.32–99.88%) and 100% specificity (95% Confidence Interval, 99.58–100.00%) in the tested clinical samples, including a total of 518 HTLV-I/II positive specimens (396 HTLV-I infection, 97 HTLV-II infection and 25 HTLV-I/II dual infection) and 872 HTLV negative clinical specimens consisting of 691 healthy donor samples, 116 potentially cross-reactive samples, and 65 samples with interfering substances. The ASSURE HTLV-I/II Rapid Test can effectively be deployed as a screening tool in any prevalence studies, blood banks or organ transplant centres.

Risk of Transmission of Human T-Lymphotropic Virus Through Transplant

To the Editor: As Ramanan et al indicate in their report of the first human T-lymphtropic virus (HTLV) associated myelopathy acquired through live donor kidney transplant in the United States, prevalence of HTLV infection varies considerably in different parts of the world 1. Seroprevalence of HTLV as high as 4.4% has been reported in Central Brooklyn 2. We conducted an Institutional Review Board-approved review of serostatus of 362 potential live kidney donors that presented for evaluation to Downstate Medical Center from 1999 to 2008 and identified eight (2.2%) who were HTLV seropositive. Serology for HTLV was performed with enzyme immunoassay and Western blot (Quest Diagnostics, Madison, NJ). We also analyzed the geographic distribution of HTLV-positive deceased donors (DD) using Scientific Registry of Transplant Recipients data from 1987 to 2011. There were 176 (0.16%) HTLV-positive donors among 106 141 DDs, after excluding donors with equivocal or unknown serological results. Although the overall prevalence of HTLV seropositivity is low, HTLV-positive donors appear to cluster in certain states, as shown in Table 1. Specifically, states with the 10 highest numbers of HTLV-positive DDs account for 56.1% of all HTLV-positive DDs nationally. HTLV-positive donors were older (45.8 ± 2.3 vs. 38.6 ± 0.1, p < 0.001) and had higher rates of serpositivity for VDRL, hepatitis C virus (HCV), and hepatitis B core antibody (2.8% vs. 0.8%, 11.5% vs. 3.5%, and 11% vs. 5.4%, respectively; p < 0.01 for all three comparisons by χ2). The proportion of donors who meet criteria for high-risk behavior as defined by Centers for Disease Control and Prevention was also higher (13% vs. 8%, p = 0.03 by χ2) in the HTLV-positive group. Logistic regression analysis, however, showed only age (odds ratio [OR] [CI] per decade: 1.16 [1.05–1.22], p = 0.003) and HCV seropositivity (OR [CI]: 2.0 [1.1–3.6], p = 0.03) to be independently associated with HTLV seropositivity, suggesting that clinical predictors have limited role in identifying HTLV-infected donors. Screening serological assays do not distinguish HTLV-I from HTLV-II infections—an important distinction as the clinical relevance of HTLV-II infection is uncertain—and have low specificity. Unlike the results from SRTR data, these shortcomings are less likely to have influenced our center's results in view of additional testing performed using Western blot, and predominance of HTLV-I infection and endemicity of HTLV-associated disease previously reported in our area 2-4. Overall, the observations described above highlight the geographic heterogeneity of risk for HTLV transmission through transplantation. We suggest that Organ Procurement Organizations and transplant programs ascertain their local prevalence of HTLV infection to help guide appropriate screening of live and deceased donors. F. Tedla1,*, A. Brar1, D. John2 and N. Sumrani2 1Division of Nephrology, Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY 2Division of Transplant Surgery, Department of Surgery, State University of New York Downstate Medical Center, Brooklyn, NY *Corresponding author: Fasika Tedla, fasika.tedla@downstate.edu The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

No Evidence of HTLV-II Infection Among Immonoblot Indeterminate Samples Using Nested PCR in Mashhad, Northeast of Iran.

Although HTLV-I infection is endemic in different geographical parts of the world including Northeast of Iran, there have been no documents of HTLV-II infection in this region. It is reported that one possible reason for seroindeterminate state in HTLV western blot is HTLV-II virus. This study aimed to investigate the presence of HTLV-II among blood donors with seroindeterminate western blot results. Three ml whole blood obtained from 50 blood donors referring to Mashhad Blood Transfusion Organization who had reactive Elisa for HTLV-I and seroindeterminate HTLV western blot state. A conventional PCR was applied to detect HTLV-I provirus using specific primers while a nested PCR was designed with specific external and internal primers for the detection of HTLV-II. The average age of participants, 39 males and 11 females, was 37.12± 14.36 years. The average OD of the Elisa assay was 1.767± 1.195. The most common indeterminate patterns were Rgp46-II alone (n=12, 27.3%), Rgp46-I alone (n=7, 15.9%), and Rgp46-I with GD21 (n=7, 15.9%).After introducing the DNA to the PCR tests, results revealed 10 (20%) HTLV-I PCR positive samples while no HTLV-II positive sample was detected by nested PCR. There were no significant age, blood group, Optical Density of the Elisa assay, and western blot indeterminate pattern differences between HTLV-I PCR positive and negative samples. Conclusion : No HTLV-II positive sample was detected in this study which confirms the absence of HTLV-II infection in this region. However, high frequency of HTLV-I PCR positive samples among the seroindeterminate cases implies on the important role of molecular techniques for further confirmation of the infection.

HTLV II em doadores de sangue na Hemorrede do Ceará – HEMOCE

O objetivo do trabalho foi identificar a prevalência do HTLV-II em doadores de sangue da Hemorrede do Ceará e aspectos epidemiológicos de casos positivos. Foram levantados em bancos de dados os casos considerados positivos, através de método Imunoenzimático (ELISA) e confirmados pelo Western Blot, no período de 2001 a 2008. Foram identificados que 679.610 amostras de sangue de doadores voluntários foram testadas neste período. Do total de doadores, 164 amostras foram efetivamente positivas em ambos os testes, destes 33 (20,1%) foram tipadas como HTLV II, mostrando uma prevalência do último de 0,006%. Nos casos positivos, observou-se idade média de 28,2 anos, o sexo predominantemente masculino (54,5%), a cor foi considerada mulato/parda em 78,8%, a maioria procedia de Fortaleza (72,7%), sendo 51,5% casados/união consensual e 33,3% referiam ter ensino médio completo. Embora a infecção por HTLV-II seja baixa, sua presença é universal, sendo semelhante entre homens e mulheres, em sua maioria de centro urbano. É enfatizada a necessidade de medidas de prevenção como forma de evitar a expansão da infecção. To identify HTLV-II revalence in blood donors at the Blood Center Net of Ceará (Hemorrede do Ceará - HEMOCE) and epidemiological aspects of positive cases. Cases considered positive were surveyed from data bases through the immunoenzymatic method ELISA and confirmed by Western Blot from 2001 to 2008. In this period, 679,610 blood samples from voluntary donors were tested. From all donors, 164 samples were actually positive in both tests; of these, 33 (20.1%) were typed as HTLV-II, showing a prevalence of 0.006%. In positive cases, a mean age 28.2 years, and a predominantly male gender (54.5%) were observed, the race was mixed in 78.8%, most donors had Fortaleza as hometown (72.7%), with 51.5% being married/consensual union, and 33.3% reported to have completed high school education. Although HTLV-II infection is low, its presence is universal, being similar in males and females mostly in urban centers. The need of preventive measures as a way of avoiding infection spread is stressed.

HTLV-II in blood donors at the Blood Center Net of Ceará – HEMOCE

To identify HTLV-II revalence in blood donors at the Blood Center Net of Ceará (Hemorrede do Ceará - HEMOCE) and epidemiological aspects of positive cases. Cases considered positive were surveyed from data bases through the immunoenzymatic method ELISA and confirmed by Western Blot from 2001 to 2008. In this period, 679,610 blood samples from voluntary donors were tested. From all donors, 164 samples were actually positive in both tests; of these, 33 (20.1%) were typed as HTLV-II, showing a prevalence of 0.006%. In positive cases, a mean age 28.2 years, and a predominantly male gender (54.5%) were observed, the race was mixed in 78.8%, most donors had Fortaleza as hometown (72.7%), with 51.5% being married/consensual union, and 33.3% reported to have completed high school education. Although HTLV-II infection is low, its presence is universal, being similar in males and females mostly in urban centers. The need of preventive measures as a way of avoiding infection spread is stressed.

Increased All-Cause and Cancer Mortality in HTLV-II Infection

Human T-lymphotropic virus (HTLV)-I and HTLV-II cause chronic human retroviral infections, but few studies have examined the impact of either virus on survival among otherwise healthy individuals. The authors analyzed all-cause and cancer mortality in a prospective cohort of 155 HTLV-I, 387 HTLV-II, and 799 seronegative subjects. Vital status was ascertained using death certificates, the US Social Security Death Index or family report, and causes of death were grouped into 9 categories. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. After a median follow-up of 15.9 years, there were 105 deaths: 22 HTLV-I, 41 HTLV-II, and 42 HTLV-seronegative. Cancer was the predominant cause of death, resulting in 8 HTLV-I, 17 HTLV-II, and 15 HTLV-seronegative deaths. After adjustment for confounding, HTLV-I status was not significantly associated with increased all-cause mortality, though there was a positive trend (HR: 1.6, 95% CI: 0.8 to 3.1). HTLV-II status was strongly associated with increased all-cause (HR: 2.4, 95% CI: 1.4 to 4.4) and cancer mortality (HR: 3.8, 95% CI: 1.6 to 9.2). The observed associations of HTLV-II with all-cause and cancer mortality could reflect biological effects of HTLV-II infection, residual confounding by socioeconomic status or other factors, or differential access to health care and cancer screening.

Neurologic abnormalities in HTLV-I– and HTLV-II–infected individuals without overt myelopathy

Human T-lymphotropic virus (HTLV) type I is the causative agent of HTLV-associated myelopathy (HAM)/tropical spastic paraparesis, and a number of HAM cases with HTLV-II infection have also been reported. However, despite some reports, it is unclear whether HTLV-I or -II infection is associated with other neurologic manifestations. An analysis of medical histories and screening neurologic examinations from a prospective cohort of 153 HTLV-I, 388 HTLV-II, and 810 HTLV-seronegative individuals followed up for means of 11.5, 12.0, and 12.2 years was performed. Participants diagnosed with HAM were excluded. We calculated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for age, sex, race or ethnicity, income, educational attainment, body mass index, alcohol and cigarette consumption, injection drug use, diabetes, and hepatitis C virus status, using generalized estimating equations for repeated measures. HTLV-I and -II participants were more likely than seronegative participants to have leg weakness (ORs 1.67 [95% CI 1.28-2.18] and 1.44 [1.16-1.78]), impaired tandem gait (ORs 1.25 [95% CI 1.07-1.47] and 1.45 [1.27-1.64]), Babinski sign (ORs 1.54 [95% CI 1.13-2.08] and 1.51 [1.18-1.93]), impaired vibration sense (ORs 1.16 [95% CI 1.01-1.33] and 1.27 [1.14-1.42]), and urinary incontinence (ORs 1.45 [95% CI 1.23-1.72] and 1.70 [1.50-1.93]). For both HTLV-I and -II participants, higher odds of sensory neuropathy by monofilament examination were no longer significant after adjustment for confounding. These results provide strong evidence that human T-lymphotropic virus (HTLV)-I and -II are associated with a spectrum of predominantly motor abnormalities in patients without overt HTLV-associated myelopathy. Further investigation of the clinical course and etiology of these abnormalities is warranted.

Long-Term Increases in Lymphocytes and Platelets in Human T-Lymphotropic Virus Type II Infection

Human T-lymphotropic viruses types I and II (HTLV-I and HTLV-II) cause chronic infections of T-lymphocytes, leading to adult T-cell lymphoma (HTLV-I) and myelopathy (both types) in a minority of infected humans. However, their long-term effects on blood counts and hematopoiesis are not fully understood. We followed 151 HTLV-I and 387 HTLV-II seropositive former blood donors, and 799 HTLV seronegative donors from five US blood centers prospectively for a median of 14.0 years. Complete blood counts were performed every 2 years on fresh anticoagulated blood at licensed clinical laboratories near each center. Multivariable repeated measures analyses were conducted to evaluate the independent effect of HTLV infection and potential confounders on 9 hematologic measurements. HTLV-II subjects had significant (p<0.05) increases in their adjusted lymphocyte counts (+126 cells/mm3; approx +7%), hemoglobin (+0.2 gm/dL) and mean corpuscular volume (MCV; 1.0 fL) compared to seronegative subjects. Both HTLV-I and -II subjects had higher adjusted platelet counts (+16,544 and +21,657 cells/mm3; p<0.05) than seronegatives. Among all subjects, time led to decreases in platelet count (−6,750 to −6,600 cells) and lymphocyte counts (−67 to −66 cells), and to increases in MCV (+0.4 fL) and monocytes (+19 to +20 cells per uL; all per two-year interval). Women had lower hemoglobin but higher platelet and white blood cell (WBC) counts than men. Blacks had lower hemoglobin, MCV and neutrophil counts, but higher platelet and lymphocyte counts than whites. Heavy drinking was associated with higher MCV but lower WBC counts, whereas cigarette smoking was associated with higher WBC counts of all lineages. These results suggest that HTLV-I and -II infection can produce significant, independent and long term changes in lymphocytes, platelets and red blood cells. The finding of increased lymphocytes in HTLV-II infection is novel and may be related to viral transactivation or immune response. HTLV-I and –II associations with higher platelet counts suggest viral effects on hematopoietic growth factors or cytokines.

Spontaneous proliferation of memory (CD45RO+) and naive (CD45RO-) subsets of CD4 cells and CD8 cells in human T lymphotropic virus (HTLV) infection: distinctive patterns for HTLV-I versus HTLV-II.

Spontaneous lymphocyte proliferation (SLP) in vitro is a characteristic feature of about 50% of individuals infected with HTLV-I or HTLV-II. Both CD4 cells and CD8 cells contribute to SLP in HTLV-I infection, whereas SLP in HTLV-II infection is usually restricted to CD8 cells. In this study, we asked if SLP was restricted to the memory (CD45RO+) cell subset of CD4 and CD8 cells in HTLV infection. Purified CD4 and CD8 cells were separated into CD45RO+ and CD45RO- populations by a modified panning technique, and spontaneous proliferation (SP) of the cell subsets was assessed. For all five HTLV-I-infected persons whose mononuclear cell cultures were SLP+, only CD45RO+ cells, but not CD45RO- cells, within CD4 and CD8 subsets showed SP. In contrast, five of six SLP+ HTLV-II+ individuals showed SP in both the CD45RO+ and the CD45RO- subsets of CD4 cells, and 10 of 12 SLP+ HTLV-II+ individuals showed SP of both the CD45RO+ and CD45RO- subsets of CD8 cells. Polymerase chain reaction studies showed that proviral genome was generally present in both CD45RO+ and CD45RO- subsets of CD4 and CD8 cells, regardless of HTLV type and SP activity. These findings show that SP of both CD4 and CD8 cells in HTLV-I infection is usually restricted to CD45RO+ memory cells, whereas in HTLV-II infection, both CD45RO+ memory and CD45RO- naive subsets of CD4 and CD8 cells may exhibit SP. It thus appears that HTLV-I infection and HTLV-II infection exhibit distinctive dysregulatory effects on memory and naive T cell subpopulations.

Concomitant augmentation of CD4+ CD29+ helper inducer and diminution of CD4+ CD45RA+ suppressor inducer subset in patients infected with human T cell lymphotropic virus types I or II.

To examine the immunomodulatory effects of HTLV infection, lymphocyte subset analysis was performed on patients infected with human T cell lymphotropic virus type-I (HTLV-I, n = 6) or -II (HTLV-II, n = 12) and on normal blood donors (n = 16). The percentages of total B lymphocytes (CD19), natural killer (NK) cells (CD16), T lymphocytes and their subsets (CD2, CD3, CD4, CD5, CD7, CD8), and IL-2R (CD25) were found to be within the range found in normal donors. However, the expression of CD8+ HLA-DR+ increased significantly in patients with HTLV-I or HTLV-II infection (14.1 +/- 3.9% and 9.7 +/- 2.4% respectively; P less than 0.01) when compared with controls (3.2 +/- 1.1%). In addition, there was a significantly greater proportion of CD4+CD29+ T lymphocytes (29.3 +/- 6.1% and 31.1 +/- 9.0%; P less than 0.05) with concomitant diminution of CD4+CD45RA+ T lymphocytes (8.3 +/- 3.3% and 11.4 +/- 1.5%; P less than 0.01) in patients infected with HTLV-I or HTLV-II respectively, when compared with controls. The increased percentage of CD4+CD29+ subpopulations showed a direct correlation (rs = 0.86; P less than 0.001) with HTLV-specific antibody production. No difference in the CD8 population coexpressing CD29 and S6F1 (an epitope of LFA-1) were observed in the HTLV-infected group when compared with normal donors and functional analysis exhibited minimal cytotoxicity against lectin labelled heterologous target cells. Thus, the shift in the suppressor/cytotoxic to helper/inducer 'memory' CD4+ may be associated with immunoregulatory abnormalities often found in persons infected with HTLV-I or HTLV-II.

HTLV-III in persons with intravenous drug abuse. Correlation of antibodies against HTLV-III with neopterin and TH/TS

Antibodies against HTLV-III, neopterin levels in blood and urine, TH/TS ratio and hepatitis marker were determined in 34 clinically symptom-free persons known to be intravenous drug abusers. 15 persons were positive in the ELISA and Western-blot tests. There was a strong reaction to protein p24 compared with that to protein p41. In 12 of 14 persons who were antibody-positive the neopterin level in morning urine was elevated; an abnormal TH/TS ratio was present in nine of 13 persons. In future, determination of neopterin and of antibodies against certain proteins of HTLV-III may make it possible to provide a simple way of prognosticating on the course of an HTLV-III infection.

Adult T-cell Lymphoma with HTLV-I and HTLV-II Infection

Adult T-cell Lymphoma with HTLV-I and HTLV-II Infection

Human T cell lymphotropic virus: necessity for and feasibility of a vaccine.

Human T cell lymphotropic virus types I and II (HTLV-I/II) are endemic in certain areas of the world. They cause two life-threatening diseases, adult T cell leukaemia/lymphoma and tropical spastic paraparesis. A vaccine is needed because in developing countries there are no other feasible preventive interventions against these diseases and in Western countries intravenous drug users at high risk for HTLV-I and HTLV-II infections and the health workers in contact with such populations must be protected. We have developed a rat model in which we observed variations of susceptibility to viral infection between inbred strains, the most susceptible being the Fischer F344, and the possibility of viral latency in the nervous system. We have prepared a recombinant adenovirus vector that expresses the HTLV-I envelope glycoprotein env in HeLa cells. A target human population in French Guyana, in which the prevalence rate reaches 5.6% in one ethnic group (Bonis), has been identified for possible intervention.

Clinical and epidemiological aspects of HTLV-II infection in São Paulo, Brazil: presence of Tropical Spastic Paraparesis/HTLV-Associated Myelopathy (TSP/HAM) simile diagnosis in HIV-1-co-infected subjects

In this study, the epidemiological and clinical features observed in solely HTLV-II-infected individuals were compared to those in patients co-infected with HIV-1. A total of 380 subjects attended at the HTLV Out-Patient Clinic in the Institute of Infectious Diseases "Emilio Ribas" (IIER), São Paulo, Brazil, were evaluated every 3-6 months for the last seven years by infectious disease specialists and neurologists. Using a testing algorithm that employs the enzyme immuno assay, Western Blot and polymerase chain reaction, it was found that 201 (53%) were HTLV-I positive and 50 (13%) were infected with HTLV-II. Thirty-seven (74%) of the HTLV-II reactors were co-infected with HIV-1. Of the 13 (26%) solely HTLV-II-infected subjects, urinary tract infection was diagnosed in three (23%), one case of skin vasculitis (8%) and two cases of lumbar pain and erectile dysfunction (15%), but none myelopathy case was observed. Among 37 co-infected with HIV-1, four cases (10%) presented with tropical spastic paraparesis/HTLV-associated myelopathy (TSP/HAM) simile. Two patients showed paraparesis as the initial symptom, two cases first presented with vesical and erectile disturbances, peripheral neuropathies were observed in other five patients (13%), and seven (19%) patients showed some neurological signal or symptoms, most of them with lumbar pain (five cases). The results obtained suggest that neurological manifestations may be more frequent in HTLV-II/HIV-1-infected subjects than those infected with HTLV-II only.

HTLV-II transmission to a health care worker

Health care workers, mainly in emergency and forensic services, are at risk of exposure to bloodborne pathogens. Human T-cell lymphotropic virus type I and type II (HTLV-I and HTLV-II) are cosmopolitan human delta retroviruses causing endemic infection in Japan, the Caribbean basin, South America, and sub-Saharan Africa, and in clusters among intravenous drug users in Europe and the United States. The seroprevalence of HTLV-I and HTLV-II among Brazilian blood donors ranges from 0.08% to 1.35%. HTLV-I transmission to a Japanese researcher has already been reported. We describe the transmission of HTLV-II infection to a Brazilian laboratory worker caused by a needlestick injury when she was recapping a syringe after collecting material for arterial blood gas analysis. To our knowledge, this is the first report of an occupational transmission of HTLV-II to a health care worker.

Co-Infection by the Human T-Cell Lymphotropic Virus Type II in Patients Infected by the Human Immunodeficiency Virus in Yucatan, Mexico

The HTLV-II infection has been reported in patients with HIV infection as often in asymptomatic as those with acquired immunodeficiency syndrome (AIDS). The aim of this study was to determine the prevalence of HTLV-II infection in a group of patients infected by HIV in our region, as well as determining the risk factors associated with HTLV-II transmission in this group of patients and its impact on the clinical course of HIV infection. A cross-sectional study was carried out to determine the prevalence of co-infection of HIV-1 and HTLV-II among 192 patients from Yucatán, México. Serum specimens were tested for HTLV antibodies by an enzyme-linked immunosorbent assay (ELISA) test. Positive results were confirmed and typed by Western blot. Twenty four (12.5%) patients were confirmed with antibodies for HTLV-II, but none had antibodies for HTLV-I. Specific risk factors for HTLV-II transmission were not identified. Candidiasis (42 vs. 12%, p = 0.0004) and more than two defining entities of AIDS (37 vs. 18%, p = 0.02) was observed with greater prevalence in the group co-infected. In our study, a higher frequency of candidiasis and a larger number of AIDS-defining pathologies were observed in the co-infected patients, suggesting that co-infection is associated with greater immunodeficiency.

Coinfection With HIV-1 and Human T-Cell Lymphotropic Virus Type II in Intravenous Drug Users Is Associated With Delayed Progression to AIDS

Human T-cell lymphotropic virus (HTLV) type II has spread among intravenous drug users (IDUs), many of whom are coinfected with HIV-1. We have investigated the rate of HTLV-II infection in 3574 Italian IDUs screened for HIV-1, HTLV-I, and HTLV-II from 1986 to the present. HTLV-II proviral load was determined by a real-time polymerase chain reaction specifically designed for tax amplification. The frequency of HTLV-II infection was 6.7% among HIV-1-positive subjects and 1.1% among HIV-1-negative subjects (P < 0.0001). For examination of AIDS progression, a group of 437 HIV-1-monoinfected subjects and another group of 96 HIV-1/HTLV-II-coinfected subjects were monitored. Enrollees were matched at entry by CD4 cell counts and followed for an average of 13 years. HIV-1/HTLV-II coinfection was associated with older age (P < 0.0001) and higher CD4 (P < 0.0001) and CD8 (P < 0.001) cell counts compared with monoinfected IDUs. The number of long-term nonprogressors for AIDS was significantly higher (P < 0.0001) among coinfected patients (13 [13.5%] of 96 patients) than HIV monoinfected patients (5 [1.1%] of 437 patients), showing that HTLV-II exerts a protective role. An increased incidence of liver disease and hepatitis C virus positivity among coinfected IDUs was observed. Five coinfected subjects undergoing antiretroviral therapy showed a significant (P < 0.05) increase in HTLV-II proviral load concomitant to a decrease in HIV-1 viremia, suggesting that the treatment is ineffective against HTLV-II infection.

Infection with human T lymphotropic virus type I in organ transplant donors and recipients in Spain

Human T-cell lymphotropic virus (HTLV) antibody screening is not recommended uniformly before transplantation in Western countries. In the year 2001, the first cases of HTLV-I infection acquired through organ transplantation from one asymptomatic carrier were reported in Europe. All three organ recipients developed a subacute myelopathy shortly after transplantation. This report rose the question about whether to implement universal anti-HTLV screening of all organ donors or selective screening of donors from endemic areas for HTLV-I infection should be carried out. A national survey was conducted thereafter in which anti-HTLV antibodies were tested in 1,298 organ transplant donors and 493 potential recipients. None was seropositive for HTLV-I and only one recipient, a former intravenous (i.v.) drug user, was found to be infected with HTLV-II. In a different survey, HTLV screening was conducted in 1,079 immigrants and 5 (0.5%) were found to be asymptomatic HTLV-I carriers. All came from endemic areas for HTLV-I infection. No cases of HTLV-II infection were found among immigrants. These results support the current policy of mandatory testing of anti-HTLV antibodies in Spain only among organ transplant donors coming from HTLV-I endemic areas or with a highly suspicion of HTLV-I infection.

HIV-2 and HTLV-I/II infections in Spain

Up to December 2002, a total of 56, 566 and 109 cases of human T-lymphotropic virus type 1 (HTLV-I), HTLV-II and human immunodeficiency virus type 2 (HIV-2) infection, respectively, were identified in Spain. Most HTLV-I- and HIV-2-infected subjects were immigrants from endemic areas or Spaniards who had traveled to, or had sexual contacts with natives from, these areas. In contrast, HTLV-II infection was mainly limited to Spanish intravenous drug users (IDU) who were frequently coinfected with HIV-1. Among HTLV-I-infected patients, 12 developed subacute myelopathy and 4 adult T-cell leukemia. As for the HIV-2-positive subjects, only 20 (18.3%) developed AIDS. There was no evidence of an increase in the incidence of HIV-2 and HTLV-I infections over time. In contrast, HTLV-II infection has spread in recent years among the HIV-1-positive IDU population in prisons, with a rate of 18% in some regions of Spain. Nevertheless, the prevalence of HTLV-II infection in HIV-1-positive IDU outpatients is still low (4.7%).

Respiratory and urinary tract infections, arthritis, and asthma associated with HTLV-I and HTLV-II infection.

Human T-lymphotropic virus types I and II (HTLV-I and -II) cause myelopathy; HTLV-I, but not HTLV-II, causes adult T-cell leukemia. Whether HTLV-II is associated with other diseases is unknown. Using survival analysis, we studied medical history data from a prospective cohort of HTLV-I– and HTLV-II–infected and –uninfected blood donors, all HIV seronegative. A total of 152 HTLV-I, 387 HTLV-II, and 799 uninfected donors were enrolled and followed for a median of 4.4, 4.3, and 4.4 years, respectively. HTLV-II participants had significantly increased incidences of acute bronchitis (incidence ratio [IR] = 1.68), bladder or kidney infection (IR = 1.55), arthritis (IR = 2.66), and asthma (IR = 3.28), and a borderline increase in pneumonia (IR = 1.82, 95% confidence interval [CI] 0.98 to 3.38). HTLV-I participants had significantly increased incidences of bladder or kidney infection (IR = 1.82), and arthritis (IR = 2.84). We conclude that HTLV-II infection may inhibit immunologic responses to respiratory infections and that both HTLV-I and -II may induce inflammatory or autoimmune reactions.