Human T-Cell Lymphotrophic Viruses Follow-up

  • Author: Ewa Maria Szczypinska, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 11, 2012
 

Deterrence/Prevention

Strategies for human T-cell lymphotropic virus (HTLV) infection prevention should include education regarding transmission on a global and individual basis. Both HTLV-1 and HTLV-2 can be transmitted through breastfeeding, sexual contact, and direct blood-to-blood contact.

  • Women diagnosed with HTLV infection should not breast feed. In Japan, HTLV screening is a standard procedure in pregnant women, and seropositive women are discouraged from breastfeeding. One caveat is that infant malnutrition result from breastfeeding avoidance in endemic developing nations.
  • The routine use of latex condoms should be recommended, as well as limiting the number of sexual partners.
  • Parenteral transmission of HTLV is prevented through abstaining from needle sharing and through blood-donor screening.
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Complications

Complications of HTLV infection are due mostly to end-stage diseases rather than to the infection itself, as the vast majority of individuals with this infection are asymptomatic. However, the following should be kept in consideration:

  • HTLV-1 is a risk factor for the development of severe strongyloidiasis; close follow-up of patients following treatment for strongyloidiasis is recommended.[40]
  • Patients with adult T-cell leukemia (ATL) are immunocompromised, potentially leading to opportunistic infections including the following:
    • Pneumocystis jiroveci pneumonia: Prophylaxis with sulfamethoxazole-trimethoprim should be initiated.
    • Cryptococcal meningitis
    • Fungal infections
    • Viral infections (eg, cytomegalovirus, herpes zoster, herpes simplex)
    • S stercoralis infection: Prophylaxis with ivermectin or albendazole should be considered in patients with a history of past or present exposure or positive serology results.[40]

Co-infection of either HTLV-1 or HTLV-2 with HIV remains a controversial topic.

  • Conclusive and reproducible data of such coinfections are not yet available, as most of the data are limited by the testing methodology.
  • Theoretically, HTLV-1 and HIV affect the same cell type, and the additive result might be detrimental to the immune system, leading to faster progression to AIDS. Future research might lead to recommendations concerning coinfections (eg, starting HAART or prophylaxis for opportunistic infections); however, no specific guidelines exist at this time. A recent retrospective cohort study of Peruvian men with HIV/HTLV-1 coinfection did not show that coinfection increased the risk of death.[41] This area remains controversial, as some studies show an unfavorable outcome for HIV/HTLV-1 coinfection, while others do not.
  • No evidence has shown that HIV/HTLV-2 coinfection leads to faster progression to AIDS; in fact, coinfection might have some protective effects based on in vitro studies.[42]
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Prognosis

  • Infection with HTLV-1 or HTLV-2 is lifelong, and most (95%) infected individuals remain asymptomatic throughout life, without progression to any end-point diseases.
  • The latency period for ATL is about 20-40 years. Patients with smoldering and chronic type ATL live an average of 2 years, and those with acute and lymphoma-type ATL live an average of 6 months. Chemotherapy or interferon plus antiretroviral drugs can produce complete remission, but the median survival remains under 2 years.
  • HTLV-1–associated myelopathy/tropical spastic paraparesis (HAM/TSP) carries a poor prognosis. The latency period ranges from a few months to 30 years postinfection. Within 10 years of onset, despite therapy, most patients are unable to walk unassisted and are wheelchair-bound within 21 years.[33]
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Patient Education

  • Patients determined to have infection with any subtype of HTLV should share this information with their physicians and undergo regular follow-up.
  • Education should focus on preventing transmission to others through unprotected sexual activity. Sexual partners of patients with HTLV-1 infection who are in a mutually monogamous sexual relationship should consider being tested. If the partner is positive then no further recommendation is warranted. If the partner is negative, then the use of latex condoms is advised. Specific testing guidelines for partners of HTLV-2 infected individuals have not been established.
  • Patients should be instructed to avoid sharing needles.
  • Women with HTLV-1 or HTLV-2 infection should not breast feed their infants. If this is unfeasible (ie, women in undeveloped countries), breastfeeding should be limited to the first 6 months.
  • Patients should be counseled against donating blood, body organs, or tissues.
  • Patients with HTLV-1 infection should be informed about the 1%-6% lifetime chance of developing ATL or HAM/TSP.[35]
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Contributor Information and Disclosures
Author

Ewa Maria Szczypinska, MD  Fellow, Department of Infectious Diseases, Orlando Health

Ewa Maria Szczypinska, MD is a member of the following medical societies: American College of Physicians, American Medical Association, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Mark R Wallace, MD, FACP, FIDSA  Clinical Professor of Medicine, Florida State University College of Medicine; Head of Infectious Disease Fellowship Program, Orlando Regional Medical Center

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Booth Wainscoat, DO  Assistant Director, Division of Infectious Disease, Hartford Hospital; Assistant Professor of Clinical Medicine, University of Connecticut School of Medicine

Booth Wainscoat, DO is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Gilead Consulting fee Consulting

Christopher Mark Salas, MD  Resident Physician, Department of Internal Medicine, Maine Medical Center

Disclosure: Nothing to disclose.

Josiah D Rich, MD, MPH  Associate Professor, Department of Internal Medicine, Division of Infectious Disease, Brown University School of Medicine

Josiah D Rich, MD, MPH is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Medical Association, American Public Health Association, Infectious Diseases Society of America, Massachusetts Medical Society, and Rhode Island Medical Society

Disclosure: alkermes stockholder Ownership interest None; isis stockholder Ownership interest None; repligen Ownership interest None

Specialty Editor Board

Joseph Richard Masci, MD  Professor of Medicine, Professor of Preventive Medicine, Mount Sinai School of Medicine; Director of Medicine, Elmhurst Hospital Center

Joseph Richard Masci, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, Association of Professors of Medicine, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Joseph F John Jr, MD, FACP, FIDSA, FSHEA  Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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