Human T-Cell Lymphotropic Viruses Treatment & Management

Updated: Oct 05, 2015
  • Author: Ewa Maria Szczypinska, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Treatment

Medical Care

No treatment intervention exists for acute or chronic human T-cell lymphotropic virus (HTLV) infection. Thorough neurological and ophthalmologic examinations, in addition to a complete physical examination, should be performed in patients infected with HTLV. Additional blood work should also be performed (see Lab Studies). Good oral care and routine dental follow-up are recommended.

All patients with HTLV-1 or HTLV-2 infection should be counseled extensively on the lifelong implications of their infection (see Patient Education). [43, 44]

The treatment of adult T-cell leukemia (ATL) is the same regardless of the presence or absence of HTLV infection, as follows:

  • Treatment should begin immediately in patients diagnosed with the aggressive types of ATL (acute or lymphoma). Patients diagnosed with an indolent type of ATL (chronic or smoldering) should be monitored closely for disease progression. Chronic ATL usually progresses to the acute form within two years. [42]

  • Mogamulizumab, a defucosylated humanized anti-CCR4 IgG1 monoclonal antibody, was approved in Japan as a new therapy for ATL. ATL cells usually express chemokine receptor CCR4. [36] Mogamulizumab is pending phase 2 results in the United States. [45]

  • Chemotherapy is the primary treatment approach. CHOP (cyclophosphamide, doxorubicin [hydroxydaunomycin], vincristine [Oncovin], and prednisone) or a similar regimen is used. However, no known regimen increases the median survival time (2 years). Complete remission can occur, but relapse is common.

  • Other regimens include interferon alfa, topoisomerase inhibitors, zidovudine plus interferon alfa, arsenic trioxide plus interferon alfa, blockade of NF-κB with several experimental agents, and monoclonal antibodies against the IL-2R and other receptors on ATL cells.

  • Allogenic hematopoietic stem cell transplantation has yielded varying results in HTLV infection. Miyamura et al (2009) reported on a female patient who developed ATL along with chronic refractory eczema and corneal injury. She was subsequently treated with allogeneic hematopoietic stem cell transplantation. At one year, she had no recurrence of any symptoms. Furthermore, her HTLV-1 proviral load had decreased posttransplant. [46]

  • It is important to monitor for opportunistic infections in patients with ATL, including cytomegalovirus infection, Pneumocystis carinii infection, S stercoralis infection, Norwegian scabies, disseminated molluscum contagiosum, extrapulmonary histoplasmosis, and complications of staphylococcal and streptococcal skin infections.

HTLV-1–associated myelopathy/tropical spastic paraparesis (HAM/TSP) treatment options are even more limited and focus on symptomatic therapy, as follows:

  • Studied therapies have included corticosteroids, plasmapheresis, cyclophosphamide, and interferon, which may produce temporary improvement in signs and symptoms associated with HAM/TSP.

  • Mogamulizumab, a defucosylated humanized anti-CCR4 IgG1 monoclonal antibody, is also under study for treatment of HAM/TSP. This antibody effectively reduced HTLV-1 proviral load (56.4%), spontaneous proliferation, and production of proinflammatory cytokines. Further studies are needed if this treatment will translate into clinical treatment of HAM/TSP. [45]

  • Valproic acid has been studied to determine whether it might slow the progression of HAM/TSP by decreasing the proviral load. Although it succeeded in reducing the proviral load, there was no clinical benefit. [41] Recently, a combination of valproic acid and zidovudine has been shown to decrease proviral loads in baboons infected with simian T-cell lymphotropic virus (STLV)–1; however, this has yet to be studied in humans with HAM/TSP. [47]

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Consultations

Consultation with an infectious disease specialist is advisable to diagnose HTLV infection.

A hematologist/oncologist should be consulted for patients with ATL.

A neurologist should be consulted for patients with HAM/TSP.

An ophthalmologist should be consulted for patients with ocular symptoms and for routine examinations.

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Activity

Use of barrier protection during intercourse is important to prevent the sexual spread of HTLV. Also, intravenous drug users should avoid sharing needles.

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