Background: Community-based neurological data about HTLV-1 morbidity in sub-Saharan Africa is scarce.
Objectives: To ascertain the prevalence of neurological morbidity, in particular Tropical Spastic Paraparesis (TSP), amongst HTLV-1-infected subjects and to compare TSP prevalence in HTLV-1-infected to that in non-infected subjects in a rural West African population.
Methods: A cross-sectional study of HTLV-1-infected cases and controls (ratio 4:1) from a rural community (population approximately 10,000, HTLV-1 prevalence 7.7%). One neurologist masked to HTLV-1 serological status assessed all subjects. Clinical criteria were employed to diagnose TSP.
Results: From 205 eligible cases and controls, 139 were recruited with a mean age of 56 years, 113 (81%) were HTLV-1-infected. 108/139 (78%) were female and 8/113 HTLV-1 infected cases (7.1%) had a definite or probable TSP (all females; mean age 67 years) compared with 0/26 controls. Two with TSP were co-infected with HIV-2. Complaints of back pain and leg weakness were more common in HTLV-1-infected individuals (p=0.03, p=0.02) but no single symptom distinguished between subjects with and without TSP.
Conclusion: We report a prevalence of TSP amongst HTLV-1-infected persons in this rural West African setting of 7.1%. There are difficulties excluding other potential aetiologies here.