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Neurological morbidity among human T-lymphotropic-virus-type-1-infected individuals in a rural West African population
  1. S Cooper1,
  2. M Schim van der Loeff2,
  3. S McConkey3,
  4. M Cooper4,
  5. R Sarge-Njie5,
  6. S Kaye6,
  7. H Whittle5
  1. 1
    Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
  2. 2
    GGD (Health Service of Amsterdam) Amsterdam, Amsterdam, The Netherlands
  3. 3
    Royal College of Surgeons of Ireland, Dublin, Ireland
  4. 4
    Department of General Practice, University of Glasgow, Glasgow, UK
  5. 5
    MRC Laboratories, Fajara, The Gambia
  6. 6
    Imperial College, London, UK
  1. Dr S A Cooper, Institute of Neurological Sciences, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF, UK; sarah.cooper{at}


Background: Community-based neurological data about human T lymphotropic virus type 1 (HTLV-1) morbidity in sub-Saharan Africa are scarce.

Objectives: To ascertain the prevalence of neurological morbidity, in particular tropical spastic paraparesis (TSP), among HTLV-1-infected subjects and to compare TSP prevalence in HTLV-1-infected with 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, and 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 among HTLV-1-infected persons in this rural West African setting of 7.1%. There are difficulties excluding other potential aetiologies here.

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  • Competing interests: None.

  • Ethics approval: Ethics approval was provided by the Medical Research Council Ethics Committee in The Gambia.

  • Patient consent: Obtained.