Human T-lymphotropic virus type I in Japan

doi:10.1016/S0140-6736(94)90994-6

The Lancet

Volume 343, Issue 8891, 22 January 1994, Pages 213-216

https://doi.org/10.1016/S0140-6736(94)90994-6 Get rights and content

Abstract

Adult T-cell leukaemia (ATL) was first reported in Japan, where it has a high incidence in the southwest region. The retrovirus human T-lymphotropic virus type I (HTLV-I) is the cause of ATL; and in ATL-endemic areas, the rate of carriage of antibodies to HTLV-I is high. A definite diagnosis of ATL is based on the presence of HTLV-I proviral DNA in the tumour-cell DNA. ATL cells originate from the CD4 subset of peripheral T cells. ATL shows diverse clinical features but can be divided into four subtypes—acute, chronic, smouldering, and lymphoma type. It is resistant to chemotherapy, and the acute and lymphoma types have a poor prognosis. Familial occurrence of ATL is common. HTLV-I infection is caused by transmission of live infected lymphocytes from mother to child, from man to woman, or by transfusion. Infection with HTLV-I can lead to other diseases, including HTLV-I-associated myelopathy/tropical spastic paraparesis and HTLV-I uveitis, possibly via induction of immunodeficiency or hyperreactivity against HTLV-I-infected cells.

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Human T-lymphotropic virus type 1 (HTLV-1) is endemic amongst the Aborigines of the Northern Territory of Australia. HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) has been associated with this infection. In general population, isolated neurogenic bladder dysfunction in HTLV-1-infected individuals without HAM/TSP has been reported, and the HTLV-1 proviral load has been found to be higher in such patients compared with asymptomatic carriers. In solid organ transplantation, few cases of HAM/TSP have been reported worldwide, but not an isolated neurogenic bladder.
A 50-year-old indigenous women from Alice Springs with end stage renal disease secondary to diabetic nephropathy with no prior history of bladder dysfunction received a cadaveric renal allograft following which she developed recurrent urinary tract infections. The recipient was seropositive for HTLV-1 infection. HTLV-1 status of donor was not checked. Urodynamic studies revealed stress incontinence and detrusor overactivity without urethral intrinsic sphincter deficiency. She had no features of myelopathy. There was elevation of the serum and cerebrospinal fluid HTLV-1 proviral load. The magnetic resonance imaging myelogram was normal. Pyelonephritis was diagnosed based on clinical features, positive cultures, and renal allograft biopsy. Continuous suprapubic catheter drainage helped preventing further episodes of allograft pyelonephritis in spite of chronic colonization of the urinary tract.
Isolated bladder dysfunction is a rare manifestation of HTLV-1 infection and is probably associated with high proviral loads. This may adversely affect renal allograft and patient outcomes.
HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP): A comparative study to identify factors that influence disease progression
2016, Journal of the Neurological Sciences
HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) can progress slowly or rapidly even though a set of symptoms such as spastic paraparesis with pathological reflexes and sweating loss of the lower extremities are commonly observed in patients. Although most of the patients are thought to be infected to HTLV-1 from their mothers by breast feeding, symptoms of HAM/TSP typically manifest in patients later in life (50–60 years old in age) and also with a higher prevalence of women to men at a ratio of approximately 3:1. Probability of developing HAM/TSP and how fast an individual's disease may progress from the time of diagnosis could be multifactorial.
We reviewed the records of 150 patients with HAM/TSP admitted to Kagoshima University Hospital between 2002 and 2014. Laboratory data of cerebrospinal fluid and serum and the clinical measurements including age, age of disease onset, progression rate, duration of illness, initial symptoms, Osame's Motor Disability Score were evaluated. Rapid disease progression of the disease was defined by deterioration of motor disability by > 3 grades within 2 years.
Of 150 HAM/TSP patients in our cohort, 114 cases (76%) were females. Patients presenting with rapid disease progression are approximately 15 years older at the age of onset than those with a protracted disease course, and have increased number of cell, and elevated levels of protein as well as anti-HTLV-1 antibody titer in the CSF, suggesting a more active inflammatory process. There is no significant difference in the average values of clinical and laboratory parameters between the sexes. Furthermore, there is no apparent correlation between rate of disease progression and gender.
Our results suggest that age and virus mediated inflammation are correlated with disease phenotypes while additional factors such as host or HTLV-1 genetics and gender may influence disease susceptibility.
Incidence of human T-lymphotropic virus 1 infection in adolescent and adult blood donors in Japan: a nationwide retrospective cohort analysis
2016, The Lancet Infectious Diseases
Human T-lymphotropic virus 1 (HTLV-1) infection has an especially high prevalence in Japan. Transmission has been confirmed in infancy through breastfeeding; however, little is known about the epidemiological aspects of new HTLV-1 infections later in life. We aimed to estimate the nationwide annual number of new HTLV-1 infections among adolescents and adults in Japan.
In this retrospective cohort analysis, we assessed new HTLV-1 infections of repeat blood donors aged 16–69 years between Jan 1, 2005, and Dec 31, 2006, in the Japanese Red Cross Blood Centres database. We used results of antibody tests done in repeat blood samples collected until Dec 31, 2011, to assess the number who seroconverted to HTLV-1. We calculated the incidence density by dividing the number of seroconverters by the number of person-years of follow-up, and then extrapolated densities to regional populations to estimate the annual number of new HTLV-1 infections.
We included 3 375 821 HTLV-1-seronegative blood donors (2 100 915 men and 1 274 906 women). Within a median follow-up of 4·5 years (IQR 2·3–5·8), 532 people (204 men and 328 women) had seroconverted. The incidence density was significantly higher in women (6·88 per 100 000 person-years; 95% CI 6·17–7·66) than in men (2·29 per 100 000 person-years; 95% CI 1·99–2·62; p<0·0001). The estimated annual number of new HTLV-1 infections was 4190 (95% CI 4064–4318) with 975 (914–1038) infections in men and 3215 (3104–3328) in women.
New HTLV-1 infections in adolescents and adults are an important public health concern in Japan and preventive strategies are needed to reduce new transmission.
Ministry of Health, Labour, and Welfare of Japan; Japan Agency for Medical Research and Development.
Prevalence of human T-lymphotropic virus type 1 infection among blood donors in mainland China: A meta-analysis
2014, International Journal of Infectious Diseases
Citation Excerpt :
It is estimated that 15 to 20 million individuals are HTLV-1-infected.9,59 HTLV-1 prevalence is relatively high in southwestern Japan (up to 10%),60,61 several countries in the Caribbean area, for example Jamaica and Trinidad (up to 6%),62,63 some countries of Sub-Saharan Africa including Benin, Cameroon, and Guinea-Bissau (up to 5%),64–67 and localized areas of Australo-Melanesia and Iran (less than 5%),68,69 and it is somewhat lower in several countries of South America.70–74 For blood donors in North America and Europe, HTLV-1 prevalence is very low, i.e., 1–3/10 000 in the USA and Canada, 0.2/10 000 in Norway, and 0.56/10 000 in Greece.75–78
Human T-lymphotropic virus type 1 (HTLV-1) is considered to be the etiological agent of adult T-cell leukemia/lymphoma (ATL) and HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Blood transfusion is a common transmission pathway for HTLV-1. However, no surveys to determine the overall prevalence of HTLV-1 infection and HTLV-1 genotypes among blood donors on the Chinese mainland have yet been conducted.
A systematic review and meta-analysis of the peer-reviewed literature on this topic was carried out. Data manipulation and statistical analyses were performed using the Comprehensive Meta Analysis Version 2.0 program.
Forty-four eligible articles involving 458 525 blood donors were selected. Analysis revealed the pooled prevalences of HTLV-1 infection among blood donors in Fujian and Guangdong provinces to be 9.9/10 000 (95% confidence interval (CI) 4.4/10 000–22.2/10 000) and 2.9/10 000 (95% CI 1.7/10 000–4.8/10 000), respectively; there were only two cases of HTLV-1 infection among 204 763 donors in other areas of the Chinese mainland. In addition, 40 of 42 (95.2%) HTLV-1 isolates belonged to the Transcontinental subgroup A of the HTLV-1 subtype A (Cosmopolitan subtype).
The prevalence of HTLV-1 infection among blood donors is low and restricted mainly to the provinces of Fujian and Guangdong. Most isolates belong to the Transcontinental subgroup within HTLV-1 subtype A.
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Human T-lymphotropic virus type I in Japan

Abstract

Blood

Virology

Blood

Blood

Leukemia Res

Blood

Lancet

Lancet

Am J Ophthalmol

Adult T cell leukemia in Japan

Detection and isolation of type C retrovirus particles from fresh and cultured lymphocytes of patients with cutaneous T-cell lymphoma

Proc Natl Acad Sci U S A

A novel T-cell line derived from adult T-cell leukemia

Jpn J Cancer Res (Gann)

Adult T-cell leukemia: antigen in an adult T-cell leukemia cell line and detection of antibodies to the antigen in human sera

Proc Natl Acad Sci U S A

Isolation and characterization of retrovirus from cell lines of human adult T cell leukemia and its implication in the disease

Proc Natl Acad Sci U S A

Human adult T-cell leukemia virus: complete nucleotide sequence of the provirus genome integrated in leukemic cell DNA

Proc Natl Acad Sci U S A

Pathogenesis of adult T-cell leukemia from clinical pathologic features