Late presentation of human T-lymphotropic virus type 1 infection in Spain reflects suboptimal testing strategies. (September 2022)

• Record Type: Journal Article
• Authors: de Mendoza, Carmen; Pérez, Leire; Fernández-Ruiz, Mario; Pena, María José; Ramos, José Manuel; Richart, Alberto; Piron, María; Rando, Ariadna; Miró, Elisenda; Reina, Gabriel; Encinas, Beatriz; Rojo, Silvia; Rodriguez-Iglesias, Antonio Manuel; Benito, Rafael; Aguilera, Antonio; Treviño, Ana; Corral, Octavio; Soriano, Vicente
• Is Part Of: International journal of infectious diseases. Volume 122(2022)
• Page Start: 970
• Page End: 975
• Publication Date: 2022-09
• Subjects: HTLV-1 -- Myelopathy -- Diagnosis -- Late presentation -- Sexually transmitted infections; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2022.07.043
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: The diagnosis of human T-lymphotropic virus type 1 (HTLV-1) infection is frequently missed in asymptomatic carriers. Migrant flows from Latin America (LATAM) largely contribute to new HTLV-1 diagnoses in Spain. HTLV screening of blood donors predominantly identifies asymptomatic carriers from LATAM. HTLV screening should extend to all pregnant women and clinics for sexually transmitted infections. Abstract: Objectives: Although only 10% of persons infected with human T-lymphotropic virus type 1 (HTLV-1) may develop virus-associated illnesses over their lifetime, missing the earlier diagnosis of asymptomatic carriers frequently leads to late presentation. Methods: A nationwide HTLV-1 register was created in Spain in 1989. We examined the main demographics and clinical features at the time of the first diagnosis for more than three decades. Results: A total of 428 individuals infected with HTLV-1 had been reported in Spain until the end of 2021. Up to 96 (22%) individuals presented clinically with HTLV-1-associated conditions, including subacute myelopathy (57%), T-cell lymphoma (34%), or Strongyloides stercoralis infestation (8%). Since 2008, HTLV-1 diagnosis has been made at blood banks (44%) or clinics (56%). Native Spaniards and Sub-Saharan Africans are overrepresented among patients presenting with HTLV-1-associated illnesses suggesting that poor epidemiological and/or clinical suspicion, which led to the late presentation are more frequent in them than carriers from Latin America (LATAM) (31.7% vs 20.4%, respectively; P = 0.015). Conclusion: HTLV-1 infection in Spain is frequently diagnosed in patients presenting with characteristic illnesses. Although screening in blood banks mostly identifies asymptomatic carriers from LATAM, a disproportionately high number of Spaniards and Africans are diagnosed too late at the time of clinical manifestations. Expanding testing to all pregnant women and clinics for sexually transmitted infections could help to unveil HTLV-1 asymptomatic carriers.