HTLV-1-associated myelopathy in Spain
Autor:
De-Mendoza, Carmen
; Pérez, Leire
; Rando, Ariadna
; Reina, Gabriel
; Aguilera, Antonio
; Benito, Rafael
; Eirós, José María
; Rodríguez-Avial, Itziar
; Ortega, Diego
; Pozuelo, María José
; Pena, María José
; Soriano, Vicente
Fecha:
2023Palabra clave:
Revista / editorial:
Journal of Clinical VirologyCitación:
de-Mendoza, C., Pérez, L., Rando, A., Reina, G., Aguilera, A., Benito, R., ... & Network, S. H. (2023). HTLV-1-associated myelopathy in Spain. Journal of Clinical Virology, 169, 105619.Tipo de Ítem:
Articulo Revista IndexadaResumen:
Background: HTLV-1 infection is a neglected disease. Over 10 million people are infected worldwide, with hot spots of high endemicity across all continents. Roughly 5% of HTLV-1 carriers develop HTLV-1-associated myelopathy (HAM), a progressive subacute neurological disabling disease.
Methods: We report the main features of patients diagnosed with HAM up to date in Spain, a non-endemic country with a relatively high migrant flow from Latin America and Equatorial Africa, where HTLV-1 is endemic.
Results: A total of 451 cases of HTLV-1 had been recorded in Spain until the end of year 2022. HAM had been diagnosed in 58 (12.9%). The current incidence is of 2–3 new cases per year. Women represent 76%. Mean age at diagnosis is 49 years-old. Nearly 60% are Latin Americans. Although sexual transmission is the most likely route of HTLV-1 acquisition, up to 6 individuals had been infected following solid organ transplantation. Rapid onset myelopathy developed in all but one of these transplant recipients from three HTLV-1-positive donors. HTLV-1 subtype 1a transcontinental was the only variant recognized in HAM patients. HTLV-1 proviral load was significantly greater in HAM patients than in asymptomatic HTLV-1 carriers (677 vs 104 HTLV-1 DNA copies/104 PBMC; p = 0.012). Symptom relief medications and physiotherapy have been the only treatment providing some benefit to HAM patients. Neither significant clinical nor virological efficacy was noticed using antiretrovirals in at least 9 HAM patients. Two thirds of HAM patients ended up in a wheelchair and with urinary/fecal sphincter incontinence.
Conclusion: HAM is the most frequent clinical manifestation of HTLV-1 infection in Spain, a non-endemic country. Middle aged women migrants from Latin America are the most frequently affected. Two thirds end up in a wheelchair despite using antiretroviral therapy.
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