The meta-analysis published by Gill Schierhout and colleagues1 reported an increased relative risk of premature death in individuals infected with HTLV-1 compared with individuals not infected with HTLV-1 (RR 1·57, 95% CI 1·37–1·80). This risk was independent of adult T-cell leukaemia-lymphoma (ATL) and HTLV-1-associated myelopathy (HAM), also called tropical spastic paraparesis (TSP), the two well known diseases associated with HTLV-1. In their systematic search, the authors identified a broader number of illnesses that were significantly more prevalent in individuals infected with HTLV-1 and that could contribute to the poorer survival of these individuals.