Human T-lymphotropic virus type 1 infection and disease in Spain.
Por:
de Mendoza C, Caballero E, Aguilera A, Requena S, de Lejarazu RO, Pirón M, González R, Jiménez A, Roc L, Treviño A, Benito R, Fernández-Alonso M, Aguinaga A, Rodríguez C, García-Costa J, Blanco L, Ramos JM, Calderón E, Eirós JM, Sauleda S, Barreiro P, Soriano V and Spanish HTLV Network
Publicada:
31 jul 2017
Resumen:
: Human T-lymphotropic virus type 1 (HTLV-1) infection is a neglected disease despite roughly 15 million people are chronically infected worldwide. Lifelong less than 10% of carriers develop life-threatening diseases, mostly a subacute myelopathy known as tropical spastic paraparesis (TSP) and a lymphoproliferative disorder named adult T-cell leukemia (ATL). HTLV-1 is efficiently transmitted perinatally (breastfeeding), sexually (more from men to women) and parenterally (transfusions, injection drug user (IDU), and transplants). To date there is neither prophylactic vaccine nor effective antiviral therapy. A total of 327 cases of HTLV-1 infection had been reported at the HTLV-1 Spanish registry until December 2016, of whom 34 had been diagnosed with TSP and 25 with ATL. Overall 62% were Latin American immigrants and 13% were persons of African origin. The incidence of HTLV-1 in Spain has remained stable for nearly a decade with 20-25 new cases yearly. Of the 21 newly diagnosed HTLV-1 cases during year 2016, one was a native Spaniard pregnant woman, and four presented with symptomatic disease, including three with ATL and one with TSP. Underdiagnosis of HTLV-1 in Spain must be high (iceberg model), which may account for the disproportionate high rate of symptomatic cases (almost 20%) and the late recognition of preventable HTLV-1 transmissions in special populations, such as newborns and transplant recipients. Our current estimate is of 10 000 persons living with HTLV-1 infection in Spain. Given the large flux of immigrants and visitors from HTLV-1 endemic regions to Spain, the expansion of HTLV-1 screening policies is warranted. At this time, it seems worth recommending HTLV testing to all donor/recipient organ transplants and pregnant women regardless place of birth. Although current leukoreduction procedures largely prevent HTLV-1 transmission by blood transfusions, HTLV testing of all first-time donors should be cost-effective contributing to unveil asymptomatic unaware HTLV-1 carriers.
Filiaciones:
de Mendoza C:
aPuerta de Hierro Research Institute, Majadahonda, Madrid bHospital Vall d'Hebrón, Barcelona cHospital de Conxo-CHUS, Santiago de Compostela dClinic University Hospital, Valladolid eBlood and Tissue Bank, Barcelona fRegional Transfusion Center, Madrid gCentro de Hemoterapia de Castilla-León, Valladolid hHospital Miguel Servet, Zaragoza iHospital Clínico Universitario Lozano Blesa, Zaragoza jUniversity Clinic kComplejo Hospitalario, Pamplona lCentro Sanitario Sandoval, Madrid mCristal-Piñor
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