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From the University of California San Francisco (Drs. Orland, Engstrom, and Murphy); Blood Centers of the Pacific (Drs. Orland and Murphy), San Francisco; City of Hope National Medical Center (Dr. Fridey), Duarte, CA; Hoxworth Blood Center and University of Cincinnati (Dr. Sacher), OH; Oklahoma Blood Institute (Dr. J.W. Smith), Oklahoma City; American Red Cross Blood Services, Chesapeake Region (Dr. Nass), Baltimore, MD; American Red Cross Blood Services, Southern California Region (Dr. Garratty), Los Angeles; American Red Cross Blood Services, Southeastern Michigan Region (Dr. Newman), Detroit; and Westat (D. Smith, Dr. Wang, and K. Loughlin), Rockville, MD.
Address correspondence and reprint requests to Dr. Jennie R. Orland, UCSF Department of Epidemiology and Biostatistics and Blood Centers of the Pacific, 270 Masonic Ave., San Francisco, CA 94118; e-mail: orland{at}itsa.ucsf.edu
Background: Almost 20 years after its discovery, the prevalence and clinical course of human T-lymphotropic virus type I (HTLV-I)–associated myelopathy (HAM, also known as tropical spastic paraparesis [TSP]) remain poorly defined. Whereas the causative association of HTLV-I and HAM/TSP is generally recognized, controversy still surrounds the relationship between HTLV-II and HAM/TSP.
Methods: The HTLV Outcomes Study (HOST—formerly Retrovirus Epidemiology Donor Study [REDS]) is a prospective cohort study including 160 patients with HTLV-I, 405 patients with HTLV-II, and 799 uninfected controls who have been followed every 2 years since 1990–1992. Clinical outcomes are measured by health interviews and examinations, and blood samples are obtained.
Results: Six cases of HTLV-I–associated myelopathy (3.7%, 95% CI 1.4 to 8.0) and four cases of HTLV-II myelopathy (1.0%, 95% CI 0.3 to 2.5) have been diagnosed since the formation of the cohort. There have been no cases of HAM/TSP diagnosed among HTLV-negative subjects (0.0%, 95% CI 0.0 to 0.5). Clinical features of the cases include lower extremity hyperreflexia, variably associated with weakness, spasticity, and bladder dysfunction.
Conclusions: Systematic screening of HTLV-infected blood donors reveals a high prevalence of HAM/TSP. The clinical course of HAM/TSP appears highly variable. HTLV-II–associated myelopathy generally presents with milder and more slowly progressive signs and symptoms.
Received March 14, 2003. Accepted in final form August 4, 2003.
*A list of all HOST investigators is given in the Appendix on page 1593.
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