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December 8, 2003

Prevalence and clinical features of HTLV neurologic disease in the HTLV Outcomes Study

J. R. Orland, MD, J. Engstrom, MD, J. Fridey, MD, R. A. Sacher, MD, J. W. Smith, MD, C. Nass, PhD, G. Garratty, PhD, … Show All … , B. Newman, MD, D. Smith, B. Wang, MD DrPH, K. Loughlin, E. L. Murphy, MD MPH, and for the HTLV Outcomes Study (HOST)Authors Info & Affiliations

December 9, 2003 issue

61 (11) 1588-1594

https://doi.org/10.1212/01.WNL.0000096011.92542.DA

Abstract

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.

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References

1.

Strachan H. On a form of multiple neuritis prevalent in the West Indies. Practitioner (Lond) . 1897; 59: 477–484.

2.

Cruickshank E. A neurologic syndrome of uncertain origin: review of 100 cases. West Indian Med J . 1956; 5: 147–158.

3.

Vernant JC, Gessain A, Gout O, et al. [Tropical spastic paraparesis in Martinique. High prevalence of anti-HTLV-I antibodies.] Presse Med . 1986; 15: 419–422.

4.

Gessain A, Francis H, Sonan T, et al. HTLV-I and tropical spastic paraparesis in Africa. Lancet . 1986; 2: 698.

5.

Osame M, Usuku K, Izumo S, et al. HTLV-I associated myelopathy, a new clinical entity. Lancet . 1986; 1: 1031–1032.

6.

Harrington WJ Jr., Sheremata W, Hjelle B, et al. Spastic ataxia associated with human T-cell lymphotropic virus type II infection. Ann Neurol . 1993; 33: 411–414.

7.

Jacobson S, Lehky T, Nishimura M, Robinson S, McFarlin DE, Dhib-Jalbut S. Isolation of HTLV-II from a patient with chronic, progressive neurological disease clinically indistinguishable from HTLV-I-associated myelopathy/tropical spastic paraparesis. Ann Neurol . 1993; 33: 392–396.

8.

Murphy EL, Fridey J, Smith JW, et al. HTLV-associated myelopathy in a cohort of HTLV-I and HTLV-II-infected blood donors. The REDS investigators Neurology . 1997; 48: 315–320.

9.

Nagai M, Jacobson S. Immunopathogenesis of human T cell lymphotropic virus type I-associated myelopathy. Curr Opin Neurol . 2001; 14: 381–386.

10.

Greten TF, Slansky JE, Kubota R, et al. Direct visualization of antigen-specific T cells: HTLV-1 Tax11–19- specific CD8(+) T cells are activated in peripheral blood and accumulate in cerebrospinal fluid from HAM/TSP patients. Proc Natl Acad Sci USA . 1998; 95: 7568–7573.

11.

Manns A, Miley WJ, Wilks RJ, et al. Quantitative proviral DNA and antibody levels in the natural history of HTLV-I infection. J Infect Dis . 1999; 180: 1487–1493.

12.

Nagai M, Usuku K, Matsumoto W, et al. Analysis of HTLV-I proviral load in 202 HAM/TSP patients and 243 asymptomatic HTLV-I carriers: high proviral load strongly predisposes to HAM/TSP. J Neurovirol . 1998; 4: 586–593.

13.

Levin MC, Lee SM, Kalume F, et al. Autoimmunity due to molecular mimicry as a cause of neurological disease. Nat Med . 2002; 8: 509–513.

14.

Sheremata WA, Berger JR, Harrington WJ Jr., Ayyar DR, Stafford M, DeFreitas E. Human T lymphotropic virus type I-associated myelopathy. A report of 10 patients born in the United States. Arch Neurol . 1992; 49: 1113–1118.

15.

Dixon PS, Bodner AJ, Okihiro M, Milbourne A, Diwan A, Nakamura JM. Human T-lymphotropic virus type I (HTLV-I) and tropical spastic paraparesis or HTLV-I-associated myelopathy in Hawaii. West J Med . 1990; 152: 261–267.

16.

Kramer A, Maloney EM, Morgan OS, et al. Risk factors and cofactors for human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in Jamaica. Am J Epidemiol . 1995; 142: 1212–1220.

17.

Janssen RS, Kaplan JE, Khabbaz RF, et al. HTLV-I-associated myelopathy/tropical spastic paraparesis in the United States. Neurology . 1991; 41: 1355–1357.

18.

WHO. Virus diseases: Human T lymphotropic virus type I, HTLV-I. Wkly Epidemiol Rec . 1989; 64: 382–383.

19.

Busch MP, Laycock M, Kleinman SH, et al. Accuracy of supplementary serologic testing for human T-lymphotropic virus types I and II in US blood donors. Retrovirus Epidemiology Donor Study. Blood . 1994; 83: 1143–1148.

20.

Miley WJ, Suryanarayana K, Manns A, et al. Real-time polymerase chain reaction assay for cell-associated HTLV type I DNA viral load. AIDS Res Hum Retroviruses . 2000; 16: 665–675.

21.

Nass CC, Wu Y, Kong F, Ownby HE, Smith JW, Murphy EL. Using estimated date of infection to assess health effects of HTLV-II infection. J Acquir Immune Defic Syndr Hum Retrovirol . 1999; 20: A75.

22.

Kaplan JE, Osame M, Kubota H, et al. The risk of development of HTLV-I-associated myelopathy/tropical spastic paraparesis among persons infected with HTLV-I. J Acquir Immune Defic Syndr . 1990; 3: 1096–1101.

23.

Kayembe K, Goubau P, Desmyter J, Vlietinck R, Carton H. A cluster of HTLV-1 associated tropical spastic paraparesis in Equateur (Zaire): ethnic and familial distribution. J Neurol Neurosurg Psychiatry . 1990; 53: 4–10.

24.

Jeannel D, Garin B, Kazadi K, Singa L, de The G. The risk of tropical spastic paraparesis differs according to ethnic group among HTLV-I carriers in Inongo, Zaire. J Acquir Immune Defic Syndr . 1993; 6: 840–844.

25.

Goubau P, Carton H, Kazadi K, Muya KW, Desmyter J. HTLV seroepidemiology in a central African population with high incidence of tropical spastic paraparesis. Trans R Soc Trop Med Hyg . 1990; 84: 577–579.

26.

Murphy EL, Wilks R, Morgan OS, et al. Health effects of human T-lymphotropic virus type I (HTLV-I) in a Jamaican cohort. Int J Epidemiol . 1996; 25: 1090–1097.

27.

McDermott C, White K, Bushby K, Shaw P. Hereditary spastic paraparesis: a review of new developments. J Neurol Neurosurg Psychiatry . 2000; 69: 150–160.

28.

Mc Monagle P, Byrne P, Burke T, Parfrey N, Hutchinson M. Clinical and pathologic findings in hereditary spastic paraparesis with spastin mutation. Neurology . 2001; 56: 139.

29.

Peters AA, Oger JJ, Coulthart MB, Waters DJ, Cummings HJ, Dekaban GA. An apparent case of human T-cell lymphotropic virus type II (HTLV-II)-associated neurological disease: a clinical, molecular, and phylogenetic characterisation. J Clin Virol . 1999; 14: 37–50.

30.

Silva EA, Otsuki K, Leite AC, Alamy AH, Sa-Carvalho D, Vicente AC. HTLV-II infection associated with a chronic neurodegenerative disease: clinical and molecular analysis. J Med Virol . 2002; 66: 253–257.

31.

Murphy EL, Glynn SA, Fridey J, et al. Increased incidence of infectious diseases during prospective follow-up of human T-lymphotropic virus type II- and I-infected blood donors. Retrovirus Epidemiology Donor Study. Arch Intern Med . 1999; 159: 1485–1491.

32.

Murphy EL, Glynn SA, Fridey J, et al. Increased prevalence of infectious diseases and other adverse outcomes in human T lymphotropic virus types I- and II-infected blood donors. Retrovirus Epidemiology Donor Study (REDS) Study Group. J Infect Dis . 1997; 176: 1468–1475.

33.

Safaeian M, Wilson LE, Taylor E, Thomas DL, Vlahov D. HTLV-II and bacterial infections among injection drug users. J Acquir Immune Defic Syndr . 2000; 24: 483–487.

34.

Modahl LE, Young KC, Varney KF, Khayam-Bashi H, Murphy EL. Are HTLV-II-seropositive injection drug users at increased risk of bacterial pneumonia, abscess, and lymphadenopathy? J Acquir Immune Defic Syndr Hum Retrovirol . 1997; 16: 169–175.

Information & Authors

Information

Published In

Neurology^®

Volume 61 • Number 11 • December 9, 2003

Pages: 1588-1594

PubMed: 14663047

Copyright

© 2003.

Publication History

Received: March 14, 2003

Accepted: August 4, 2003

Published online: December 8, 2003

Published in print: December 9, 2003

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Authors

Affiliations & Disclosures

J. R. Orland, MD

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.

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J. Engstrom, MD

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.

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J. Fridey, MD

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.

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R. A. Sacher, MD

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.

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J. W. Smith, MD

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.

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C. Nass, PhD

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.

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G. Garratty, PhD

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.

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B. Newman, MD

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.

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D. Smith

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.

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B. Wang, MD DrPH

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.

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K. Loughlin

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.

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E. L. Murphy, MD MPH

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.

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for the HTLV Outcomes Study (HOST)

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.

Notes

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: [email protected]

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