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. 2015 Jul 1;61(1):49-56.
doi: 10.1093/cid/civ229. Epub 2015 Mar 27.

Neurological Manifestations in Human T-Cell Lymphotropic Virus Type 1 (HTLV-1)-Infected Individuals Without HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis: A Longitudinal Cohort Study

Davi Tanajura  1 , Néviton Castro  2 , Paulo Oliveira  2 , Abraão Neto  2 , André Muniz  2 , Natália B Carvalho  2 , Glória Orge  2 , Silvane Santos  3 , Marshall J Glesby  4 , Edgar M Carvalho  5
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Neurological Manifestations in Human T-Cell Lymphotropic Virus Type 1 (HTLV-1)-Infected Individuals Without HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis: A Longitudinal Cohort Study

Davi Tanajura et al. Clin Infect Dis. .

Abstract

Background: Human T-cell lymphotropic virus type 1 (HTLV-1) is the agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), observed in up to 5% of infected individuals. Despite low prevalence, many HTLV-1-infected patients who do not fulfill criteria for HAM/TSP present with neurological complaints related to sensory, motor, urinary, or autonomic manifestations. The aim of this study was to determine the incidence of neurologic manifestations and risk factors associated with these outcomes.

Methods: The incidence of HAM/TSP and new signs and neurologic symptoms were computed in a group of patients enrolled in a cohort study.

Results: Of 414 subjects, 76 had definite HAM/TSP, 87 had possible or probable HAM/TSP, and 251 subjects had no neurologic manifestation and were selected for analysis. Definite HAM/TSP developed in 5 (1.47%) patients. Follow-up of at least 3 years was achieved in 51% of patients. The incidence rate was computed in 1000 person-years (206 for hand numbness, 187 for feet numbness, 130 for nocturia, and 127 for urgency). Average incidence rate in neurological exam was 76 for leg hyperreflexia, 53 for leg weakness, and 37 for Babinski sign. In the applied Expanded Disability Status Scale, the incidence rate of worsening 1 point was 134 per 1000 person-years. Kaplan-Meier curves stratified by sex and proviral load showed that females and patients with proviral load >50,000 copies/10(6) peripheral blood mononuclear cells had a higher risk of progression.

Conclusions: Development of neurological symptoms or signs occurred in up to 30% of asymptomatic subjects during 8 years of follow-up.

Keywords: HAM/TSP; HTLV-1; cohort; incidence; neurologic manifestations.

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Figures

Figure 1.
Figure 1.
Outcomes of cohort participants. Abbreviations: HAM/TSP, human T-cell lymphotropic virus type 1–associated myelopathy/tropical spastic paraparesis; HTLV-1, human T-cell lymphotropic virus type 1.
Figure 2.
Figure 2.
Kaplan–Meier survival curve. Decrease in at least 1 point in Expanded Disability Status Scale in human T-cell lymphotropic virus type 1–asymptomatic individuals according to sex (n = 251).
Figure 3.
Figure 3.
Kaplan–Meier survival curve. Decrease in at least 1 point in Expanded Disability Status Scale in human T-cell lymphotropic virus type 1–asymptomatic individuals according to proviral load (n = 130). Abbreviation: PBMCs, peripheral blood mononuclear cells.
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