Prevalence and risk factors for Human T-Lymphotropic Virus Type 1 (HTLV-1) among maintenance hemodialysis patients

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Abstract

Background

Infection with the human T-cell lymphotropic virus type 1 (HTLV-1), although asymptomatic in most cases, can lead to potentially grave consequences, such as adult T-cell leukemia-lymphoma and HTLV-1-associated myelopathy / tropical spastic paraparesis. Its prevalence varies widely across different populations and geographic regions. A population-based study in the city of Salvador, located in the Northeast region of Brazil, showed an overall prevalence of HTLV-1 seropositivity of 1.7%. Blood borne virus infections are recognized as important hazards for patients and staff in maintenance hemodialysis (MHD) units but most studies focus on hepatitis B, hepatitis C and human immunodeficiency viruses. There are scarce data about HTLV-1 infection in the MHD population. We aimed to determine the prevalence and risk factors for HTLV-1 infection among MHD patients in the city of Salvador-Bahia, Brazil.

Methods

We conducted a multi-center, cross-sectional study nested in a prospective cohort of MHD patients enrolled from four outpatient clinics. HTLV-1 screening was performed with ELISA and positive cases were confirmed by Western Blot. Factors associated with HTLV-1 seropositivity were identified by multivariable logistic regression.

Results

605 patients were included in the study. The overall prevalence of HTLV-1 infection was 2.48% (15/605), which was similar to that of hepatitis B [1.98% (12/605)] and C [3.14% (19/605)] viruses in our sample. HTLV-1 seropositivity was positively associated with age [prevalence odds ratio (POR) 1.04; 95% confidence interval (CI) 1.01–1.08], unmarried status (POR 3.65; 95% CI 1.13–11.65), and history of blood transfusion (POR 3.35; 95% CI 1.01–11.13).

Conclusions

The overall prevalence of HTLV-1 infection in a sample of MHD patients was similar to that of other viral infections, such as hepatitis B and C. Our data revealed that MHD patients who are older, unmarried or who have received blood transfusions are at higher risk for HTLV-1 infection.

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Most cited references 38

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Detection and isolation of type C retrovirus particles from fresh and cultured lymphocytes of a patient with cutaneous T-cell lymphoma.

B Poiesz, F Ruscetti, A Gazdar … (1980)

Retrovirus particles with type C morphology were found in two T-cell lymphoblastoid cell lines, HUT 102 and CTCL-3, and in fresh peripheral blood lymphocytes obtained from a patient with a cutaneous T-cell lymphoma (mycosis fungoides). The cell lines continuously produce these viruses, which are collectively referred to as HTLV, strain CR(HTLV(CR)). Originally, the production of virus from HUT 102 cells required induction with 5-iodo-2'-deoxyuridine, but the cell line became a constitutive producer of virus at its 56th passage. Cell line CTCL-3 has been a constitutive producer of virus from its second passage in culture. Both mature and immature extracellular virus particles were seen in thin-section electron micrographs of fixed, pelleted cellular material; on occasion, typical type C budding virus particles were seen. No form of intracellular virus particle has been seen. Mature particles were 100-110 nm in diameter, consisted of an electron-dense core surrounded by an outer membrane separated by an electron-lucent region, banded at a density of 1.16 g/ml on a continuous 25-65% sucrose gradient, and contained 70S RNA and a DNA polymerase activity typical of viral reverse transcriptase (RT; RNA-dependent DNA nucleotidyltransferase). Under certain conditions of assay, HTLV(CR) RT showed cation preference for Mg(2+) over Mn(2+), distinct from the characteristics of cellular DNA polymerases purified from human lymphocytes and the RT from most type C viruses. Antibodies to cellular DNA polymerase gamma and anti-bodies against RT purified from several animal retroviruses failed to detectably interact with HTLV(CR) RT under conditions that were positive for the respective homologous DNA polymerase, demonstrating a lack of close relationship of HTLV(CR) RT to cellular DNA polymerases gamma or RT of these viruses. Six major proteins, with sizes of approximately 10,000, 13,000, 19,000, 24,000, 42,000, and 52,000 daltons, were apparent when doubly banded, disrupted HTLV(CR) particles were chromatographed on a NaDodSO(4)/polyacrylamide gel. The number of these particle-associated proteins is consistent with the expected proteins of a retrovirus, but the sizes of some are distinct from those of most known retroviruses of the primate subgroups.

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Epidemiological Aspects and World Distribution of HTLV-1 Infection

Antoine Gessain, Olivier Cassar, Jinyun Tang (2013)

The human T-cell leukemia virus type 1 (HTLV-1), identified as the first human oncogenic retrovirus 30 years ago, is not an ubiquitous virus. HTLV-1 is present throughout the world, with clusters of high endemicity located often nearby areas where the virus is nearly absent. The main HTLV-1 highly endemic regions are the Southwestern part of Japan, sub-Saharan Africa and South America, the Caribbean area, and foci in Middle East and Australo-Melanesia. The origin of this puzzling geographical or rather ethnic repartition is probably linked to a founder effect in some groups with the persistence of a high viral transmission rate. Despite different socio-economic and cultural environments, the HTLV-1 prevalence increases gradually with age, especially among women in all highly endemic areas. The three modes of HTLV-1 transmission are mother to child, sexual transmission, and transmission with contaminated blood products. Twenty years ago, de Thé and Bomford estimated the total number of HTLV-1 carriers to be 10–20 millions people. At that time, large regions had not been investigated, few population-based studies were available and the assays used for HTLV-1 serology were not enough specific. Despite the fact that there is still a lot of data lacking in large areas of the world and that most of the HTLV-1 studies concern only blood donors, pregnant women, or different selected patients or high-risk groups, we shall try based on the most recent data, to revisit the world distribution and the estimates of the number of HTLV-1 infected persons. Our best estimates range from 5–10 millions HTLV-1 infected individuals. However, these results were based on only approximately 1.5 billion of individuals originating from known HTLV-1 endemic areas with reliable available epidemiological data. Correct estimates in other highly populated regions, such as China, India, the Maghreb, and East Africa, is currently not possible, thus, the current number of HTLV-1 carriers is very probably much higher.

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HTLV-I in the general population of Salvador, Brazil: a city with African ethnic and sociodemographic characteristics.

Bernardo Galvão-Castro, Maria de Sousa, Inês Dourado … (2003)

The city of Salvador has the highest prevalence of HTLV-I among blood donors in Brazil. To study the prevalence of HTLV-I among the general population of Salvador, 30 "sentinel surveillance areas" were selected for the investigation of various infectious diseases, and 1385 individuals within these areas were surveyed according to a simple random sample procedure. ELISA was used to screen plasma samples for antibodies to HTLV-I, and the positive samples were tested by a confirmatory assay (Western blotting). The overall prevalence of HTLV-I was 1.76% (23/1385). Infection rates were 1.2% for males and 2.0% for females. Specific prevalence demonstrated an increasing linear trend with age. No one younger than 13 years of age was infected. Multivariate analysis estimated adjusted odds ratios for the association of HTLV-I with age of 9.7 (3.3; 30.4) for females and 12.3 (1.47; 103.1) for males. Less education and income might be associated with HTLV-I infection in females. Phylogenetic analysis of the long terminal repeat fragments showed that most of the samples belonged to the Latin American cluster of the Transcontinental subgroup (Cosmopolitan subtype). For the entire city of Salvador, it is estimated that approximately 40000 individuals are infected with HTLV-I. Our results suggest multiple post-Colombian introductions of African HTLV-Ia strains in Salvador.

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Author and article information

Contributors

Rilma F. S. Santos: +55 71 3117-7684 , rilma_santos@yahoo.com.br

Gildásio C. Conceição: gildasiocarvalho@hotmail.com

Márcia S. Martins: marjulia2000@uol.com.br

Angiolina Kraychete: oramafbu@gmail.com

Maria A. C. Penalva: acpenalva@uol.com.br

Edgar M. Carvalho: edgar@ufba.br

Antonio Alberto Lopes: aaslopesufba@gmail.com

Paulo Novis Rocha: paulonrocha@ufba.br

Journal

Journal ID (nlm-ta): BMC Nephrol

Journal ID (iso-abbrev): BMC Nephrol

Title: BMC Nephrology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2369

Publication date (Electronic): 15 February 2017

Publication date PMC-release: 15 February 2017

Publication date Collection: 2017

Volume: 18

Electronic Location Identifier: 64

Affiliations

[1 ]Division of Nephrology, Hospital Geral Roberto Santos, Salvador, Brazil

[2 ]ISNI 0000 0004 0372 8259, GRID grid.8399.b, Postgraduate Program in Health Sciences, , Federal University of Bahia, ; Salvador, Brazil

[3 ]Department of Biochemistry, APAE, Salvador, Brazil

[4 ]ISNI 0000 0004 0372 8259, GRID grid.8399.b, Unit of Clinical Epidemiology and Evidence Based Medicine of the Professor Edgard Santos University Hospital, , Federal University of Bahia, ; Salvador, Brazil

[5 ]Diretoria Médica da Clínica Nephron-Itapuã, Salvador, Brazil

[6 ]ISNI 0000 0001 0723 0931, GRID grid.418068.3, , Centro de Pesquisas Gonçalo Moniz (Fiocruz-Ba), ; Salvador, Brazil

[7 ]ISNI 0000 0004 0372 8259, GRID grid.8399.b, Department of Internal Medicine and Diagnostic Support, , Medical School of Bahia, Federal University of Bahia, ; Salvador, Brazil

Article

Publisher ID: 484

DOI: 10.1186/s12882-017-0484-y

PMC ID: 5312583

PubMed ID: 28202003

SO-VID: 937e4828-4bc4-48be-a297-f970bd25596b

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 5 October 2016

Date accepted : 9 February 2017

Funding

Funded by: The study was supported by research grants from “The Brazilian National Council for Scientific and Technological Development (CNPq)

Award ID: #480292/2009-4 and #309468/2009-4

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ScienceOpen disciplines: Nephrology

Keywords: blood transfusion,chronic kidney 47 disease,hemodialysis,hepatitis b,hepatitis c,human t-lymphotropic virus type 1

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ScienceOpen disciplines: Nephrology

Keywords: blood transfusion, chronic kidney 47 disease, hemodialysis, hepatitis b, hepatitis c, human t-lymphotropic virus type 1

Prevalence and risk factors for Human T-Lymphotropic Virus Type 1 (HTLV-1) among maintenance hemodialysis patients

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Karger: Nephrology

Most cited references 38

Detection and isolation of type C retrovirus particles from fresh and cultured lymphocytes of a patient with cutaneous T-cell lymphoma.

Epidemiological Aspects and World Distribution of HTLV-1 Infection

HTLV-I in the general population of Salvador, Brazil: a city with African ethnic and sociodemographic characteristics.

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