SOME BASIC INFORMATION ON HTLV – OCTOBER 2000

1. What is the HTLV virus?

Answer: The HTLV virus (abbreviation indicating the virus that affects the human T cells) is a retrovirus isolated in 1980 from a patient with a rare type of T cells leukemia. It has two types: The HTLV-I, which is involved in neurological disease and leukemia, and type 2 (HTLV0II), which is less evidenced as causing a disease.

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2. Do all people who are HTLV-I-infected will develop some disease

Answer: No. The minority of asymptomatic carriers (without symptoms) could develop some form of disease. In Japan, for instance, 14 in every 1,500 asymptomatic carriers could develop neurological disease (walking difficulty). In case of leukemia, the risk is even less, in other words, one in every 10,000 carriers could develop it during a lifetime .

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3. I am an HTLV-I asymptomatic carrier, what are the first symptoms that could appear?

Answer: As we emphasized, around 99% of the HTLV-I carrier people NEVER will develop any health problem related to the HTLV virus. However, some patients could develop neurological problems, generally, complaining about pains in the lower limbs (calves), in the lumbar region (lower part of the lumbar column), and defection and urination difficulty. These symptoms are always progressive and concentrated in the region below the bellybutton line .

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4. What are the most frequent modes of transmission of HTLV ?

Answer: The HTLV has the same routes of transmission as other viruses, such as the human immunodeficiency virus (HIV) and the hepatitis C virus (HCV): through unprotected sexual relation with an infected person; sharing the use of syringes and needles during drug-addiction; from infected mother to the newborn (especially through breastfeeding) .

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5. Is there a risk of transmission through blood transfusion?

Answer: Fortunately, since 1993 all blood banks in Brazil must test the blood donors for the HTLV. Therefore, the risk of transmission, practically, does not exist in our county for the last 7 years.

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6. I am an HTLV-I asymptomatic carrier and my wife is negative for this type of virus, thus I would like to know if I have the use condoms during sexual relations ?

Answer: There is a recommendation for the use of condoms in all sexual relations, in this case as well as in those where the woman is seropositive for the HTLV and the partner is not.

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7. I am 28 years old and an HTLV-I asymptomatic carrier and would like to know if there is any restriction to have children ?

Answer: The likelihood for vertical transmission are considered low (<10%) during pregnancy. However, it is not recommended breastfeeding, since the risk of transmission from breast milk is reasonable. The use of milk from milk banks or the use of formulas is an alternative .

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8. Who are the people who should be tested for HTLV ?

Answer: Knowing the modes of transmission, we can indicate the groups that could be most exposed to this virus: people who use (or had used) intravenal drugs where the exchange of syringes and needles were present, HIV carrier people, and people who received blood transfusion prior to 1993.

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9. Is there any genetic predisposition leading to the development of the disease ?

Answer: It seems that some people have the genetic predisposition for the development, but this is still under study.

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10. What types of medical care should I follow as an HTLV-I carrier ?

Answer: In the first visit, besides the serology for the HTLV-I/II, we generally ask for serology for agents that, potentially, show similar routes of transmission, such as the hepatitis B virus, hepatitis C virus, HIV, and syphilis. In our Ambulatory Service, the asymptomatic carrier individuals have an appointment every six months. The blood tests required are: full hemogram, CD4/CD8 T lymphocytes count, lymphocytes culture, proto-parasitologic, Glycemia, DHL.

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11. Is there any blood test which indicates the risk for developing the disease in HTLV-I asymptomatic and carrier people ?

Answer: Up to this moment no examination has shown this capability. However, our studies indicate that the amount of HTLV-I virus in the blood, called viral load, could indicate some sort of risk.

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12. What kind of treatment is currently available for HTLV-I asymptomatic individuals ?

Answer: Since the risk for developing the disease associated to the HTLV-I is very low, there is no indication for treatment to the asymptomatic case up to this moment.

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13. Which are the cases that need treatment ?

Answer: The cases where there are confirmed symptoms of the disease associated to the HTLV-I, such as tropical spastic paraparesis (TSP), uveitis, ATL, among others. The treatment will depend on a neurological evaluation, such as the quantification of the level of implication, evolution time, presence of other viral infections, etc.

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14. How the diagnosis of the HTLV-I infection is done ?

Answer: Only through specific serologic assay for researching the anti-HTLV-I/II antibodies in the blood. <0} {0> <}0{> After screening tests, generally applying the ELISA assay and in case this test is reactive (positive), there is a need to perform the test to confirm and differentiate the anti-HTLV-I and HTLV-II antibodies. <0}

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