PREVENTION

BLOOD DONORS NOTIFICATION AND EXCLUSION

The blood donors, whose serum specimens repeatedly ELISA reactive for HTLV-I and confirmed as seropositive for HTLV-I/II in additional specific tests, as discussed above, are notified and permanently banned from donating blood. This policy of exclusion includes donors who were confirmed positive with antibodies for the HTLV-I, HTLV-II, ou HTLV-III (if the differentiation among the infections is not executed or if it does not succeed). Blood donors with repeatedly reagent serums, but not confirmed as seropositive for HTLV-I/II (a category which includes false-positives and indeterminate specimens for HTLV), should also be notified and excluded if the same result was obtained in two separate donations. In some blood banks, such donors are banned after the first donation.

People who are repeatedly reagents during serologic screening for HTLV-I/II, but who are not confirmed as seropositives, should not be informed whether or not they are infected by the HTLV-I or HTLV-II. The previous donor exclusion policies are based on FDA recommendations. Furthermore, the recommendations from the Ministério da Saúde do Brasil (Brazilian Health Care Administration), concerning the use of blood components, should also be followed.

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COUNSELING RECOMMENDATIONS

Taken into consideration the information introduced above, the following recommendations were issued for counseling the persons seropositive for the HTLV. In cases where the viral infection possibility is true, the counseling should be virus specific. We would like to call the attention to the issue that the HTLV-I and the HTLV-II are different retroviruses and differ in terms of epidemiology and association with the disease. Therefore, the specific recommendations for people infected by the HTLV-I or HTLV-II should take into considerations these differences. According to the USPHS criteria, HTLV-II-persons identified, as seropositives for the HTLV-I/II and positive for the HTLV-I, through additional screening, should be informed that they are infected with the HTLV-I. They also should be informed that the HTLV-I is not the Aids virus, which it does not cause the Aids, and that the Aids is caused by a different virus called the HIV.

They should be told that the HTLV-I causes infection for the rest of the life. They should learn about the modes and the efficiency of the transmission, associations to the disease, and the probability to develop the disease. Due to the low probability of developing the disease (1%), there is not a particular reason to prescribe a specific treatment for the asymptomatic carriers. In particular, people infected with the HTLV-I should receive counseling on: · How to share this information with his/her physician or dentist; · Do not donate blood, breast milk, semen, body parts or other tissues; · Do not share needles or syringes with other people; · Do not breastfeed children; · Considering the use of latex condoms to prevent against sexual transmission If the HTLV-I-positive person is in a mutually monogamous sexual relation, it is recommended serologic test to the sexual partner to help in the formulation of a specific counseling. If the sexual partner is also positive, there will be no additional recommendation thus far. If the sexual partner is negative, the couple should be advised to use latex condoms, which can help to prevent against the HTLV-I transmission to the negative male or female partner. Couples, infected men and non-infected women who wish to have babies should be warned about the slight risk of HTLV-I sexual transmission during the pregnancy attempts, and the slight risk of vertical transmission from mother to child, not related to the breastfeeding. Such a couple should be advised to always wear latex condoms, excluding during the fertile period in which they are attempting the pregnancy. The use of latex condoms é strongly recommended for the HTLV-I-positive persons with multiple sexual partners, or when they are engaged in sexual relations that are not mutually monogamous. These individuals should be reminded of the risk of acquiring other sexually transmitted infections, including the HIV.