Treatment

TREATMENT FOR DISEASES ASSOCIATED TO THE HTLV-I AND HTLV-II

In clinical studies, nevertheless, the AZT did not show efficiency when administered in a dosage of 500mg to 1000mg/day in 5 patients studied (9). A further study, using higher dosages - 2g/day in the first four weeks followed by 1g/day for 20 weeks more - showed improvement in the Expanded Disability Status Scale (EDSS) in 7/10 patients involved. However, 4/5 patients with ongoing improvement did revert after the suspension of the medication (10).

There are limited references on danazol, which can offer transitory clinical benefits to the patients treated (11, 12). With broad experience, however lacking further randomized and controlled studies, we can find the interferon-alpha and the steroids. The interferon-alpha did show effectiveness in the inhibition of viral replication in vitro (13) and, during clinical studies, it could be noted a significant functional improvement of the patients (14, 15), as well as an inhibition of the previously increased spontaneous lymphocytary proliferation (16, 17), besides a decreasing in the HTLV-1 viral load (17) in the majority of the patients treated this way.

The dosage, the administration interval, and the duration of the treatment are not well established; however, treatments with a daily dosage of 3-million of UI for 28 days (15), and longer, 6-million UI/day in the first two weeks, followed by the same dosage, three days/week, alternated by six months (17), seem to have a greater impact and a higher maintenance of the clinical response and on the laboratorial indicators (17). The corticosteroids have been reported as valuable, especially for patients during the initial phase of the symptoms, those with a history of blood transfusion, and those who are not coming from tropical countries (12, 18-23).

The choice of the drug, the dosage, and the time of administration are not well established; however, it is suggested for the cases that the symptoms had been recently installed, showing liquor with inflammatory pattern, a pulse with methylprednisolone (1g/d IV for 3 to 5 days), followed by prednisone (1mg/kg/day) for an unspecified time (20, 24). Yet, it is important to evaluate the presence of co-infections that could influence the evolution and/or share options of treatment. We put an emphasis on the co-infection with the hepatitis C virus situation, which treatment, when indicated, includes the use of interferon-alpha, thus contemplating both aspects but not excluding specific approaches.

Similar situation is observed in the co-infection with the HIV, where the myelopathy is more frequent than it is in the exclusive infection by the HIV (vacuolar myelopathy), as well as in the exclusive infection by the HTLV-1, with an attack rate ten times higher the former. The use of highly active antiretroviral therapy (HAART) has a considerable clinical therapeutic impact on these cases, as it has also been observed in our experience (25, 26). Supporting therapeutic measures are worth mentioning, such as physiotherapy and the use of drugs to deal with the spasticity, where we emphasize the diazepam and the baclofen. Auxiliary techniques for the sphincterian functioning, as well as specific medication, such as the oxybutin, the propanteline, and the imipramine could help with the urinary disturbances (24).

The treatment must be preferably monitored by Dynic algorithm , to the extent that it objectifies the results, aiming at adjusting and individualizing the therapeutic proposal (12). ADULT T-CELLS LEUKEMIA (ATL) TREATMENT The adult T-cells leukemia/lymphoma predominantly assails people in their 5 th decade of life, with an attack rate of 2/1000 for men and 0.5/1000 for women, who are HTLV-I infection carriers. It is classified in four forms: latent, chronic, lymphomatosis, and acute, showing high lethality in the most aggressive forms, generally related to respiratory infections and hypercalcemia. The treatment for the acute and lymphomatosis forms are constituted of combined chemotherapy (CHOP, VEPA, or COMLA) with limited results.

New therapeutic protocols are necessary, with differentiation between the chronic and latent forms from the acute and lymphomatosis forms (27-30). The uveitis associated to the infection by the HTLV-I (HU) is the third clinical entity related to the infection by the HTLV-I (31). It has prevalence of 112/100.000 in Japan, and as a treatment, it is proposed the use of topics and/or systemic corticosteroids. The visual prognostics is favorable, however, there is a tendency of recurrence after the suspension of the drugs (32, 33).