HTLV

HTLV

There are two types- HTLV 1 and 2

Infection with these viruses are common in Caribbean countries and Far East.

Transmission

Vertical transmission is considered to be the main route of transmission. Transmission can occur during delivery or by breast feeding.

Blood transfusion and sexual transmission are considered to be the other important routes of transmission.

Plasma and serum are free from HTLV, for this reason transmission with administration of clotting factor is uncommon.

Incubation period

The incubation period is unknown.

Clinical presentations

Asymptomatic infection is common

Occasionally acute infection with these viruses causes skin rash and fever.

Tropical Spastic Paraparesis (HTLV associated myelopathy)

Myelopathy

Paraparesis

Adult cell leukaemia (ATL)

ATL develops after 30 years of infection

Lymphadenopathy is common.

May infiltrate the skin and visceral organs.

Have bad prognosis.

Investigation

Blood film and bone marrow biopsy may be used to diagnose ATL.

Diagnostic tests

Serum for HTLV 1 and 2 – to determine the presence of antibodies.

Screening test

Test for the presence of antibody to HTLV 1 and 2 (before transplant)

Recently in UK routinely screening test for HTLV 1 and 2 has been introduced to screen potential organ donors.

HTLV 1 & 2 RNA PCR is carried out in some countries like Japan to screen all blood before transfusion.

Treatment

There is no effective treatment.

Lamivudine has been shown to reduce the HTLV viral load in plasma.

Tenofovir was found to be more potent than Lamivudine in vitro study but it was not confirmed in vivo study.

At present the objective of therapy is to eradicate cancerous cells in patients who are diagnosed to have ATL.

So far there is no effective chemotherapy for ATL.

Prevention

Screening of blood before transplantation is essential to reduce nosocomial transmission.

In some endemic countries, screening of pregnant women has started recently. Those women who were found to carry the virus were advised to avoid breast feeding to curb vertical transmission.