RESUMO
BACKGROUND: The natural history of HTLV-1-associated myelopathy (HAM) has been mainly described in HTLV-1 endemic countries such as Japan, Brazil and Martinique. OBJECTIVES: The authors describe the natural history of the largest cohort of patients with HAM living in the UK from 1993 to 2007. METHODS: Prospective, longitudinal study comparing clinical and virological outcome between first and last clinical visit. Incidence and cause of death were documented and the mortality calculated. RESULTS: 48 patients were included: 79.2% were female, 79.2% were of Afro-Caribbean origin, and 83.3% acquired HTLV-1 through breastfeeding or unprotected heterosexual intercourse. The mean age of onset was 46 years. The median durations from onset of symptoms to diagnosis and to last follow-up were 2 and 11.6 years. The median time of follow-up was 3.8 years. The most common first recalled symptom was unilateral leg weakness. The median times from onset to unilateral, bilateral walking aid and frame or a wheelchair were 11, 11.2, 11.3 and 18 years. The overall average deterioration in timed walk in patients whose need for aid did not change was 2 s/10 m/year. Three patients progressed rapidly and were unable to walk within 2 years. Six patients were slow/non-progressors. The mortality was 2.4/100 person year follow-up. The median HTLV-1 viral load remained unchanged at 14%. CONCLUSIONS: HAM is a slowly progressing chronic disease. Timed walk deteriorates by 2 s/10 m/year, and patients remain ambulant for 10 years but become wheelchair-dependent a decade later. HTLV-1 viral load remains high and unchanged over time regardless of clinical progression.
Assuntos
Infecções por HTLV-I/diagnóstico , Paraparesia Espástica Tropical/diagnóstico , Adolescente , Adulto , Idade de Início , Idoso , Criança , Estudos de Coortes , Avaliação da Deficiência , Progressão da Doença , Feminino , Infecções por HTLV-I/mortalidade , Infecções por HTLV-I/transmissão , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Exame Neurológico , Medição da Dor , Paraparesia Espástica Tropical/mortalidade , Paraparesia Espástica Tropical/transmissão , Estudos Prospectivos , Análise de Sobrevida , Reino Unido , Adulto JovemRESUMO
The role of human papilloma virus (HPV) in esophageal cancers from the low-incidence area (Western population) is unclear. We report a case of esophageal squamous papillomatosis associated with underlying esophageal squamous cell carcinoma (OSCC). The esophagectomy specimen confirmed presence of HPV-5 and HPV-16 suggesting a viral etiology. The significance of this dual infection is not known, but it suggests that esophageal papillomatosis is premalignant and should receive regular endoscopic follow-up. This is the first report of both HPV-5 and HPV-16 DNA detected in an esophageal cancer occurring in the Western population.