Epidemiological and clinical profile of HTLV-1 patients: a closer look at a reference center in Bahia, Brazil.

The human T-lymphotropic virus type 1 (HTLV-1) affects over 5 million people worldwide and is endemic in Brazil. Though HTLV-1 is a notifiable disease, the last epidemiological report regarding HTLV-1 infection covered the period from 2012 to 2019. To understand the specific challenges and to develop the best strategies for controlling HTLV-1 infection, it is important to know the characteristics of each region providing care to people living with this virus. This descriptive cross-sectional study evaluated patients treated at the HTLV reference center in Vitória da Conquista, Bahia, Brazil, between July 2021 and August 2022. The data were obtained through the analysis of medical records and routine clinical consultations. A total of 67 patients were evaluated, with 79.1% being female, 79.1% identifying as black, indigenous, and people of color, 37.31% being married, 80.6% identifying as heterosexual, and 59.7% reporting inconsistent condom use. Additionally, 37.3% of the patients were diagnosed with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), a chronic disease with a considerable effect on the quality of life. Furthermore, 53.7% of the patients had incomplete/complete elementary education, and 52.2% had an income of up to one minimum wage. The data highlight the necessity for more specific public policies (such as health education strategies, aimed at reducing the number of new infections) targeting the described at-risk population.

Neurological aspects of HTLV-1 infection: symptoms in apparently asymptomatic carriers.

Human T-lymphotropic virus type 1 (HTLV-1) is classically associated with the HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), although the mechanisms of this neurological disorder remain unclear. In addition, some patients who develop "minor" neurological signs that do not meet diagnostic criteria for HAM/TSP are classified as asymptomatic carriers. This study aims to demonstrate the neurological symptoms of Brazilian patients living with HTLV-1 classified as not-HAM.TSP. This observational study evaluated patients treated in an HTLV reference center in Bahia, Brazil, between February 2022 and July 2023. The data were obtained through the analysis of medical records and neurological consultation. Those individuals classified as HAM/ TSP were excluded from this study. 74 patients were submitted to a careful neurological evaluation: 23 HAM/TSP, 22 were classified with intermediate syndrome (IS), and 29 were oligosymptomatic. Self-reported symptoms were significantly more common in the IS group, including urinary symptoms such as nocturia, urgency, incontinence, dysuria, weakness, paresthesia, lumbar pain, xerostomia, and xerophthalmia. Physical examination findings consistent with reduced vibratory and tactile sensitivity were more common in the IS group (p = 0.017 and p = 0.013). Alterations in the V and VIII cranial nerves were present in both groups. HTLV-1 can lead to the development of important neurological signs and symptoms in apparently asymptomatic individuals. This data highlights the need for more research into the neurological aspects of HTLV-1 infection and emphasizes the importance of early diagnosis, treatment, and support for individuals living with this virus.

Neurological symptoms and signs in HTLV-1 patients with overactive bladder syndrome / Sinais e sintomas neurológicos em pacientes com HTLV-1 e síndrome de bexiga hiperativa

OBJECTIVE: To compare neurological symptoms and signs in HTLV-1 asymptomatic carriers and HTLV-1 patients with overactive bladder (OB) syndrome. METHODS: We studied 102 HTLV-1 positive individuals without HAM/TSP (HTLV-1 associated myelopathy/tropical spastic paraparesis) divided into two groups according to the presence or absence of OB syndrome. Clinical interview, neurological exam and proviral load was performed in all patients. RESULTS AND CONCLUSIONS: Individuals with OB were more commonly female (84.3 vs. 60.8% of asymptomatics, p=0.01). The prevalence of neurological complaints was higher in OB group, especially hand or foot numbness and arm or leg weakness. There was no difference between the groups in neurological strength and reflexes. Weakness complaint remained strongly associated with OB in multivariate logistic regression analysis adjusting for sex and age [adjusted odds ratio and 95%CI 3.59 (1.45-8.88) in arms and 6.68 (2.63-16.93) in legs]. Proviral load was also different between the two groups with higher level on OB individuals.

OBJETIVO: Comparar sintomas e sinais neurológicos em pacientes portadores do HTLV-1 assintomáticos e com síndrome de bexiga hiperativa (BH). MÉTODOS: Foram estudados 102 indivíduos com HTLV-1 sem HAM/TSP (mielopatia associada ao HTLV-I/paraparesia espástica tropical), divididos em dois grupos segundo a presença ou ausência de BH. Foram realizados em todos os pacientes entrevista clínica, exame neurológico e carga proviral. RESULTADOS E CONCLUSÕES: Indivíduos com BH foram na maioria do sexo feminino (84,3 vs. 60,8% dos assintomáticos, p=0,01). A prevalência de queixas neurológicas foi maior no grupo BH, especialmente dormências e fraqueza em extremidades. Não houve diferença entre os grupos em relação a achados do exame neurológico. Fraqueza subjetiva permaneceu fortemente associada com BH na regressão logística multivariada ajustada para sexo e idade [OR e IC95% 3,59 (1,45-8,88) nos braços e 6,68 (2,63-16,93) nas pernas]. A carga proviral foi também diferente entre os dois grupos com nível maior em indivíduos com BH.