Uso da eletromiografia de superfície na resultância do treinamento muscular inspiratório com carga linear em portadores do vírus linfotrópico humano tipo 1 / Use of surface electromyography in results of inspiratory muscle training with linear load in patients with type 1 human lymphotropic virus

Este estudo visa avaliar por eletromiografia de superfície o comportamento dos músculos inspiratórios no treinamento muscular em voluntários com vírus linfotrópico de célula T humana do tipo 1. Trata-se de um ensaio clínico. Sete voluntários, com idade 58,85 ± 7,2) anos, realizaram treinamento muscular inspiratório domiciliar por 4 semanas, 3 vezes por semana, 30 minutos diários por meio de incentivador de carga linear. Para avaliação utilizou-se os dados de pressão inspiratória máxima e os dados da eletromiografia de superfície nas fases pré (T0), segunda semana (T2) e após a quarta semana (T4) de treinamento. Observou-se aumento progressivo da força muscular inspiratória de T0 a T4 (p = 0,007), assim como, aumento do recrutamento das unidades motoras pela análise da amplitude do sinal eletromiográfico, sendo mais evidente para o músculo esternocleidomastóideo (p = 0,12) em comparação ao músculo diafragma (p = 0,6). Verificou-se que no decurso do treinamento muscular ocorreu melhora significativa da força muscular inspiratória com maior recrutamento das fibras musculares dos músculos analisados na amostra. (AU)

This study aimed to evaluate by surface electromyography the behavior of inspiratory muscles in the muscle training of volunteers with human T-cell lymphotropic virus type 1. This was a clinical trial. Seven volunteers, 58,85 ± 7.21 years old, underwent inspiratory muscle training at home for 4 weeks, 3 times a week, 30 minutes daily by means of a linear load stimulator. The maximum inspiratory pressure data and the surface electromyography data were used for evaluation in the pre (T0), second week (T2) and after the fourth week (T4) training phases. There was a progressive increase in inspiratory muscle strength from T0 to T4 (p = 0.007), as well as an increase in the recruitment of motor units by analyzing the amplitude of the electromyographic signal, being more evident for the sternocleidomastoid muscle (p = 0.12) in comparison to the diaphragm muscle (p = 0.6). During the muscle training inspiratory muscle strength improves with greater recruitment of muscle fibers from the muscles analyzed in the sample. (AU)

HTLV-1 Associated Neurological Complex. What is Hidden below the Water?

The human T-cell lymphotropic virus type 1 (HTLV-1) infects 5-10 million people worldwide and causes fatal and disabling diseases in a significant proportion of them. A chronic myelitis named HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) is the typical neurological manifestation of HTLV-1. However, other neurological syndromes can be either associated with HAM/TSP or occur in isolation in the HTLV-1 infected individual. Although this fact has been widely described over the years, it has been somewhat neglected by the mainstream literature, which has been largely focused on HAM/TSP. Cognitive dysfunction, encephalopathy, neurogenic bladder, motor neuron disease, inflammatory myopathies, polyneuropathy, and dysautonomia can also occur in the HTLV-1 infected patient and may remain unnoticed to the unsuspecting physician. In the present review, we intend to draw attention, primarily to the infectious disease specialist and to the general practitioner, to the fact that HTLV-1 has a broader neurological spectrum than the designation HAM/TSP suggests and that infected individuals may harbor other neurological syndromes in addition to HAM/TSP.

Quality of life, risk behaviors and depression among carriers of hepatitis C virus and human T-cell lymphotropic virus type 1: a comparative study

Abstract Human T-cell lymphotropic virus type 1 (HTLV-1) has low prevalence rates, but is endemic in some regions of the world. It is usually a chronic asymptomatic infection, but it can be associated with serious neurologic and urinary conditions. Hepatitis C virus (HCV) is broadly spread out worldwide. The majority of these infections have a chronic course that may progress to cirrhosis and hepatocellular carcinoma. Objectives: To compare sociodemographic and mental health (risk behaviors, depression, and suicide) aspects, and quality of life among patients with HCV or HTLV-1. Methods: Observational, comparative and cross-sectional study involving outpatients with HCV or HLTV-1 infection. Sociodemographic characteristics, risk behaviors and quality of life were assessed through the questionnaires Mini International Neuropsychiatric Interview - MINI Plus (depression and suicide) and Medical Outcomes Study 36-Item Short-Form Health Survey (quality of life). Univariate and multivariate statistical analyses (hierarchical logistic regression) were conducted. Results: 143 individuals with HCV and 113 individuals with HTLV-1 infection were included. Males were predominant in the HCV group (68.8%) and females in the HTLV-1 group (71.7%). The frequency of risk behaviors (sexual and drug use) was greater in those with HCV (p < 0.05). A past depressive episode was more common in the HTLV-1 group (p = 0.037). Quality of life was significantly worse in the physical functioning, vitality, mental health, and social functioning domains in those with HTLV-1 (p < 0.05). HTLV-1 infection remained independently associated with worse quality of life in multivariate analysis. Conclusions: Risk behaviors are frequent among those infected with HCV. Additionally, despite HTLV-1 being considered an infection with low morbidity, issues related to mental health (depressive episode) and decreased quality of life are relevant.

Quality of life, risk behaviors and depression among carriers of hepatitis C virus and human T-cell lymphotropic virus type 1: a comparative study.

Human T-cell lymphotropic virus type 1 (HTLV-1) has low prevalence rates, but is endemic in some regions of the world. It is usually a chronic asymptomatic infection, but it can be associated with serious neurologic and urinary conditions. Hepatitis C virus (HCV) is broadly spread out worldwide. The majority of these infections have a chronic course that may progress to cirrhosis and hepatocellular carcinoma. OBJECTIVES: To compare sociodemographic and mental health (risk behaviors, depression, and suicide) aspects, and quality of life among patients with HCV or HTLV-1. METHODS: Observational, comparative and cross-sectional study involving outpatients with HCV or HLTV-1 infection. Sociodemographic characteristics, risk behaviors and quality of life were assessed through the questionnaires Mini International Neuropsychiatric Interview - MINI Plus (depression and suicide) and Medical Outcomes Study 36-Item Short-Form Health Survey (quality of life). Univariate and multivariate statistical analyses (hierarchical logistic regression) were conducted. RESULTS: 143 individuals with HCV and 113 individuals with HTLV-1 infection were included. Males were predominant in the HCV group (68.8%) and females in the HTLV-1 group (71.7%). The frequency of risk behaviors (sexual and drug use) was greater in those with HCV (p < 0.05). A past depressive episode was more common in the HTLV-1 group (p = 0.037). Quality of life was significantly worse in the physical functioning, vitality, mental health, and social functioning domains in those with HTLV-1 (p < 0.05). HTLV-1 infection remained independently associated with worse quality of life in multivariate analysis. CONCLUSIONS: Risk behaviors are frequent among those infected with HCV. Additionally, despite HTLV-1 being considered an infection with low morbidity, issues related to mental health (depressive episode) and decreased quality of life are relevant.

Human T-Cell Lymphotropic Virus Type 1 and associated diseases in Latin America.

This narrative review, which is based on a systematic literature search following the PRISMA guidelines, provides a general overview of Human T-cell Lymphotropic Virus type 1 (HTLV-1) and associated diseases: Adult T-cell Leukaemia-Lymphoma (ATLL) and HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) in Latin America, focusing on epidemiology and prevention. Using the published information on HTLV-1, ATLL and HAM/TSP prevalence, we present comprehensive and accurate maps and tables, and developed an algorithm to assist in the prevention of HTLV-1 transmission through breastfeeding while considering socio-economic status. Latin America is an interesting scenario to study HTLV-1 because of the diverse origin of its population. Apart from the expected high prevalence in inhabitants of African ancestry, the presence of endemic foci affecting indigenous populations is particularly striking. ATLL prevention is the biggest challenge in this field. Most ATLL cases are transmitted through breastfeeding; thus, prevention methods to avoid ATLL in endemic countries have to be focused on this. In view of the high inequality in most Latin American countries, reduction in breastfeeding duration, freezing/thawing and pasteurisation of breastmilk can be suitable interventions in poor settings, considering that avoiding the risk of malnutrition and infant mortality must be the priority.

Cette revue narrative, qui repose sur une recherche bibliographique systématique conforme aux recommandations de PRISMA, fournit un aperçu général sur le virus lymphotropique des lymphocytes T humaines de type 1 (HTLV-1) et les maladies associées: Le lymphome leucémique des cellules T d'adulte (ATLL)) et la myélopathie/paraparésie spastique tropicale (HAM/TSP) associée à HTLV-1 en Amérique latine, en se focalisant sur l'épidémiologie et la prévention. En utilisant les informations publiées sur la prévalence de HTLV-1, ATLL et HAM/TSP, nous présentons des cartes et des tableaux complets et précis et avons développé un algorithme pour aider à la prévention de la transmission du HTLV-1 par l'allaitement tout en tenant compte du statut socioéconomique. L'Amérique latine est un scénario intéressant pour l'étude de HTLV-1 en raison de la diversité des origines de sa population. Outre la forte prévalence escomptée chez les habitants de descendance africaine, la présence de foyers endémiques affectant les populations autochtones est particulièrement frappante. La prévention de l'ATLL est le plus gros défi dans ce domaine. La plupart des cas d'ATLL sont transmis par l'allaitement. Ainsi, les méthodes de prévention pour éviter l'ATLL dans les pays d'endémie doivent être concentrées sur cela. Compte tenu de la forte inégalité qui règne dans la plupart des pays d'Amérique latine, la réduction de la durée de l'allaitement, la congélation/décongélation et la pasteurisation du lait maternel peuvent constituer des interventions appropriées dans les milieux pauvres, tout en considérant que la priorité est d'éviter les risques de malnutrition et de mortalité infantile.

HTLV-1 and -2 in a first-time blood donor population in Northeastern Brazil: Prevalence, molecular characterization, and evidence of intrafamilial transmission.

Independent epidemiology for respective human T-cell lymphotropic virus (HTLV) types 1 and 2 is little known in blood donors in Brazil, where screening for HTLV-1/2 is mandatory at blood banks, but no testing to confirm/differentiate these viruses. Therefore, this study aims to assess the prevalence of HTLV-1 and -2 in a first-time blood donor population in Northeastern Brazil and to carry out molecular characterization of respective isolates. A cross-sectional study was conducted at the State Blood Bank in Piauí. Samples were screened for anti-HTLV-1/2 by enzyme immunoassay, and reactive samples were confirmed using a line immunoassay and polymerase chain reaction (PCR). Of 37 306 blood donors, 47 were anti-HTLV-1/2 reactive by enzyme immunoassay. After confirmed by line immunoassay, 22 were positive for HTLV-1 (0.59 per 1000; 95% CI: 0.38-0.87), 14 were positive for HTLV-2 (0.37 per 1000; 95% CI: 0.21-0.61), 1 was indeterminate, and the remaining donors were negative. The HTLV-1 infection was also confirmed by PCR in all anti-HTLV-1-positive samples, and sequencing classified these isolates as belonging to the Transcontinental (A) subgroup of the Cosmopolitan (1a) subtype. Of 14 anti-HTLV-2-positive samples, 11 were also PCR positive, which belonged to subtype a (HTLV-2a/c). In addition, 38 family members of 5 HTLV-1- and 3 HTLV-2-infected donors were analyzed. Familial transmission of HTLV-1 and -2 was evidenced in 3 families. In conclusion, in Northeastern Brazil, where HTLV-1 and -2 are endemic, counseling blood donor candidates and their families might play a key role in limiting the spread of these viruses.

Adult T-cell leukemia/lymphoma treatment in Bahia, Brazil.

BACKGROUND: Adult T-cell leukemia/lymphoma is a peripheral disease associated with human T-cell lymphotropic virus type 1. Treatment is carried out according to clinical type with watchful waiting being recommended for less aggressive types. Aggressive adult T-cell leukemia/lymphoma is generally treated with chemotherapy and/or antivirals. The objective of this study was to correlate the survival of patients diagnosed in Bahia, Brazil, with the therapeutic approaches employed and to evaluate what issues existed in their treatment processes. METHODS: Eighty-three adult T-cell leukemia/lymphoma patients (26 smoldering, 23 chronic, 16 acute, 13 lymphoma and five primary cutaneous tumoral) with available data were included in this study. RESULTS: Complete response was achieved in seven smoldering patients with symptomatic treatment, in two with chronic disease using antivirals/chemotherapy, in one with acute disease using antivirals and in one lymphoma using the LSG15 regimen [vincristine, cyclophosphamide, doxorubicin, and prednisolone (VCAP); doxorubicin, ranimustine, and prednisolone (AMP); and vindesine, etoposide, carboplatin, and prednisolone (VECP)]. Smoldering patients who received symptomatic treatment presented longer survival. Favorable chronic patients treated with antivirals presented longer survival compared to the unfavorable subtype. However, for the acute form, first-line chemotherapy was better, albeit without significance, than antivirals. Only one of the patients with lymphoma and primary cutaneous tumors responded. CONCLUSIONS: Watchful waiting associated with phototherapy represents the best option for smoldering adult T-cell leukemia/lymphoma with survival in Bahia being superior to that described in Japan. There was a trend of better results with zidovudine/interferon-alpha in favorable chronic disease. Excellent results were achieved in the lymphoma type treated with the LSG15 protocol. Patients are diagnosed late probably due to lack of knowledge of adult T-cell leukemia/lymphoma by primary healthcare doctors and a Brazilian treatment protocol needs to be established.

Adult T-cell leukemia/lymphoma treatment in Bahia, Brazil

Abstract Background: Adult T-cell leukemia/lymphoma is a peripheral disease associated with human T-cell lymphotropic virus type 1. Treatment is carried out according to clinical type with watchful waiting being recommended for less aggressive types. Aggressive adult T-cell leukemia/lymphoma is generally treated with chemotherapy and/or antivirals. The objective of this study was to correlate the survival of patients diagnosed in Bahia, Brazil, with the therapeutic approaches employed and to evaluate what issues existed in their treatment processes. Methods: Eighty-three adult T-cell leukemia/lymphoma patients (26 smoldering, 23 chronic, 16 acute, 13 lymphoma and five primary cutaneous tumoral) with available data were included in this study. Results: Complete response was achieved in seven smoldering patients with symptomatic treatment, in two with chronic disease using antivirals/chemotherapy, in one with acute disease using antivirals and in one lymphoma using the LSG15 regimen [vincristine, cyclophosphamide, doxorubicin, and prednisolone (VCAP); doxorubicin, ranimustine, and prednisolone (AMP); and vindesine, etoposide, carboplatin, and prednisolone (VECP)]. Smoldering patients who received symptomatic treatment presented longer survival. Favorable chronic patients treated with antivirals presented longer survival compared to the unfavorable subtype. However, for the acute form, first-line chemotherapy was better, albeit without significance, than antivirals. Only one of the patients with lymphoma and primary cutaneous tumors responded. Conclusions: Watchful waiting associated with phototherapy represents the best option for smoldering adult T-cell leukemia/lymphoma with survival in Bahia being superior to that described in Japan. There was a trend of better results with zidovudine/interferon-alpha in favorable chronic disease. Excellent results were achieved in the lymphoma type treated with the LSG15 protocol. Patients are diagnosed late probably due to lack of knowledge of adult T-cell leukemia/lymphoma by primary healthcare doctors and a Brazilian treatment protocol needs to be established.

Perfil clínico-epidemiológico de pacientes infectados pelo HTLV-1 em Belém/Pará / Clinical-epidemiological profile of HTLV-1 infected patients in Belém, Pará state, Brazil

ResumoObjetivoInvestigar o perfil clínico-epidemiológico de pacientes portadores do HTLV-1 em Belém, no Estado do Pará, Brasil, descrevendo as características de indivíduos infectados e atendidos no Laboratório de Clínica e Epidemiologia de Doenças Endêmicas (LCEDE) do Núcleo de Medicina Tropical (NMT) da Universidade Federal do Pará (UFPA).MetodologiaFoi um estudo descritivo de corte transversal, com coleta em prontuários de pacientes infectados pelo HTLV-1, matriculados no LCEDE do NMT da UFPA entre os anos 2000 a 2012. Foi aplicada a análise descritiva pelo programa Epi Info 3.2.5.ResultadosDos 182 prontuários, 35,2% eram do sexo masculino, e 64,8%, do sexo feminino. Houve predomínio de indivíduos casados (47,8%). A maioria (73,6%) tinha procedência do município de Belém-PA. Dentre os pacientes sintomáticos, 51% apresentavam sintomas neurológicos, 21%, queixas dermatológicas, 18%, queixas reumatológicas, e 10%, queixas autonômicas. Com relação aos pacientes com sintomas neurológicos, 16 (39,0%) foram diagnosticados com PET/MAH.ConclusõesHouve o predomínio do sexo feminino, na faixa etária entre 40 e 49 anos, casado, trabalho informal, procedentes de Belém, com queixas neurológicas e com retorno regular as consultas médicas.

AbstractObjectiveThe clinical-epidemiological profile of patients with HTLV-1 in Belém, Pará state, Brazil was investigated describing the characteristics of these patients at an outpatient service of the Clinical and Epidemiologic Laboratory of Endemic Diseases - LCEDE from the Tropical Medicine Center - NMT of the Federal University of Pará - UFPA.MethodologyIt was a descriptive, cross-sectional study with data collected from the records of HTLV-1 patients from 2000 to 2012. Descriptive analysis used Epi Info 3.2.5 software.ResultsOf the 182 patients, 35.2% were male and 64.8% female, with a predominance of married individuals (47.8%), approximately 73.6% were from Belém. Among the symptomatic patients, 51% presented neurological symptoms, 21% dermatological complaints, 18% rheumatologic complaints, and 10% autonomic complaints. Among the patients with neurological symptoms, 16 (39%) were diagnosed with HAM/TSP.ConclusionThere is predominance of females, aged 40-49 years, married, with informal jobs, from Belém, with neurological sings and regular return to medical visits.

Sexual transmission of human T-cell lymphotropic virus type 1

Human T-cell lymphotropic virus type 1 (HTLV-1) is endemic in many parts of the world and is primarily transmitted through sexual intercourse or from mother to child. Sexual transmission occurs more efficiently from men to women than women to men and might be enhanced by sexually transmitted diseases that cause ulcers and result in mucosal ruptures, such as syphilis, herpes simplex type 2 (HSV-2), and chancroid. Other sexually transmitted diseases might result in the recruitment of inflammatory cells and could increase the risk of HTLV-1 acquisition and transmission. Additionally, factors that are associated with higher transmission risks include the presence of antibodies against the viral oncoprotein Tax (anti-Tax), a higher proviral load in peripheral blood lymphocytes, and increased cervicovaginal or seminal secretions. Seminal fluid has been reported to increase HTLV replication and transmission, whereas male circumcision and neutralizing antibodies might have a protective effect. Recently, free virions were discovered in plasma, which reveals a possible new mode of HTLV replication. It is unclear how this discovery might affect the routes of HTLV transmission, particularly sexual transmission, because HTLV transmission rates are significantly higher from men to women than women to men.

Modulation of glutathione intracellular levels alters the spontaneous proliferation of lymphocyte from HTLV-1 infected patients.

The human T-cell lymphotropic virus type 1 (HTLV-1) is a retrovirus associated with neoplasias and inflammatory diseases, such as adult T-cell leukemia/lymphoma and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). HTLV-1-infected individuals present a spontaneous T lymphocyte proliferation. This phenomenon is related to the HTLV-1-proviral load and the persistence of the infection. Viral proteins induce many cellular mediators, which can be associated with the abnormal cellular proliferation. The intracellular levels of glutathione (GSH) are important to modulate the cellular proliferation. The aim of this study was to investigate the correlation between the modulation of intracellular GSH levels and the spontaneous lymphocyte proliferation during the HTLV-1 infection. Intracellular GSH level can be modulated by using dl-buthionine-[S,R]-sulfoximine (BSO, GSH synthesis inhibitor) and N-acetylcysteine (NAC, peptide precursor). Our results demonstrated that BSO was capable of inducing a decrease in the spontaneous proliferation of PBMC derived from HTLV-1 carriers. On the other hand, the GSH precursor induces an increase in mitogen-stimulated cellular proliferation in infected and uninfected individuals. Similar results were observed by the inhibition of ABCC1/MRP1 protein, augmenting the mitogen-induced proliferation. This effect can be related with an increase in the GSH levels since ABCC1/MRP1 transports GSH to the extracellular medium. There was a significant difference on the expression of CD69 and CD25 molecules during the lymphocyte activation. We did not observe any alterations on CD25 expression induced by BSO or NAC. However, our results demonstrated that NAC treatment induced an increase in CD69 expression on unstimulated CD8(+) T lymphocytes obtained from HTLV-1 infected individuals, healthy donors and HTLV carriers. Therefore, our results suggest that the cellular proliferation promoted by the infection with HTLV-1 and the activation phenotype of CD8(+) T lymphocytes can be regulated by changing the intracellular GSH levels; suggesting the modulation of these intracellular levels as a new approach for the treatment of pathologies associated with the HTLV-1 infection.

Sulfated fucan from marine alga inhibits HeLa cells infection by HTLV-1 free particles: semi-quantitative analysis

A sulfated fucan from Laminaria abyssalis marine alga prevented the interaction of HTLV-1 particles, purified from the MT-2 cell line, with HeLa cells. The infection obtained using a concentrated virus suspension was detected only by amplification of the newly synthesized HTLV-1 proviral cDNA by the nested-polymerase chain reaction (PCR). The sulfated polysaccharide was not toxic to the cells at a concentration of 100 µg/mL and prevented infection by the viral particles when added to the cell monolayers. The proviral cDNA was only detected when the sulfated polysaccharide was added to the cells three hours post-infection, indicating that the inhibitory activity occurred in the initial stages of virus-cell interaction. Our results demonstrate, for the first time, the ability of a sulfated fucan from marine algae to inhibit virus transmission through free virus particles.

Seroprevalencia del virus linfotrópico humano de células T tipo 1 (HTLV-1) en pacientes con tiroiditis autoinmune / Human T cell lymphotropic virus type 1 (HTLV-1) seroprevalence among out-patients with autoimmune thyroiditis

Objetivo: Describir la seroprevalencia de infección por HTLV-1 en pacientes con tiroiditis autoinmune. Material y Métodos: Estudio transversal realizado en pacientes con tiroiditis autoinmune que acudieron al consultorio de Endocrinología del Hospital Nacional Cayetano Heredia entre octubre del 2008 y enero del 2010. Se usó un cuestionario estructurado para obtener datos epidemiológicos y clínicos, paralelamente, se revisaron las historias clínicas para obtener datos de laboratorio. A los participantes se les tomó una muestra de sangre para el diagnóstico de HTLV-1 mediante prueba de ELISA y confirmación por Western Blot, previa firma de consentimiento informado. Resultados: Durante el período de estudio, se atendieron 285 pacientes con tiroiditis autoinmune. Se incluyeron 145 pacientes(50,9%); la edad media fue 48,1 ± 15 años y 135 (93,1%) fueron de sexo femenino. Tres pacientes tuvieron infección por HTLV-1, con una prevalencia estimada de 2,1% (IC 95%: 0-4,4%). Los seropositivos fueron de sexo femenino y tuvieron el diagnóstico de Enfermedad de Graves hipertiroidea. La frecuencia de infección por HTLV-1 en este grupo fue de 5% (3/60); IC 95%: 0-11%. No se encontró diferencia significativa entre los pacientes HTLV-1 positivos y negativos en cuanto a características demográficas, clínicas y de laboratorio. Conclusión: La prevalencia de infección por HTLV-1 en los pacientes con tiroiditis autoinmune fue similar a la prevalencia estimada para la población peruana en general.

Objective: To describe the seroprevalence of human T-cell lymphotropic virus type 1 (HTLV-1) infection among patients with autoimmune thyroiditis diagnosis. Material and Methods: Cross-sectional study including subjects with autoimmune thyroiditis at the outpatient Endocrinology unit of the Hospital Nacional Cayetano Heredia from October 2008 to January 2010. A structured questionnaire was used to get epidemiologic and clinic data; and hospital registries were reviewed to determine laboratory data. Participants were tested for HTLV-1 using Enzyme-Linked Immunosorbent Assay and Western blot confirmation. All participant provided informed consent. Results: During the study period, 285 subjects with autoimmune thyroiditis were attended at the Endocrinology Outpatient Service. We included 145 (50.9%); their mean age was 48,1±15 years and 135 (93.1%) were female. Three were HTLV-1 positive, with estimated prevalence of 2.1% (95% CI: 0-4.4%). All seropositive patients were women andhad Graveæs disease. The frequency of HTLV-1 infection in this group was 5% (3/60); 95% CI: 0-11%. Non significant differences for demographic, clinical and laboratory characteristics between the HTLV -1 seropositive and seronegative patients were founded. Conclusions: The seroprevalence of HTLV-1 infection among outpatients with autoimmune thyroiditis was similar to that estimated for the peruvian general population.

HTLV-1 associated myelopathy diagnosed during lepromatous leprosy reaction treatment: a case report / Mielopatia associada ao HTLV-1 diagnosticada durante tratamento de hanseníase virchowiana reacional: relato de caso

Leprosy and human T cell lymphotropic virus type 1 infection are prevalent in Brazil. Coinfection by Mycobacterium leprae and HTLV-1 is reviewed and a case is reported. A 59 year-old woman was followed and HTLV-1 associated myelopathy was diagnosed during leprosy treatment. The clinical and neurological aspects of this unusual association were initially reviewed. Immunological markers and the possible prognoses due to the association of the diseases were discussed. The unexpected association of leprosy and HTLV-1 associated myelopathy may occur in endemic areas and causes difficulties in determining the correct diagnosis and adequate management of the neurological manifestations.

Hanseníase e infecção pelo HTLV-1 são prevalentes no Brasil. A associação de hanseníase e infecção por HTLV-1 é revista e é relatado um caso de coinfecção. Paciente feminina de 59 anos teve diagnóstico de mielopatia associada ao HTLV-1 durante o tratamento para hanseníase. Aspectos clínicos e neurológicos desta associação, ainda não descrita, são revistos e os marcadores imunológicos e possíveis evoluções relacionadas com a associação dessas doenças discutidos. A associação de hanseníase e mielopatia associada ao HTLV-1, aparentemente pouco usual, pode ocorrer em áreas endêmicas e trazer dificuldades para o diagnóstico e tratamento das manifestações neurológicas.

Introdução da reação em cadeia da polimerase em tempo real no algoritmo de testes laboratoriais para o diagnóstico de infecção por HTLV-1 e HTLV-2 / Use of the real-time polymerase chain reaction in the HTLV-1 and HTLV-2 infections diagnostic testing algorithm

Em vista das dificuldades encontradas no diagnóstico de infecção por vírus linfotrópicos de células T humanas dos tipos 1 e 2 (HTLV-1 e HTLV-2) no Instituto Adolfo Lutz (IAL) de São Paulo, foi proposto o presente estudo que objetivou avaliar o valor do cut-off dos testes de triagem sorológica e os algoritmos de testes laboratoriais, dando ênfase ao emprego da reação em cadeia da polimerase (PCR) como teste confirmatório. Do total de 3.271 amostras de sangue provenientes da rotina diagnóstica dos anos de 1998 a 2010: (a) 2.312 amostras de soro (1998-2006) foram empregadas para estabelecer o melhor valor de cut-off para os ensaios imunoenzimáticos (EIAs) usando a análise ROC (receiving operating characteristics); (b) 313 amostras de sangue (2009) foram analisadas por algoritmo de duas coletas seqüências de sangue; (c) 73/959 amostras de sangue reagentes na triagem sorológica (2007-2010) foram empregadas no estudo comparativo de sensibilidade e custo dos testes confirmatórios de Western blot (WB), PCR convencional (tax e pol) e PCR em tempo real (pol). As PCRs foram otimizadas usando DNA extraído de linhagens celulares infectadas por HTLV-1 (C91-PL) e por HTLV-2 (BBF) e realizada pesquisa de gene da albumina humana como controle endógeno. Os resultados da análise ROC mostraram que um ajuste no valor do cut-off dos EIAs de 3ª geração aumentou a especificidade desses ensaios em 7,8%, sem alterar significativamente a sua sensibilidade. O algoritmo de coleta seqüencial de sangue se mostrou inadequado sendo mais apropriada a coleta única em tubo contendo anticoagulante. Os resultados do ensaio confirmatório de WB mostraram que este foi mais sensível (90,56%) do que a PCR convencional (77,36%) e a PCR em tempo real (79,25%), provavelmente pela pequena carga proviral de HTLV-1 e HTLV-2 presente no sangue, principalmente de portadores assintomáticos. Todavia, as técnicas de PCR se mostraram úteis na elucidação de amostras com padrão indeterminado à análise pelo WB, sendo os ensaios sorológicos e moleculares complementares. Concluindo, em vista da PCR em tempo real ser um teste rápido, seguro, de menor custo e de fácil execução, ele pode ser aplicado como primeiro teste confirmatório de infecção por HTLV-1 e HTLV-2 seguido do WB (AU).

Taking into account the difficulties in diagnosing the human T-cell lymphotropic virus type 1 and type 2 (HTLV-1 and HTLV-2) in Instituto Adolfo Lutz of São Paulo, the present study was conducted aiming at evaluating the cut-off values of screening enzyme immunoassays (EIAs) and the tests algorithms, emphasizing the use of polymerase chain reaction (PCR) as confirmatory assay. Of 3,271 blood samples routinely analyzed from 1998 to 2010: (a) 2,312 serum samples (1998-2006) were assessed for the best cutoff value by using the receiving operating characteristics analyses (ROC); (b) 313 blood samples (2009) were tested following the algorithm which employs two sequential blood collection, and (c) 73/959 blood samples (2007-2010) showing reactive results on screening testing were employed for comparative analysis of serologic (Western blot ­ WB) and molecular confirmatory assays [PCR (tax and pol) and real time PCR (pol)]. The PCRs were optimized using the cells lines infected with HTLV-1 (C91-PL) and HTLV-2 (BBF), and the human albumin gene. The ROC analysis showed that an adjustment of the cut-off value in the third generation EIAs increased their specificity in 7.8%. The use of the sequential blood collection algorithm for serological diagnosis was completely inefficient and a unique blood collection in an anticoagulantcontaining tube seems to be the most appropriate. The WB confirmatory assay resulted to be more sensitive (90.56%) than the standard PCRs (77.36%) and the real-time PCR (79.25%), probably owing to the low HTLV-1 and HTLV-2 proviral load in asymptomatic carriers' blood. However, the PCRs were able in elucidating the samples with indeterminate WB profile, thereby standing the serologic and molecular assays as complementary tests. In conclusion, because of the low cost, rapidity, reliability and easiness to perform, the real-time PCR could be used as the first confirmatory assay for performing the HTLV-1 and HTLV-2 diagnosis, followed by the WB technique (AU).

Frequência de transtorno de humor e impacto na qualidade de vida dos pacientes portadores de HTLV-1 com paraparesia espástica tropical / Study of the psychological aspects and the impact on life quality of the patients who are carriers of HTLV with tropical spastic paraparisie

A HAM/TSP, doença ocasionada pelo vírus HTLV-1, geralmente leva seus portadores a quadros incapacitantes podendo evoluir para a paraplegia. Tanto a evolução dos sintomas quanto as dificuldades do tratamento podem ocasionar quadro de Depressão e Ansiedade e impacto na Qualidade de Vida de seus portadores, afetando potencialmente o estado de saúde física, mental, funcional, bem-estar geral, interação social e satisfação do paciente. O objetivo desta pesquisa foi verificar a frequência de depressão e ansiedade e o impacto na qualidade de vida dos pacientes portadores de HAM/TSP associada ao HTLV-1. Foi realizado um estudo do tipo transversal no qual foram incluídos 67 portadores assintomáticos e 63 pacientes com HAM/TSP. Como instrumentos foram utilizados: questionário sócio-demográfico, Inventário de Depressão de Beck, Inventário de Ansiedade de Beck, Questionário para a avaliação da Qualidade de Vida da Organização Mundial da Saúde (WHOQOL-Brief) e Escala Motora Revisada de Osame. A aplicação dos questionários foi realizado no Instituto de Infectologia Emílio Ribas, no período de maio de 2008 a julho de 2009. Para a análise estatística foi realizado o teste U de Mann-Whitney e o coeficiente de correlação de Spearman. Os dados obtidos foram correlacionados com a evolução e gravidade da marcha. Os resultados apontaram que os pacientes com HAM/TSP em relação aos portadores assintomáticos apresentaram índices mais elevados de depressão (p<0,001) e ansiedade (p<0,001), e comprometimento na qualidade de vida nos domínios: insatisfação com a saúde (p<0,001), física (p<0,001) e meio ambiente (p=0,003). Os principais fatores que apresentaram relação com os graus de Depressão e Ansiedade e com as domínios do WHOQOL-brief foram: escolaridade, renda familiar e classe social. A HAM/TSP ocasiona em seus portadores uma ferida narcísica, podendo acarretar sintomas depressivos e ansiosos e prejuízo na percepção da qualidade de vida, principalmente nos pacientes com... (AU).

The HAM/TSP caused by the infection of HTLV-I virus, usually affects patients to disabling states and sometimes can lead them to paraplegia. Both the evolution of symptoms and the difficulties of treatment can lead frame of Depression and Anxiety and impact on quality of life of their patients, potentially affecting the state of physical, mental, functional, health general, social interaction and satisfaction . The purpose of this study was to check the frequency of depression and anxiety and impact on quality of life in TSP/HAM patients HTLV-1-infected people. A cross-sectional study including 67 asymptomatic (control group) and 63 with TSP/HAM. The used instruments as a demographic questionnaire, scales for anxiety and depression diagnosis (BDI and BAI), Questionnaire for the assessment of Quality of Life of the World Health Organization (WHOQOL-Brief) and neurological scale to measure the disability level (Osame´s Disability Status Scale) and scales for anxiety and depression diagnosis (BDI and BAI) on all the participants. All patients had HTLV-I diagnosis by serological and molecular approaches, in monitoring on Emílio Ribas Infectious Diseases Institute from May 2008 to July 2009. Data were analyzed statistically by frequencies, the U Mann-Whitney test and the Spearman correlation test. Data among groups were analyzed and correlated with functional and gravity aspects. The results showed that patients with HAM /TSP compared to asymptomatic carriers had higher rates of depression (p<0.001) and anxiety (p<0,001), and impaired quality of life in the areas: dissatisfaction with health (p< 0,001), physical (p<0.001) and environment (p=0,003). The main factors that correlate with levels of Depression and Anxiety and the domains of the WHOQOL-brief were: education, family income and social class. HAM / TSP causes its carriers a narcissistic wound, which may cause psychological distress and impairment in the perception of quality of life, especially in patients with lower financial and intellectual resources. A well conducted evaluation and counseling may help in treatment, for a better quality of life of these patients (AU).

Prevalência, fatores de risco e caracterização genética dos vírus linfotrópico de células T humana tipo 1 e 2 em pacientes infectados pelo vírus da imunodeficiência humana tipo 1 nas Cidades de Ribeirão Preto e São Paulo / Prevalence, risk factors and genetic characterization of human T-cell lymphotropic virus types 1 and 2 in patients infected with human immunodeficiency virus type 1 in the cities of Ribeirão Preto and São Paulo

O objetivo deste estudo foi definir a prevalência dos vírus linfotrópico de células T humana tipo 1 e 2 em pacientes positivos para o vírus da imunodeficiência humana tipo 1 no Estado de São Paulo, Brasil. Avaliamos 319 indivíduos atendidos em clínicas de Ribeirão Preto e Capital. Os pacientes foram entrevistados e testados sorologicamente. Foram seqüenciadas as regiões tax e long terminal repeat para diferenciação e determinação do subtipo. A soroprevalência geral foi de 7,5 por cento (24/319) e esteve associada somente com uso de drogas injetáveis e ao vírus da hepatite tipo C (p<0, 001). O genoma viral foi detectado em 13 das 24 amostras, sendo 12 caracterizadas como HTLV-2 subtipo 2c e uma como 1a. Nossos dados mostraram que o uso de drogas injetáveis é um importante fator de risco para a transmissão de HTLV-2 em populações infectadas pelo vírus da imunodeficiência humana tipo 1.

The aim of this study was to define the prevalence of human T cell lymphotropic virus types 1 and 2 in patients who were positive for human immunodeficiency virus type 1 in the State of São Paulo, Brazil. We evaluated 319 individuals infected with HIV type 1 who were attended at specialized clinics in two cities (Ribeirão Preto and São Paulo). The patients were interviewed and tested for antibodies against HTLV types 1 and 2 (Orthoâ HTLV-1/HTLV-2 Ab-Capture enzyme immunoassay). Direct DNA sequencing of polymerase chain reaction products from the tax region of HTLV type 2 and the long terminal repeat region of HTLV types 1 and 2 were performed to differentiate and determine the subtypes. The overall prevalence of anti-HTLV type 1 and 2 antibodies was 7.5 percent (24/319; 95 percent CI: 5.2-11.5). HTLV type 1 and 2 infection was associated with a history of injected drug use and with antibodies for hepatitis C virus (p < 0.001), but not with age (p = 0.2), sex (p = 0.9), sexual behavior or serological markers for sexually transmitted diseases (anti-Treponema pallidum, anti-human herpesvirus type 8 or anti-hepatitis B virus antibodies) (p > 0.05). HTLV DNA was detected in 13 out of 24 samples, of which 12 were characterized as HTLV subtype 2c and one as HTLV subtype 1a. Among the 12 HTLV type 2 samples, seven were from injected drug users, thus indicating that this route is an important risk factor for HTLV type 2 transmission among our population infected with HIV type 1.

Mapping the molecular characteristics of Brazilian human T-cell lymphotropic virus type 1 Env (gp46) and Pol amino acid sequences for vaccine design

This study was carried out to evaluate the molecular pattern of all available Brazilian human T-cell lymphotropic virus type 1 Env (n = 15) and Pol (n = 43) nucleotide sequences via epitope prediction, physico-chemical analysis, and protein potential sites identification, giving support to the Brazilian AIDS vaccine program. In 12 previously described peptides of the Env sequences we found 12 epitopes, while in 4 peptides of the Pol sequences we found 4 epitopes. The total variation on the amino acid composition was 9 and 17 percent for human leukocyte antigen (HLA) class I and class II Env epitopes, respectively. After analyzing the Pol sequences, results revealed a total amino acid variation of 0.75 percent for HLA-I and HLA-II epitopes. In 5 of the 12 Env epitopes the physico-chemical analysis demonstrated that the mutations magnified the antigenicity profile. The potential protein domain analysis of Env sequences showed the loss of a CK-2 phosphorylation site caused by D197N mutation in one epitope, and a N-glycosylation site caused by S246Y and V247I mutations in another epitope. Besides, the analysis of selection pressure have found 8 positive selected sites (w = 9.59) using the codon-based substitution models and maximum-likelihood methods. These studies underscore the importance of this Env region for the virus fitness, for the host immune response and, therefore, for the development of vaccine candidates.