Increasing awareness of human T-lymphotropic virus type-1 infection: a serious, invisible, and neglected health problem in Brazil

Pooling of sera for human T-cell lymphotropic virus (HTLV) screening in a time of increasing health care expenditure and limited resources

“…In recent years, several attempts have been made to make HTLV-1 infection and associated diseases visible worldwide and in Brazil [1][2][3][4] . One of the means to achieve this goal is to know the real prevalence of the infection and associated diseases in the general population and in individuals who could acquire/transmit this infection more easily, such as individuals infected with other microorganisms that share routes of transmission with HTLV-1 8,9,19,20 and HTLV-1-infected mothers who could transmit the virus to their infants during breastfeeding 4,6,7 .…”

“…In recent years, several attempts have been made to make HTLV-1 infection and associated diseases visible worldwide and in Brazil [1][2][3][4] . One of the means to achieve this goal is to know the real prevalence of the infection and associated diseases in the general population and in individuals who could acquire/transmit this infection more easily, such as individuals infected with other microorganisms that share routes of transmission with HTLV-1 8,9,19,20 and HTLV-1-infected mothers who could transmit the virus to their infants during breastfeeding 4,6,7 . In Brazil, the estimated number of HTLV-1-infected individuals, as well as individuals with HTLV-1-associated diseases, is high but misdiagnosed 1,4,5,[21][22][23][24] ; thus, we decided to search for strategies that could reduce the cost of HTLV screening in this country to help the Ministry of Health of Brazil to introduce the serology of HTLV-1/2 in health care programs, especially in the national HTLV antenatal screening program.…”

“…One of the means to achieve this goal is to know the real prevalence of the infection and associated diseases in the general population and in individuals who could acquire/transmit this infection more easily, such as individuals infected with other microorganisms that share routes of transmission with HTLV-1 8,9,19,20 and HTLV-1-infected mothers who could transmit the virus to their infants during breastfeeding 4,6,7 . In Brazil, the estimated number of HTLV-1-infected individuals, as well as individuals with HTLV-1-associated diseases, is high but misdiagnosed 1,4,5,[21][22][23][24] ; thus, we decided to search for strategies that could reduce the cost of HTLV screening in this country to help the Ministry of Health of Brazil to introduce the serology of HTLV-1/2 in health care programs, especially in the national HTLV antenatal screening program. Using two EIAs commonly employed in screening in public health laboratories in Brazil, we tested the strategy of pooling sera, taking into account previous studies that demonstrated that pooling is feasible and costeffective mostly in populations with low prevalence of HIV and HTLV and/or in countries with limited resources [12][13][14][15] .…”

“…In recent years, several attempts have been made to persuade the World Health Organization (WHO) and other local health organizations to include human T-cell lymphotropic virus, primarily type 1 (HTLV-1) and associated diseases, in the list of neglected pathogens/infectious diseases [1][2][3][4] . This is due to the high number of HTLV-infected individuals worldwide 1,5 , as well the high mortality and morbidity of HTLV-1-associated diseases, such as adult T-cell leukemia/lymphoma (ATLL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) [1][2][3][4][5][6] .…”

“…Identifying the true prevalence of HTLV-1-infected individuals and the number of patients with HTLV-1-associated diseases is one way to highlight the importance of this neglected human retrovirus 1,2,4,6 . Currently, introducing HTLV-1/2 serology in prenatal care for pregnant women to avoid breastfeeding transmission 4,6,7 , in individuals infected with other viruses that share transmission routes with HTLV-1/2 [8][9][10] , and including HTLV in the National Mandatory Notification List are actions to control HTLV transmission/dissemination in Brazil and worldwide 2,4,10 . As Brazil is endemic to HTLV-1/2 5 and at a time in which there is increasing health care expenditure, but resources are limited, any strategy that could reduce the cost of HTLV screening is needed and welcomed.…”