Brazilian Protocol for Sexually Transmitted Infections 2020: human T-cell lymphotropic virus (HTLV) infection

Abstract

This article addresses the Human T-lymphotropic virus (HTLV). This subject comprises the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health. HTLV-1/2 infection is a public health problem globally, and Brazil has the largest number of individuals living with the virus. HTLV-1 causes several clinical manifestations of neoplasm (adult T-cell leukemia/lymphoma) and inflammatory nature, such as HTLV-1-associated myelopathy and other manifestations such as uveitis, arthritis, and infective dermatitis. These pathologies have high morbidity and mortality and negatively impact the quality of life of infected individuals. This review includes relevant information for health authorities professionals regarding viral transmission, diagnosis, treatment, and monitoring of individuals living with HTLV-1 and 2 in Brazil.

Development and Validation of Multiplex Quantitative Real-Time PCR Assays for Simultaneous Detection and Differentiation of HTLV-1 and HTLV-2, Using Different PCR Platforms and Reagent Brands

“…Brazil has the highest number of HTLV-1/2-infected individuals in Latin America and worldwide ( Gessain and Cassar, 2012 ; CGIST/DDCI/SVS et al, 2020 ). Although the majority of the individuals remain asymptomatic, many people living with HTLV may develop one or more of a range of related diseases ( Haziot et al, 2019 ; Rosadas et al, 2021a ). At least two diseases of high morbidity and mortality rates are associated with HTLV-1, including HTLV-1-associated myelopathy (HAM) and adult T-cell leukemia/lymphoma (ATL), while HTLV-2 is rarely associated with a disease ( Paiva and Casseb, 2015 ; Rosadas et al, 2021a ).…”

“…Although the majority of the individuals remain asymptomatic, many people living with HTLV may develop one or more of a range of related diseases ( Haziot et al, 2019 ; Rosadas et al, 2021a ). At least two diseases of high morbidity and mortality rates are associated with HTLV-1, including HTLV-1-associated myelopathy (HAM) and adult T-cell leukemia/lymphoma (ATL), while HTLV-2 is rarely associated with a disease ( Paiva and Casseb, 2015 ; Rosadas et al, 2021a ). Thus, it is important to perform confirmatory and discriminatory diagnosis of HTLV-1/2 infections.…”

“…The screening tests detect antibodies against HTLV-1/2 in plasma/serum samples; they have high sensitivities, and negative results exclude HTLV-1/2 infection ( da Silva Brito et al, 2018 ; Caterino-de-Araujo et al, 2021 ). The most common screening tests are the particle agglutination (PA), enzyme immunoassays (EIA or ELISA), and chemiluminescence immunoassays (CLIA) ( Okuma et al, 2020 ; Caterino-de-Araujo et al, 2021 ; Rosadas et al, 2021a ). Confirmatory serologic tests identify antibodies specific for HTLV-1 and -2 antigens in plasma/serum samples, and the most common types of these tests are western blotting (WB) and the line immunoassay (LIA).…”

Prevalence of human T-lymphotropic virus type 1 and 2 (HTLV-1/-2) infection in pregnant women in Brazil: a systematic review and meta-analysis

“…The introduction of PCR as a method to analyze HTLV-1/-2 might lead to higher prevalence estimates, due to an increase in sensitivity 55 – 57 . However, as most protocols are established in-house and will not have an extensive validation 22 , this can also be a source of heterogeneity between estimated prevalence standard PCR assays for HTLV-1/-2 58 .…”

“…Although HTLV-1/-2 during pregnancy is within the scope of surveillance program in Brazil, the screening test for HTLV-1/-2 among pregnant women is not implemented as a universal screening program in the Public Health System until now 22 , 23 . Also, the HTLV-1/-2 infection is not included in the list of conditions that require compulsory notification to the Brazilian Ministry of Health 24 .…”