Seroprevalence of human T‐lymphotropic virus (HTLV) in blood donors in sub‐Saharan Africa: a systematic review and meta‐analysis

Abstract

Background and objective Human T‐cell lymphotropic viruses (HTLV) 1 and 2 are endemic in sub‐Saharan Africa (SSA), transfusion‐transmissible and causally linked to various severe diseases. However, even in SSA countries with moderate to high endemicity, routine blood donor screening for HTLV is rarely, if ever, performed. Information on seroprevalence is limited. The aim of this review is to establish the prevalence of HTLV‐1 and HTLV‐1/2 among blood donors in sub‐Saharan Africa. Materials and Methods We systematically reviewed databases including EMBASE, MEDLINE and the Cochrane database library from their inception to June 2018. Studies presenting data on HTLV prevalence among blood donors in sub‐Saharan Africa were included. A random‐effect meta‐analysis was conducted on all eligible studies. Results A total of 25 studies were included, representing 74 119 blood donors, of whom over 80% (61 002) were only tested for HTLV‐1. The evidence base was high and moderate in quality. The pooled prevalence of the 17 studies that screened only for HTLV‐1 and the nine studies that screened for HTLV‐1/2 was 0·68 (95% CI: 0·29–1·60) and 1·11 (95% CI: 0·47–2·59) per 100 blood donors, respectively. Conclusion The prevalence of HTLV‐1 infection among blood donors is relatively low. The current review is intended to inform debates and decisions about best practices to prevent transfusion‐transmitted HTLV in sub‐Saharan Africa. Further work is required to determine the risk of infections by transfusion and the cost‐effectiveness of any new measures such as routine screening.

Population‐based prevalence of human T‐lymphotropic virus type 1 in sub‐Saharan Africa: a systematic review and meta‐analysis

“…Compared to blood donors, the prevalence in the general population is higher [3.19% (95% CI 2.36–4.12%) vs . 0.68% (95% CI 0.29–1.60%)] . The lower prevalence among blood donors can be explained by the younger age and male predominance of blood donors compared to the general population in many African countries .…”

Prevalence and Molecular Epidemiology of Human T-Lymphotropic Virus Type 1 among Women Attending Antenatal Clinics in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

“…Compared with blood donors in SSA, the prevalence in pregnant women was nearly 3-fold higher. 40 Why? The prevalence of HTLV-1 infection increases with age, particularly among women.…”

Human T‐lymphotropic virus in Irish blood donors: Impact on future testing strategy

“…The onset of HAM/TSP can occur as early as 3 months after a blood transfusion contaminated with HTLV-1 and clinical manifestations of HTLV disease are more likely to present in immunocompromised individuals. 13 Molecular techniques for HTLV proviral DNA detection, are not usually part of blood donor screening algorithms, but are used in reference laboratories for the investigation of donors with reactive HTLV antibody results for example. [14][15][16] In accordance with the European Directive (Directive 2004/33/EC Annex III) individuals who have a history of HTLV infection are permanently excluded from blood donation.…”