Human T-Lymphotropic Virus (HTLV I-II) Infection among Patients in an Inner-City Emergency Department

doi:10.1059/0003-4819-113-5-368

Human T-Lymphotropic Virus (HTLV I-II) Infection among Patients in an Inner-City Emergency Department

Abstract

Objective: To determine the seroprevalence and epidemiologic features of human T-lymphotropic virus (HTLV I-II) among an emergency department patient population with a high rate of human immunodeficiency virus (HIV-I) infection.

Design: Prospective survey using identity-unlinked consecutive sampling during a 6-week period in 1988.

Setting: Inner-city teaching hospital.

Patients: Sequential sample of 2544 adult patients with sufficient excess sera for analysis.

Measurements and Main Results: Twenty-eight (1.1%) (95% CI, 0.7% to 1.5%) serum samples were seropositive for HTLV I-II whereas 152 (6.0%) (CI, 5.1% to 6.9%) were seropositive for HIV-I. The age distribution of HTLV I-II was similar to the study population while HIV-I was concentrated among younger (25 to 44 years) age groups (P < 0.05). Only 16 (57.1%) HTLV I-II infected patients had identified risk factors; 11 were intravenous drug users, 4 received transfusions, and 1 had heterosexual exposure to a high-risk partner. None of 39 identified homosexual men had HTLV I-II antibodies although 29 (74.3%) were HIV-I seropositive.

Conclusion: HTLV I-II infection may be more prevalent among certain segments of the U.S. population than previously realized and appears to have a different demographic distribution than HIV-I infection. Although HTLV I-II may represent a nosocomial risk to health care providers, the risk of occupational transmission is probably less than for hepatitis B virus and even HIV-I. Adherence to universal precautions should minimize the risk.

Article and Author Information

From The Johns Hopkins University School of Medicine, Baltimore, Maryland; the Centers for Disease Control, Atlanta, Georgia; and the National Institute for Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland. For current author addresses, see end of text.
Grant Support: Dr. Kelen was supported in part by the W. M. Keck Foundation Clinician Scientist Award and the Emergency Medicine Foundation/Genentech Career Development Award. Dr. DiGiovanna was supported by the Emergency Medicine Foundation Research Scholars Award.
Requests for Reprints: Gabor D. Kelen, MD, Department of Emergency Medicine, Marburg B190A, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21205.
Current Author Addresses: Drs. Kelen, DiGiovanna, and Quinn, and Mr. Junkins and Mr. Stein: The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21205.

Dr. Lofy: Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55415.

Dr. Lairmore: Retroviral Disease Branch, 1600 Clifton Road, Centers for Disease Control, Atlanta, GA 30003.

Dr. Sivertson: Department of Emergency Medicine, Marburg B-186, Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21205.