Chronic Myelopathy Associated with Human T-Lymphotropic Virus Type I (HTLV-I)

doi:10.1059/0003-4819-117-11-933

Chronic Myelopathy Associated with Human T-Lymphotropic Virus Type I (HTLV-I)

Antoine Gessain, MD, PhD; and
Olivier Gout, MD

Abstract

▪ Purpose: To review the clinical, epidemiologic, immunologic, and virologic aspects of the chronic myelopathy associated with human T-cell leukemia/lymphoma virus type I (HTLV-I), currently called tropical spastic paraparesis/HTLV-I-associated myelopathy (TSP/HAM).

▪ Data Identification: Studies done after 1985, when TSP/HAM was first recognized, were identified by a computer search using MEDLARS II and CANCERLIT. Additional information was acquired from personal files and bibliographies of existing literature.

▪ Study Selection: A total of 400 articles, 90 book chapters, and 150 abstracts from meetings covering all aspects of HTLV-I and neurologic diseases were critically analyzed, and information from 250 publications was included.

▪ Results of Data Analysis: TSP/HAM is present in most HTLV-I endemic areas, with a prevalence ranging from 5.1 to 128 per 100 000 inhabitants. Up to 20% of patients develop TSP/HAM after transfusion of HTLV-I contaminated blood. Pathologic characteristics indicate a chronic meningomyelitis. The clinical features consist of a chronic progressive spastic paraparesis or paraplegia, sphincter disturbances, and minimal sensory loss. Supraspinal and peripheral nerve involvement is sometimes observed. High titers of HTLV-I-specific antibodies are present in the serum and cerebrospinal fluid. The high level of humoral and cellular immunologic response and the association of TSP/HAM with other immunologic diseases suggest an immune-mediated process. Corticosteroids and immunosuppressor treatment usually result in only short-term improvement.

▪ Conclusion: TSP/HAM is a common neurologic disease in many parts of the world. All patients with chronic progressive myelopathies should be tested for serum and cerebrospinal fluid HTLV-I-specific antibodies. Systematic screening of blood donors for HTLV-I is necessary to help prevent the dissemination of the virus and the occurrence of post-transfusional cases.

Article and Author Information

From the National Cancer Institute and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland. For current author addresses, see end of text.
Requests for Reprints: Antoine Gessain, MD, PhD, Laboratory of Tumor Cell Biology, National Cancer Institute, National Institutes of Health, Building 37, Room 6A11, 9000 Rockville Pike, Bethesda, MD 20892; or Laboratoire d'Epidémiologie des Virus Oncogènes, Institut Pasteur, 28 rue du Dr Roux, 75724 Paris Cedex 15, France.
Current Author Addresses: Dr. Gessain: Laboratoire d'Epidémiologie des Virus Oncogenes, Institut Pasteur, 28 rue du Dr Roux, 75724 Paris Cedex 15, France.

Dr. Gout: Clinique de Neurologie et de Neuropsychologie, Hôpital de la Salpétrière, 47 bvld de l'Hôpital, 75013 Paris Cedex 13, France.