HTLV Flashcards
What diseases does HTLV cause?
Human T-cell leukaemia or lymphoma
Tropical spastic paraparesis
What is incubation period of HTLV?
10 - 40 years
There is no evidence based treatment for HTLV.
Following a needle-stick injury. What PEP can be considered?
Few cases of occupational exposure have been described in the literature and no instances where prophylaxis has been given after an HTLV exposure in humans. Significant exposures include exposure to cellular fluid (such as whole blood) of an HTLV-infected patient through needlestick injury, particularly where the proviral DNA level is high.
In vitro data show that raltegravir, a drug that prevents integration of HIV DNA into the host genome, and certain HIV-1 nucleoside analogue reverse transcriptase inhibitors also have activity against HTLV-1. In the absence of clinical data, some specialists recommend that individuals who have sustained a significant occupational exposure to HTLV-1 should receive post exposure prophylaxis with raltegravir, zidovudine and lamivudine for 6 weeks
What is the difference between HTLV1 and HTLV2?
Geography
Disease
HTLV-2 has mainly been detected in indigenous Americans and people from Western Africa; it is less common in the UK than HTLV-1.
Transmission is through the same routes as HTLV-1, with a particularly strong association with injecting drug use in some groups.
However, there are no recent data on the prevalence of HTLV-2 in people who inject drugs in the UK. HTLV-2 is less frequently associated with disease than HTLV-1 and, where disease does occur, it is generally milder.
However, there is currently little information available about the role of HTLV-2 in disease.
How many people with HTLV infection develop disease?
5-10%
56 year old male, originally from Japan, admitted for coronary surgery.
Healthcare worker sustains significant needlestick injury during the procedure.
First aid is performed.
Source is tested for HBV/ HCV and HIV.
Should the source be tested for HTLV?
No specific guidelines
Patient originally from “high risk” country – increased exposure risk
Very few cases of definite exposures transmission in literature
Consider benefits/ risks to source of knowing their HTLV status
Benefit to patient – look out for symptoms, enrol in trials
Benefit to population – understand prevalence, identify trial participants
Drugs as PEP – no documented cases of use after HTLV exposure
Hypothetically may provide biggest benefit – preventing infection (as no treatment)
Expert advice - consider using zidovudine/ lamivudine/ raltegravir as PEP for 6 weeks
Surgeon from Barbados moves to UK to work performing EPPs.
They are known HTLV1 positive.
Is this surgeon able to perform EPPs?
No documented cases off HCW to patient transmission
Most sources have low viraemia/ transmissibility
However long incubation – other cases could be missed
High HTLV viral load – probably higher risk of transmission
However, not known that lower loads prevent transmission
Advice - no restriction on EPPs, but OH should be aware of HTLV status. Consider checking a pro-viral load. But it is unclear how this would change management. Expert advice could consider giving
36 year old Caucasian male, who has never left UK, planning to freeze sperm for fertility preservation.
Does he need screened for HTLV?
Mandatory screening not required – as no risk factors, and UK low prevalence
36 year old Caucasian male, who has never left UK, planning to freeze sperm for fertility preservation.
Wife is from Ghana
Does he need screened for HTLV?
Mandatory screening not required – as no risk factors, and UK low prevalence
Because partner is from high risk area, he should be offered screening
24 year female with known HTLV delivers a healthy baby.
She asks if she can breastfeed the baby.
What is your advice?
Avoid if possible
If needs to breastfeed e.g developing country – stop after 6 months. Risk seems to increase after this time
24 year female with known HTLV delivers a healthy baby.
You advise not to breastfeed, but she does this anyway.
What is your management following this?
No routine follow up
20-30% will acquire infection
5% of those with infection will develop disease
No treatment available if infection diagnosed in baby
However, some recommend screening mother proviral load, adn risk stratifying risk of transmission.
If mother low risk, normal antenatal care, and test baby at 18 months.
If high risk, consider PEP for duration of breastfeeding. Zidovudine/ lamivudine/ raltegravir
27 year old female patient with HTLV1
What is advice regarding delivery methods?
If low viral load in mother/ low risk - then normal delivery
If high viral load in mother/ high risk - recommend C-section
