HTLV Flashcards
What sort of virus in HTLV?
Which type is more common?
What cells does it infect?
Does it integrate into hose genome?
Type C retrovirus
HTLV-1 is much more prevalent
CD4 cells
Yes
Is there a viraemia in HTLV infection?
No, replication within cells so no viraemia
Where is HTLV endemic?
Caribbean, South America, Romania, Iran, Africa, Japan, Melanesia, indigenous Australia
What percentage of people infected with HTLV will develop HTLV associated disease?
5-10%
There is a higher all cause mortality in HTLV infected patients
What are the transmission routes of HTLV?
Vertical (esp through breastfeeding, >6 m is risk)
Sex (more common from men to woman)
IVDU
Blood and organ transplant
Occupational exposure
Flagellation
What diseases do HTLV-1 cause?
Adult T cell leukaemia/lymphoma
HTLV1 associated myelopathy
Others: uveitis, infective dermatitis, disseminated strongyloidiasis, peripheral nerve disease, bronchiectasis, joint inflammation
What diseases do HTLV-2 cause?
No link to lymphoproliferative disease but a possible link to HAM
What is the first line diagnostic test for HTLV?
What is the confirmation test for HTLVI/II?
ELISA for HTLV-I/II antibodies (test can’t differentiate)
Confirmed by Western Blot or line assay
What molecular test is done for new diagnosis of HTLV?
How does this predict disease risk?
Proviral DNA testing
Viral load of >4% is considered high and can predict onward transmission and disease development
Who would you test for HTLV?
Children of HTLV infected mothers
Sexual contacts
Those with occupational exposure
Blood/organ donors
Patients with compatible symptoms
What drugs have activity against HTLV?
NRTIs and INSTIs
NNRTIs and PIs don’t have any activity
What would you give for HTLV PEP in occupational exposure (i.e. NSI)
Zidovudine, lamivudine and raltegravir
Can HCW with HTLV perform EPPs?
UKAP say no HTLV clearance is required, however risk assessment may be performed by OCH, which includes viral load measurement
What screening is required in new diagnosis of HTLV?
Strongyloidiasis
HTLV - Why should asymptomatic patients be monitored?
Early identification of symptoms
Access to clinical trials
Prevention of transmission advice
IS HTLV screened for in blood donors?
Can HTLV infected people donate?
What about sexual contacts of HTLV?
Yes since 2002
No
Only 3 months after last contact
Is HTLV tested for in organ donors? Cell and tissue donors?
Only in patients from high risk countries for organ donation
Cell and tissue donors should be tested
For live donors, follow up testing at 180 days in those at risk of sexual transmission
What is advised re: breastfeeding in HTLV infected mothers?
Shorter duration of breastfeeding (<6 m)
Symptoms of Adult T cell leukaemia/lymphoma and treatment
Lymph node swelling
Hepatosplenamegaly
Bone and skin lesions a
Flower cells in blood film
Chemo, mAbs or BMT
Leukaemic forms can be treated with zidovudine and IFNa
Symptoms of HTLV1 associated myelopathy and treatment
Progressive weakness and spasticity of both legs
Lower limb weakness, lower back pain, bowel and bladder dysfunction
Mylethylpred
