![]() ![]() What is the prevalence of HTLV-1 infection in pregnant women in different countries/regions?.What We Need to Know About HTLV-1 Infection in Pregnant Women This review aims to summarize what is known, the current limitations of this knowledge and to identify the most important areas for further research. Despite almost 40 years passing since the discovery of HTLV-1 many gaps in our understanding of MTCT remain. Moreover, transmission is known to be associated with the risk of adult T-cell leukemia (ATL), a highly aggressive and usually fatal malignancy caused by HTLV-1. Thus, this route of infection is well stablished and is responsible for the maintenance of HTLV-1 in several generations of the same family ( The T and B-cell malignancy study group, 1988 Plancoulaine et al., 1998 Catalan-Soares et al., 2005 da Costa et al., 2013 Mendes et al., 2016). Early after the first identification of HTLV-1 the possibility of mother-to-child transmission (MTCT) was supported by several pieces of evidence including: (1) high incidence of HTLV-1 infection in children born to HTLV infected mothers (2) high prevalence of infection in mothers of HTLV-1 seropositive children (3) presence of approximately 10 3 cells infected with HTLV/mL in milk from carrier mothers (4) experimental infection in animals using fresh milk cells from HTLV-1 infected women ( Hino, 2011) (5) low transmission risk among bottle-fed children when comparing to breast fed and more recently reduced incidence of infection after implementation of antenatal screening and avoidance of breastfeeding observed in Japan. Human T-cell lymphotropic virus type 1 (HTLV-1) is a human retrovirus that is mostly transmitted through sexual intercourse and from mother-to-child. Whilst breast-feeding is strongly associated with transmission and avoidance of breast-feeding a proven intervention little is known about the mechanism of transmission from the breast milk to the infant and there have been no clinical trials of antiretroviral therapy (ARV) to prevent this route of transmission. Few studies have examined the impact of HTLV-1 infection on fertility or pregnancy outcomes nor the susceptibility of the mother to infection during pregnancy and lactation. Understanding the contribution of peripartum infection to the burden of disease will be important to gauge the risk-benefit of interventions in this area. Questions remain regarding frequency and risk factors for in utero peri-partum transmission whilst little is known about the efficacy of pre-labor cesarean section to reduce these infections. In order to successfully avoid HTLV-1 MTCT, it is important to understand all the variables involved in this route of infection. In this context, prevention of MTCT is expected to contribute disproportionately to reducing both the incidence of HTLV-1 and the burden of HTLV-1 associated diseases. To date there is no cure for HTLV-1 infection other than bone marrow transplantation for ATL nor any measure to prevent HTLV-1 associated diseases in an infected individual. HAM/TSP is a disabling neurodegenerative disease that greatly impact patient’s quality of life. Whilst HTLV-1-associated myelopathy (HAM) follows sexual and iatrogenic infection approximately 30% of patients presenting with HAM/TSP acquired the infection through their mothers. Infective dermatitis also only occurs following neonatal infection. ![]() Adult T-cell leukemia (ATL), which is caused by HTLV-1 and has a median survival of 8 months is linked to MTCT, indeed evidence of ATL following infection as an adult is sparse. Infection early in life is associated with a higher risk of disease development. Although most infected individuals remain asymptomatic ∼10% develop high morbidity, high mortality disease. Studies of regional variation are required to better understand the contribution of MTCT to the global burden of infection. At least 5–10 million individuals worldwide are currently living with HTLV-1. Mother-to-child transmission (MTCT) of Human T-cell lymphotropic virus type 1 (HTLV-1) causes lifelong infection. Retrovirology and GU Medicine, Department of Medicine, Imperial College London, London, United Kingdom. ![]()
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