Int J Infect Dis. 2022 Jul 25:S1201-9712(22)00440-4. doi: 10.1016/j.ijid.2022.07.043. Online ahead of print.
BACKGROUND: . Although only 10% of persons infected with HTLV-1 may develop virus-associated illnesses lifelong, missing the earlier diagnosis of asymptomatic carriers frequently leads to late presentation.
METHODS: . A nationwide HTLV-1 register was created in Spain in 1989. We examined the main demographics and clinical features at the time of first diagnosis during more than three decades.
RESULTS: . A total of 428 individuals infected with HTLV-1 had been reported in Spain until the end of 2021. Up to 96 (22%) individuals presented clinically with HTLV-1-associated conditions, including subacute myelopathy (57%), T-cell lymphoma (34%), or Strongyloides stercoralis infestation (8%). Since 2008, HTLV-1 diagnosis has been made either at blood banks (44%) or at clinics (56%). Native Spaniards and Sub-Saharan Africans are overepresented among patients presenting with HTLV-1-associated illnesses suggesting that poor epidemiological and/or clinical suspicion leading to late presentation are more frequent in them compared to LATAM carriers (31.7% vs 20.4%, respectively; p=0.015).
CONCLUSION: . HTLV-1 infection in Spain is frequently diagnosed in patients presenting with characteristic illnesses. Whereas screening in blood banks mostly identifies asymptomatic LATAM carriers, a disproportionately high number of Spaniards and Africans are diagnosed too late, at the time of clinical manifestations. Expanding testing to all pregnant women and clinics for sexually transmitted infections could help to unveil HTLV-1 asymptomatic carriers.