R e v is ta d a S o c ie d a d e B r a s ile ir a d e M e d ic in a T r o p ic a l 2 5 ( 2 ) : 1 4 ] - 1 4 3 , a b r - ju n , 1 9 9 2
COM UNICAÇAO
HTLV-II A N D A NEW ENDEM IC AREA FOR HTLV-I IN
BRAZIL
E dsun D u arte M oreira Junior, W illiam H arrington J un io r, T erezinha T up in am h á R ib eiro, A ilton M elo, C arlos B rites, Roberto B ad aró,
Priscila Sw anson and H elen Lee
H um an T -c e ll leukem ia v irus type one (H T L V -I) is associated w ith adult T -cell leukem ia/ lym p h om a (A T L ) and tropical spastic paraparesis (T S P ). H T L V -I is en d em ic in Southw estern Japan, Central A frica, and the Caribbean basin. Human T -c e ll leu k em ia virus typ e tw o (H T L V -I l), another virus related to H T L V -I, has been linked to tw o ca ses o f an atypical variant o f hairy cell leukem ia4 . H T L V -II has been id en tified in IV drug abusers in the U n ited States7.
H T L V -I in fectio n has also been reported in
so m e p op u lation s in B ra zil1 2 5 .Salv ador, the capital o f the State o f B ah ia, is a city o f nearly tw o m illio n inhabitants, and until 1763 w a s the major site o f sla v e trade in B rasil. L ik e the Caribbean b asin , the pop u la tion in Bahia is rough ly 80% black or racially m ixed . W e studied the prevalence o f H T L V -I and H T L V -II in several groups in S alvad or and an other inner city in Bahia, Jacobina. D u rin g 1 9 9 0 , sera w ere obtained from the fo llo w in g group s: 1) a random cross sectio n o f 129 patients adm itted to a hospital w h ich cares for the lo w er so c io -e c o n o m ic classes; 2) 9 0 patientes w ith
tu b erculosis: 3) 88 patients w ith A ID S; 4 ) 14 patients w ith m yelo path y; 5 ) 16 patients w ith leu k em ia/lym p h om a ; 6 ) 9 0 b lood donors; 7 ) 90 pregnant w o m en ; 8) 103 health care w orkers and 9 ) 4 4 health y adults from Jacobina, an endem ic area fo r leish m an iasis.
A n tib o d ies to H T L V -I/II w ere detected w ith a c o m m e r c ia lly a v a ila b le en zy m e im m u n oassay (E IA ) (C ou lter L aboratories, H ialeah, F L ). EIA
L a b o r a t ó r i o d e R e t r o v i r u s , H o s p i t a l U n i v e r s i t á r i o P r o f e s s o r E d g a r d S a n t o s . U n i v e r s i d a d e F e d e r a l d a B a h i a , S a l v a d o r B A , B r a s i l a n d U n i v e r s i t y o f M i a m i , C o r n e l l U n i v e r s i t y M e d i c a l C o l l e g e , N e w Y o r k , A b b o t t L a b o r a t o r i e s , N o r t h C h i c a g o , I L U S A .
S u p p o r t e d b y G r a n t s A I 2 6 5 0 6 a n d T W 0 0 1 8 f r o m t h e U n i t e d S l a t e s P u b l i c H e a l t h S e r v i c e .
A d d r e s s, to c o rr e s p o n d e n c e : D r . R o b e r t o B a d a r ó , L a b o r a t ó r i o d e R e t r o v i r u s / H U P r o f . E d g a r d S a n t o s / U F B A . R J o ã o d a s B o t a s s / n , 6 ° a n d a r . 4 0 1 1 0 - 1 6 0 S a l v a d o r , B A .
R e c e b i d o p a r a p u b l i c a ç ã o e m 2 7 / 0 1 / 9 2 .
repeatedly reactive sam ples w ere further con firm ed by a n ew dot blot confirm atory im m u noassay usin g h ig h ly pu rified H T L V -I viral and recom binant protein s as an an tigen sou rce (A bbott L aboratories, N orth C h ica g o , IL ). S am p les w e r e co n sid ered ser o lo g ica lly p o sitiv e i f a n tib od ies against both the gag (p 2 4) and en v (p 2 1 E ) g en e products w ere present, accordin g to A m erican H ealth S ervices r e c o m m e n d a tio n s fo r la b o r a to r y te c h n iq u e s 6 . C onfirm ed sam ples w ere a lso tested fo r a n tib o d ies to HTLV-1 or II usin g a series o f syn th etic pep tid e-coated p olystyren e bead s in a so lid ph ase EIA (A b b o tt).
T h is study dem onstrated a rela tiv ely high prevalence o f antib ody to HTL V-1 (1 .8 % ) am ong adults representig the general p opu la tion in Bahia (T able 1). T h is rate is h igh er than that reported in b lood donors in the U nited States (0 .0 2 5 % ) 10, and in Britain (0 .0 1 %)9. A n d , it is sim ila r to antib ody rates observed in African population in Gabon (3 .9 % ), Kenya (1 .7 % ), Liberia (1 .6 % ), N ig er ia (2 .6 % ), Sen egal (1 .2 % ) and Z aire ( 3 .2 % ) 3. T h is sim ilarity, presu m ab ly , reflects th e A frican o r ig in o f the population in Bahia.
A high preva len ce o f H T L V -I in fectio n w as detected am ong patient g roup s, regardless o f w heth er their d iseases w ere H T L V -I related or not. T here w as a high er prevalen ce o f H T L V -I in fectio n in tuberculosis patients (11% ) com pared w ith the healthy population (1 .8 % ), p < 0 . 0 0 1 . H o w e v er, it rem ains to be determ in ed w h eth er a c tiv e tu b ercu losis, through transient im m unosu pression a n d /or an tigenic T -cell stim ulation cau ses a recru d escen se o f latent H T L V -I i n f e c t i o n p r e v i o u s l y u n d e t e c t a b e l
sero lo g ica lly ; or w heth er H T L V -I ca u se a general or s p e c if ic d e f e c t w h ic h fa v o r s r e a c t iv a t io n o f tu b erculosis am ong tu b erculous in fected persons. Further studies are needed to a ssess th e se h y p o th ese s. HT L V -I induced m ito g en ic stim ulation in creases the H IV -1 production fro m th e peripheral b lo od leu k ocytes i n v i t r o 1 1 . T h e increased serop re v a len ce
C o m u n ic a ç ã o . M o r e ir a J ú n io r E D , H a r rin g to n J ú n io r W, R ib e ir o TT , M e lo A , B r ite s C, B a d a r ó R , S w a n s o n P , L e e H . H T L V l l a n d n e w e n d e m ic a r e a f o r H T L V I in B razil. R e v is ta d a S o c ie d a d e B r a s ile ir a d e M e d ic in a T r o p ic a l 2 5 :1 4 1 -1 4 3 , a b r - ju n , -1 9 92 .
o f H T L V -I in th e A ID S group m ay thus result from 2 situ ation s: eith er H T L V -I latent in fectio n enhaces r e p lic a tio n o f H IV lea d in g to im m u n o lo g ic a l im b alan ce and ev en tu a lly to clin ical A ID S , or H IV in fectio n activ ates a latent, ser o lo g ica lly silen t, H T L V -I in fectio n . A m o n g the A ID S patients, the c o in fe c tio n w ith H T L V -I/II w as sig n ifica n tly more frequen t in in traven ous drug a b u sers(IV D A ) 14/19 (74 % ) than in th e h o m o sex u a l/b isex u a l m en 6 /5 0 (1 2 %), p < 0 .0 0 0 0 1 . In contrast w ith som e reports from th e U .S . 7 and U .K .8, that sh o w ed HT L V -II to b e m ore frequen t than H T L V -I am ong IV D A , w e fou nd in 14 patients co in fected w ith H IVx/H T L V :
13 (93 % ) w ith an tib o d ies to H T L V -I, and o n ly
1 (7% ) w ith H T L V -II in fectio n . T he sig n ific a n c e o f this differen ce, as w e ll as the clin ica l and b io lo g ica l con seq u en ces o f th e h ig h p rev a len ce o f H IV j and H T L V -I/II co in fectio n rem ains to be determ ined.
T h e p resence o f H T L V -I a n tib od ies in four patients w ith m y elo pathy su g g e stiv e o f T S P , and in three patients w ith suspected A T L , co n firm s that th e se tw o c lin ic a l e n t itie s , a lr e a d y rep o rted p rev io u sly 2 5 do e x ist in B razil.
W e co n clu d e that Salvador is a n ew en d em ic area for H T L V -1, and w e reported on the first three confirm ed cases o f H T L V -II - in B razil. Larger e p id em io lo g ic studies o f H T L V -I and II in Brazil are warranted.
T a b l e 1 - P r e v a l e n c e o f a n t i b o d i e s t o H T L V - I / I I a m o n g s e l e c t e d g r o u p s in B a h i a , B r a z i l , 1 9 9 0 .
G roups N ° N ° H T L V typ in g
tested p o sitiv e (% )
I II E q u iv o ca l/
N e g a tiv e
P atien t g roups
H osp italized
patients (randon) 129 25 (1 9 .4 ) * 1 8 /2 0 1/2 0 1/2 0
T u b ercu losis 90 10 (1 1 .1 ) 7 /1 0 1 /10 2 /1 0
M yelo p ath y 14 4 (2 8 .6 ) 4 /4 0 0
L eu k aem ia /lym p h o m a 16 3 (1 8 .8 ) 3/3 0 0
A ID S /A R C /H I V + 88 20 (2 2 .7 ) 15 /2 0 1 /20 1 /20
H ealth y popula tio ns
H ealth care w ork ers 103 2 (1 .9 ) 2 /2 0 0
B lo o d d onors 90 1 (1 .1 ) 1/1 0 0
Pregnant w om en 9 0 2 (2 .2 ) 2 /2 0 0
A d u lts from Jacob ina 4 4 1 (2 -3 ) 1/1 0 0
T ota l 6 6 4 6 8 (1 0 .2 ) 5 3 /6 3 3 /6 3 7 /6 3
* 5 c o n f i r m e d s a m p l e s w e r e n o t a v a i l a b l e f o r t y p i n g .
C o m u n i c a ç ã o . M o r e i r a J ú n i o r E D , H a r r i n g t o n J ú n i o r W , R i b e i r o T T , M e l o A , B r i t e s C , B a d a r ó R , S w a n s o n P , L e e
H . H T L V I I a n d n e w e n d e m i c a r e a f o r H T L V 1 i n B r a z i l . R e v i s t a d a S o c i e d a d e B r a s i l e i r a d e M e d i c i n a T r o p i c a l 2 5 : 1 4 1
-1 4 3 , a b r - j u n , -1 9 9 2 .
R E F E R E N C E S
1 . C o r t e s E , D e t e l s R , A b o u l a f i a D , L i X L , M o u d g i l
T , A l a m M , B o n e c k e r C , G o n z a g a A , O y a f u s o L ,
T o n d o M , B o i t e C , H a m m e r s h l a c k N , C a p i t a n i C ,
S l a m o n D J , H o D D . H I V - 1 , H I V - 2 , a n d H T L V - I
i n f e c t i o n i n h i g h - r i s k g r o u p s in B r a z i l . N e w E n g l a n d
J o u r n a l o f M e d i c i n e 3 2 0 : 9 5 3 - 9 5 9 , 1 9 8 9 .
2 . C o s t a C M C , S a l g u e i r o M R , C a r t o o n H , V a l e O C ,
A r r u d a A M . T r o p i c a l s p a s t i c p a r a p e r e s i s in N o r t h e a s t e r n B r a z i l . A r q u i v o d e N e u r o p s i q u i a t r i a
S ã o P a u l o 4 7 : 1 3 4 - 1 3 8 , 1 9 8 9 .
3 . H u n s m a n n G , B a y e r H , S h n e i d e r J , S c h i m i t z H ,
K e r n P , D i e t r i c h M , B l a t t n e r D W , G o u d e a u A M ,
K u l k a r n i G , F l e m i n g A F . A n t i b o d i e s t o A T L V /
H T L V - I i n A f r i c a . M e d i c a l M i c r o b i o l o g y
I m m u n o l o g y 1 7 3 : 1 6 7 - 1 7 0 , 1 9 8 4 .
4 . K a l y a n a r a m a n V S , S a m g a d h a r a n M G , R o b e r t -
G u r o f f M , M i y o s h i l , B l a y n e y D , G o l d D , G a l l o R C .
A n e w s u b t y p e o f h u m a n T c e l l l e u k e m i a v i r u s
( H T L V - I I a s s o c i a t e d w i t h a T - c e l l v a r i a n t o f h a i r y
c e l l l e u k e m i a . S c i e n c e 2 1 8 : 5 7 1 - 5 7 3 , 1 9 8 2 .
5 . P o m b o d e O l i v e i r a M S , M a t u t e s E , F a m a d a s L C ,
S c h u l z T F , C a l a b r o M L , N u c c i M , A n d r a d a - S e r p a
M J , T e d d e r R S , W e i s s R A , C a t o v s k y D . A d u l t T -
c e l l l e u k a e m i a / l y m p h o m a in B r a z i l a n d its r e l a t i o n
t o H T L V - I . L a n c e t 3 3 6 : 9 8 7 - 9 9 0 , 1 9 9 0 .
6 . P u b l i c H e a l t h S e r v i c e W o r k i n g G r o u p ( F D A / C D C /
N I H ) . L i c e n s u r e o f s c r e e n i n g t e s t s f o r a n t i b o d y
h u m a n T l y m p h o t r o p i c v i r u s t y p e I . M o r b i d M o r t a l
W e e k l y R e p u b l i c 3 7 : 7 3 6 - 7 4 7 , 1 9 8 8 .
7 . R o b e r t - G o u r o f f M , W e i s s S H , G i r o n J A , J e n n i n g s
A M , G i n z b u r g H M , M a r g o l i s I B , B l a t t n e r W A ,
G a l l o R C . P r e v a l e n c e o f a n t i b o d i e s t o H T L V - I , -II
a n d - I I I i n i n t r a v e n o u s d r u g a b u s e r s f r o m a n A I D S
e n d e m i c r e g i o n . J o u r n a l o f t h e A m e r i c a n M e d i c a l A s s o c i a t i o n 2 2 5 : 3 1 3 3 - 3 1 3 7 , 1 9 8 6 .
8 . T e d e r R S , S h a n s o n D C , J e f f r i e s D J , C h e i n g s o n g -
P o p o v R , C l a p h a m P , D a l g l e i s h A , N a g y K , W e i s s
R A . L o w p r e v a l e n c e i n t h e U K o f H T L V - I a n d
H T L V - I I i n f e c t i o n i n s u b j e c t s w i t h A I D S , w i t h
e x t e n d e d l y m p h o d e n o p a t h y , a n d a t r i s k o f A I D S .
L a n c e t 1 1 : 1 2 5 - 1 2 8 , 1 9 8 4 .
9 . W e b e r J . H T L V - I i n f e c t i o n i n B r i t a i n . B r i t i s h M e d i c i n e o f J o u r n a l 3 0 1 : 7 1 - 7 2 , 1 9 9 0 .
1 0 . W i l l i a m s A E , F a n g C T , S l a m o n D , P o i e s z B ,
S a n d l e r S G , D a r r W F , S h u l m a n G , M c G o w a n E L ,
D o u g l a s D , B o w m a n R , P e e t o m F , K l e i n m a n S ,
L e n e s B , P r i n c e H , D o d d R . S e r o p r e v a l e n c e a n d
e p i d e m i o l o g i c c o r r e l a t e s o f H T L V - I i n f e c t i o n i n U S
b l o o d d o n o r s . S c i e n c e 2 4 0 : 6 4 3 - 6 4 6 , 1 9 8 8 .
1 1 . Z a c k J A , C a n n A J , L u g o J P , C h e n I S Y . H I V - 1
p r o d u c t i o n f r o m i n f e c t e d p e r i p h e r a l b l o o d T c e l l s
a f t e r H T L V - I i n d u c e d m i t o g e n i c s t i m u l a t i o n . S c i e n c e
