Relevance of Regional Epidemiology of Retroviral Coinfections: HIV and Human T-Lymphotropic Virus.

Abstract

Retroviral coinfections with HIV-1/HTLV-1 or HTLV-2 occur with variable frequencies world-wide and despite an increased risk for development of neurologic complications including TSP/HAM, leukemia, lymphoma and other neurological disorders in such coinfection scenarios, their global and regional surveillance outside the context of research has steadily declined coincidental to the post-HAART era. Therefore, we thought it relevant to ascertain the prevalence of HTLV-1/2 among HIV positive individuals as HTLV/HIV coinfection is reported among patients involved in high risk behaviors. Towards this, we estimated the co-prevalence of HIV and HTLV-1/2 in a German cohort of Caucasian individuals through random sampling and additionally reviewed epidemiological data of HTLV prevalence among the general German population. A total of 106 individuals under antiretroviral therapy were assayed for antibodies using HTLV-I/II assay. We found no case of HTLV-1 or -2 infection (Table) consistent with earlier studies. Literature review revealed a seroepidemiological study of HTLV-1 and HTLV-2 by Taylor et. al. demonstrating lowest seroprevalence rate (0.7 per 10,000) in Germany as opposed to other European countries. Taken together, it demonstrates a very low regional prevalence/absence of HTLV infection among both HIV positive individuals and the native population in Germany. Hence any national investment or proactive public health intervention for routine HTLV-1 testing in Germany along the lines of proposals made by Martin et. al. in their open letter to WHO was deemed unwarranted. In the light of the above observations, we propose that countries need to consider an a priori survey of HTLV among both HIV positive individuals and the general population before implementing interventions as proposed by Martin et. al. and if regional prevalence of HTLV found low, then a donor-specific HTLV risk screening should suffice instead of an universal HTLV screening to reduce the burden on public health services.