PDF(Pubmed)
Abstract：
HIV pre-exposure prophylaxis (HIV-PrEP) is effective in reducing the likelihood of HIV acquisition in HIV-negative people at high risk of exposure. Guidelines recommend testing for sexually transmitted infections (STIs) before starting, and periodically on PrEP, including bacterial infections, HIV, hepatitis C virus, and, for those who are non-immune, hepatitis B virus. Diagnosed infections can be promptly treated to reduce onward transmission. HTLV-1 is not mentioned; however, it is predominantly sexually transmitted, causes adult T-cell leukaemia/lymphoma (ATL) or myelopathy in 10% of those infected, and is associated with an increased risk of death in those without any classically HTLV-associated condition. The 2021 WHO Technical Report on HTLV-1 called for the strengthening of global public health measures against its spread. In this scoping review, we, therefore, (1) discuss the epidemiological context of HIV-PrEP and HTLV-1 transmission; (2) present current knowledge of antiretrovirals in relation to HTLV-1 transmission prevention, including nucleos(t)ide reverse transcriptase inhibitors (NRTIs) and integrase strand transfer inhibitors (INSTIs); and (3) identify knowledge gaps where data are urgently required to inform global public health measures to protect HIV-PrEP users from HTLV-1 acquisition. We suggest that systematic seroprevalence studies among PrEP-using groups, including men who have sex with men (MSM), people who inject drugs (PWIDs), and female sex workers (FSWs), are needed. Further data are required to evaluate antiretroviral efficacy in preventing HTLV-1 transmission from in vitro studies, animal models, and clinical cohorts. PrEP delivery programmes should consider prioritizing the long-acting injectable INSTI, cabotegravir, in HTLV-1 endemic settings.
摘要：
HIV暴露前预防（HIV-PrEP）可有效降低处于高暴露风险的HIV阴性人群感染HIV的可能性。指南建议在开始之前对性传播感染（STIs）进行检测，并定期在PrEP上，包括细菌感染,艾滋病毒,丙型肝炎病毒，and,对于那些没有免疫力的人来说，乙型肝炎病毒。诊断出的感染可以及时治疗以减少继续传播。没有提到HTLV-1;然而，它主要是性传播的，在10％的感染者中导致成人T细胞白血病/淋巴瘤（ATL）或脊髓病，并且与没有任何经典HTLV相关疾病的人的死亡风险增加相关。2021年世卫组织关于HTLV-1的技术报告呼吁加强全球公共卫生措施以防止其传播。在这次范围审查中，我们,因此,（1）讨论HIV-PrEP和HTLV-1传播的流行病学背景；（2）介绍与预防HTLV-1传播有关的抗逆转录病毒药物的最新知识，包括核苷（t）ide逆转录酶抑制剂（NRTIs）和整合酶链转移抑制剂（INSTIs）；（3）确定迫切需要数据以告知全球公共卫生措施以保护HIV-PrEP使用者免受HTLV-1感染的知识空白。我们建议在使用PrEP的人群中进行系统的血清阳性率研究，包括男男性行为者（MSM），注射毒品的人（PWID），和女性性工作者（FSW），是需要的。需要进一步的数据来评估体外研究中预防HTLV-1传播的抗逆转录病毒功效，动物模型,和临床队列。PrEP交付计划应考虑优先考虑长效可注射INSTI，Cabotegravir,在HTLV-1地方性环境中。
