■对人类嗜T淋巴细胞病毒(HTLV)的理解仍主要基于流行地区的流行病学和临床数据。全球化导致患有HTLV(PLHTLV)的人从流行地区迁移到非流行地区,以及美国HTLV感染的上升。然而,由于这种疾病的历史罕见,受影响的患者通常诊断不足和错误。因此,我们试图描述流行病学的特征,临床特征,合并症,以及在非流行区确定的HTLV-1或HTLV-2阳性个体的存活率。
■我们的研究是一个单一的机构,1998年至2020年HTLV-1或HTLV-2患者的回顾性病例对照分析。我们使用了两个HTLV阴性对照,年龄相匹配,性别,和种族,对于每个HTLV阳性病例。我们评估了HTLV感染与几种血液学,神经学,传染性,和风湿病协变量。最后,评估了预测总生存期(OS)的临床因素.
■我们确定了38例HTLV感染,其中23例为HTLV-1,15例为HTLV-2阳性。我们对照组中的大多数患者(约54%)接受了HTLV测试以进行移植评估,与约24%的HTLV血清阳性患者相比。与HTLV相关的共病,与对照组相比,HTLV血清阳性患者的丙型肝炎血清阳性率更高(OR10.7,95%CI=3.2-59.0,p<0.001).丙型肝炎和HTLV共感染导致OS降低,与没有感染相比,仅丙型肝炎感染,或单独的HTLV感染。与患有癌症或单独的HTLV的患者相比,患有任何癌症诊断和HTLV感染的患者的OS更差。与HTLV-2患者相比,HTLV-1阳性患者的中位OS较低(47.7个月与77.4个月)。在单变量分析中,HTLV血清阳性患者的1年全因死亡率风险增加,成人T细胞白血病,急性骨髓性白血病,和丙型肝炎感染。更正后,多变量分析显示,HTLV血清阳性与1年全因死亡率不再相关;然而与AML和丙型肝炎感染的相关性仍然显著。
■在多变量分析中,HTLV血清阳性与1年死亡率增加无关。然而,我们的研究受到患者样本量小的限制,以及由于HTLV测试的选择因素而导致的偏倚患者对照人群。
UNASSIGNED: Understanding of human T-lymphotropic virus (HTLV) remains largely based on epidemiologic and clinical data from endemic areas. Globalization has resulted in migration of persons living with HTLV (PLHTLV) from endemic to non-endemic areas, and a rise of HTLV infection in the United States. Yet, due to the historical rarity of this disease, affected patients are often under- and mis-diagnosed. Thus, we sought to characterize the epidemiology, clinical features, comorbidities, and survival of HTLV-1- or HTLV-2-positive individuals identified in a non-endemic area.
UNASSIGNED: Our study was a single institution, retrospective case-control analysis of HTLV-1 or HTLV-2 patients between 1998 and 2020. We utilized two HTLV-negative controls, matched for age, sex, and ethnicity, for each HTLV-positive case. We evaluated associations between HTLV infection and several hematologic, neurologic, infectious, and rheumatologic covariates. Finally, clinical factors predictive of overall survival (OS) were assessed.
UNASSIGNED: We identified 38 cases of HTLV infection, of whom 23 were HTLV-1 and 15 were HTLV-2 positive. The majority (~54%) of patients in our control group received HTLV testing for transplant evaluation, compared to ~24% of HTLV-seropositive patients. Co-morbidities associated with HTLV, hepatitis C seropositivity were higher in HTLV-seropositive patients compared to controls (OR 10.7, 95% CI = 3.2-59.0, p < 0.001). Hepatitis C and HTLV co-infection resulted in decreased OS, compared to no infection, hepatitis C infection alone, or HTLV infection alone. Patients with any cancer diagnosis and HTLV infection had worse OS compared to patients with cancer or HTLV alone. HTLV-1 positive patients had lower median OS compared to HTLV-2 patients (47.7 months vs. 77.4 months). In univariate analysis, the hazard for 1-year all-cause mortality was increased among patients with HTLV-seropositivity, adult T-cell leukemia, acute myelogenous leukemia, and hepatitis C infection. When corrected, multivariate analysis showed that HTLV seropositivity was no longer associated with 1 year all-cause mortality; however association with AML and hepatitis C infection remained significant.
UNASSIGNED: HTLV-seropositivity was not associated with increased 1 year mortality in multivariate analysis. However, our study is limited by our small patient sample size, as well as the biased patient control population due to selection factors for HTLV testing.