Prevalence of HTLV-1/2 in Pregnant Women Living in the Metropolitan Area of Rio de Janeiro

et al. (2014) Prevalence of HTLV-1/2 in Pregnant Women Living in the Metropolitan Area of Rio de Janeiro. PLoS Negl Trop Dis 9(8): e3146. doi:10.1371/journal.pntd.0003146 Prevalence of HTLV-1/2 in Pregnant Women Living in the Metropolitan Area of Rio de Janeiro Denise Leite Maia Monteiro 0 Stella Regina Taquette 0 Danielle Bittencourt Sodre Barmpas 0 Na dia 0 Cristina P. Rodrigues 0 Se rgio A. M. Teixeira 0 Lucia Helena C. Villela 0 Ma rcio Neves Bo ia 0 Alexandre Jose Baptista Trajano 0 Joseph Raymond Zunt, University of Washington, United States of America 0 1 Universidade do Estado do Rio de Janeiro (UERJ) , Rio de Janeiro, Rio de Janeiro , Brazil , 2 Centro Universita rio Serra dos O rga os (UNIFESO) , Tereso polis, Rio de Janeiro, Brazil, 3 Fundac a o Oswaldo Cruz (Fiocruz), Rio de Janeiro, Rio de Janeiro , Brazil , 4 Hospital Estadual da Ma e - Mesquita , Rio de Janeiro, Brazil, 5 Universidade do Grande Rio (UNIGRANRIO), Duque de Caxias, Rio de Janeiro , Brazil Background: HTLV-1/2 infection can cause severe and disabling diseases in children and adults. The aim of the study was to estimate the prevalence of HTLV-1/2 infection in pregnant women living in the metropolitan area of Rio de Janeiro. Methodology/Principal Findings: 1,204 pregnant women were tested upon hospital admission for delivery in two public hospitals in the cities of Rio de Janeiro and Mesquita, between November, 2012 and April, 2013. The samples were screened by chemiluminescent microparticle immunoassay (CMIA) and reactive ones were confirmed by Western blot (WB). Epi-info software was used for building the database and performing the statistical analysis. Eight patients had confirmed HTLV-1/2 infection (7 HTLV-1, one HTLV-2), equivalent to a prevalence rate of 0.66%. Two further reactive screening tests had negative Western blot results and therefore were considered negative in the statistical analysis. All HTLV-1/2-positive patients were born in Rio de Janeiro, most were non-Caucasian (87.5%), in a stable relationship (62.5%), had at least ten years of formal education (62.5%) and a monthly family income of up to US$600.00 (87.5%). There was only one case of coinfection with syphilis and none with HIV. The mean age of the infected women was 28.4 (SD = 6.3) years and of the seronegative ones was 24.8 (SD = 6.5) (p = 0.10). The median number of pregnancies were 3.0 and 1.0 (p = 0.06) and the median number of sexual partners were 3.5 and 3.0 (p = 0.33) in the seropositive and negative groups, respectively. There were no statistically significant differences between the groups. Conclusions/Significance: A significant prevalence of HTLV-1/2 was found in our population. The socio-epidemiological profile of carrier mothers was similar to the controls. Such findings expose the need for a public health policy of routine HTLV-1/2 screening in antenatal care, since counselling and preventive measures are the only strategies currently available to interrupt the chain of transmission and the future development of HTLV-1/2-related diseases. - Data Availability: The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper and its Supporting Information files. Funding: This study was supported by a grant from Fundacao de Amparo a` Pesquisa do Estado do Rio de Janeiro (FAPERJ - E-26/110.351/2012) to SRT and DLMM (www.faperj.br). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. Human T-lymphotropic virus (HTLV)-1 and HTLV-2 were the first oncogenic human retroviruses identified in the early 1980s [1]. They have a strong tropism for T-lymphocytes and are transmitted mostly via cell-cell infection [2]. HTLV-1/2 infection has a worldwide distribution, with an estimate of up to 1520 million people affected [3]. Prevalence changes substantially according to geographical area, ethnical and social background and in specific risk groups such as intravenous (IV) drug users and sex workers [3]. HTLV-1 is highly prevalent in Sub-Saharan Africa, South-western Japan, Central and South America and in parts of the Middle East and Melanesia [3]. Regardless of the region, seroprevalence increases with age, particularly in women, in view of the excess efficiency of the malefemale sexual transmission. HTLV-2 is endemic in several Native American populations and Pygmy tribes in Central Africa and also thrives in IV drug users worldwide, often in co-infection with HIV [4,5]. Infection is life long and most of the patients remain asymptomatic, becoming viral reservoirs and keeping the chain of transmission. On the other hand, about 4% of HTLV-1 carriers will develop adult T-cell leukaemia/lymphoma (ATLL), a highly aggressive CD4+ T-cells malignancy. Type 1 virus is also associated with a wide range of inflammatory conditions, from the mild nonspecific dermatitis and uveitis to the disabling HTLV1-associated myelopathy/Tropical Spastic Paraparesis (HAM/ TSP) which affects 23% of the infected people [6]. HTLV-2 has HTLV-1/2 are retroviruses transmitted by blood products, sexual contact and from mother to child, mainly through breastfeeding. The infection has a characteristic geographical distribution with endemic areas often neighbouring very low prevalence areas. Infection is life long and although asymptomatic in most cases, it can cause severe and disabling diseases in children and adults. There is currently no cure, vaccine or effective treatment for HTLV1/2 infections. Our research is the first to study the prevalence of HTLV-1/2 in pregnant women living in the metropolitan area of Rio de Janeiro, the second largest in Brazil. 1,204 pregnant women were tested upon hospital admission for delivery in two public hospitals in the cities of Rio de Janeiro and Mesquita, between November, 2012 and April, 2013 and a significant prevalence of HTLV-1/2 was found (0.66%). The socio-epidemiological profile of carrier mothers was similar to the controls. Epidemiological knowledge is fundamental for the elaboration of public health policies such as routine HTLV-1/2 screening in antenatal care, since counselling and preventive measures, mainly avoidance of breastfeeding, are the only strategies currently available to interrupt the chain of transmission and the future development of HTLV-1/2related diseases. been associated to hairy cell leukaemia, erithrodermatitis and a growing number of neurologic disorders [4]. Recent researches also suggest that the incidence of HTLV-1/2 linked diseases might be even higher than the literature traditionally reports due to the influence of local factors in their pathogenesis [7,8]. There are three main routes of HTLV-1/2 transmission: sexual intercourse, infected whole blood or cell containing blood products and from mother-to-child (vertical transmission - VT) (...truncated)