Respiratory and urinary tract infections, arthritis, and asthma associated with HTLV-I and HTLV-II infection - eScholarship

RESEARCH Respiratory and Urinary Tract Infections, Arthritis, and Asthma Associated with HTLV-I and HTLV-II Infection Edward L. Murphy,* Baoguang Wang,† Ronald A. Sacher,‡ Joy Fridey,§ James W. Smith,¶ Catharie C. Nass,# Bruce Newman,** Helen E. Ownby,** George Garratty,†† Sheila T. Hutching,†† and George B. Schreiber† Human T-lymphotropic virus types I and II (HTLV-I and -II) cause myelopathy; HTLV-I, but not HTLV-II, causes adult T-cell leukemia. Whether HTLV-II is associated with other diseases is unknown. Using survival analysis, we studied medical history data from a prospective cohort of HTLV-I– and HTLV-II–infected and –uninfected blood donors, all HIV seronegative. A total of 152 HTLV-I, 387 HTLV-II, and 799 uninfected donors were enrolled and fol- lowed for a median of 4.4, 4.3, and 4.4 years, respectively. HTLV-II participants had significantly increased incidences of acute bronchitis (incidence ratio [IR] = 1.68), bladder or kidney infection (IR = 1.55), arthritis (IR = 2.66), and asth- ma (IR = 3.28), and a borderline increase in pneumonia (IR = 1.82, 95% confidence interval [CI] 0.98 to 3.38). HTLV-I participants had significantly increased incidences of blad- der or kidney infection (IR = 1.82), and arthritis (IR = 2.84). We conclude that HTLV-II infection may inhibit immunolog- ic responses to respiratory infections and that both HTLV-I and -II may induce inflammatory or autoimmune reactions. uman T-lymphotropic virus types I and II (HTLV-I and -II) are presumed to have derived from primate T- lymphotropic viruses with which they share significant nucleotide sequence homology (1). They are transmitted by sexual intercourse; by parenteral modes such as unscreened blood or shared injection equipment; and from mother to child, predominantly by breast feeding (2–4). HTLV-I has been causally associated with adult T-cell H *University of California San Francisco, California, USA; †Westat, Rockville, Maryland, USA; ‡Hoxworth Blood Center, Cincinnati, Ohio, USA; §Blood Bank of San Bernardino and Riverside Counties, San Bernardino, California, USA; ¶Oklahoma Blood Institute, Oklahoma City, Oklahoma, USA; #American Red Cross Blood Services Chesapeake and Potomac, Baltimore, Maryland, USA; **American Red Cross Blood Services Southeastern Michigan, Detroit, Michigan, USA; and ††American Red Cross Blood Services Southern California, Los Angeles, California, USA leukemia and HTLV-associated myelopathy. HTLV-II has also been associated with HTLV-associated myelopathy, but not with leukemia (5). Other possible health outcomes of chronic HTLV-I and -II infection have not yet been adequately investigated. Patients with adult T-cell leukemia may develop oppor- tunistic infections such as Pneumocystis carinii pneumo- nia (6) or Strongyloides superinfection (7), but clinical immunodeficiency does not appear to develop in most per- sons with chronic HTLV-I or -II infection. On the con- trary, syndromes suggestive of increased immunologic response such as uveitis (8), pneumonitis (9,10), and rarely, cases of lymphocytic arthritis (11,12) have been reported, although only uveitis has been epidemiologically associated with HTLV-I (8). Investigators in Japan have linked HTLV-I to a higher occurrence of various medical conditions (13) and virus-associated malignancies (14). Other investigators have reported an association between HTLV-II and pneumonia among injection drug users (15). Case series and cross-sectional studies of HTLV-I and - II disease outcomes are vulnerable to potential bias and confounding. We have prospectively followed a large cohort of former blood donors with well-documented HTLV-I and -II infection at enrollment, and a similar group of uninfected donors, all of whom are HIV seronegative. We report on the occurrence of various disease outcomes in this cohort after a median follow-up of 4.3 years. Methods Study Design and Participants This study is a prospective, multicenter cohort of per- sons with HTLV-I and -II infections, which were detected at the time of attempted blood donation at five U.S. blood centers and comparable HTLV–seronegative donors. Emerging Infectious Diseases • www.cdc. gov/eid • Vol. 10, No. 1, January 2004