Clinical Presentation of Individuals With Human T-Cell Leukemia Virus Type-1 Infection in Spain
Authors: De Mendoza Carmen , Pirón Maria , Gonzalez Rocío , Jiménez Ana , Caballero Estrella , Roc Lourdes , Benito Rafael , Ramos Jose Manuel , Soriano Vicente ,   The HTLV Spanish Study Group, Rodríguez C , Vera M , del Romero J , Marcaida G , Ocete M D , Caballero E , Molina I , Aguilera A , Rodríguez-Calviño J J , Navarro D , Rivero C , Vilariño M D , Benito R , Algarate S , Gil J , Ortiz de Lejarazu R , Rojo S , Eirós J M , San Miguel A , Manzardo C , Miró J M , García J , Paz I , Poveda E , Calderón E , Escudero D , Trigo M , Diz J , García-Campello M , Rodríguez-Iglesias M , Hernández-Betancor A , Martín A M , Ramos J M , Gimeno A , Gutiérrez F , Rodríguez J C , Sánchez V , Gómez-Hernando C , Cilla G , Pérez-Trallero E , López-Aldeguer J , Fernández-Pereira L , Niubó J , Hernández M , López-Lirola A M , Gómez-Sirvent J L , Force L , Cifuentes C , Pérez S , Morano L , Raya C , González-Praetorius A , Pérez J L , Peñaranda M , Hernáez-Crespo S , Montejo J M , Roc L , Martínez-Sapiña A , Viciana I , Cabezas T , Lozano A , Fernández J M , García-Bermejo I , Gaspar G , García R , Górgolas M , Vegas C , Blas J , Miralles P , Valeiro M , Aldamiz T , Margall N , Guardia C , do Pico E , Polo I , Aguinaga A , Ezpeleta C , Sauleda S , Pirón M , Torres P , González R , Jiménez A , Blanco L , Suárez A , Rodríguez-Avial I , Pérez-Rivilla A , Parra P , Fernández M , Fernández-Alonso M , Treviño A , Requena S , Benítez-Gutiérrez L , Cuervas-Mons V , de Mendoza C , Barreiro P , Soriano V , Corral O , Gomez-Gallego F 
Published: January 2019

Background

Although only 8%–10% of persons infected with human T-cell leukemia virus type 1 (HTLV-1) may develop virus-associated diseases lifelong, misdiagnosis of asymptomatic infected carriers frequently leads to late diagnoses.

Methods

A nationwide HTLV-1 register was created in Spain in 1989. A total of 351 infected persons had been reported by the end of 2017. We examined all new HTLV-1 diagnoses during the last decade and compared their clinical presentation.

Results

A total of 247 individuals with HTLV-1 infection had been reported in Spain since year 2008. The incidence has remained stable with 20–25 new diagnoses yearly. Women represented 62%. Only 12% were native Spaniards, most of whom were foreigners from Latin America (72.5%). Up to 57 (23%) individuals presented clinically with HTLV-1-associated conditions, including subacute myelopathy (n = 24; 42.1%), T-cell lymphoma (n = 19; 33.3%), or Strongyloides stercoralis infestation (n = 8; 14%). Human T-cell leukemia virus type 1 diagnosis had been made either at blood banks (n = 109; 44%) or at clinics (n = 138; 56%). It is interesting to note that Spaniards and especially Africans were overrepresented among patients presenting with HTLV-1-associated illnesses, suggesting that misdiagnosis and late presentation are more frequent in these populations compared to Latin Americans.

Conclusions

Given that 23% of new HTLV-1 diagnoses in Spain are symptomatic, underdiagnosis must be common. Although screening in blood banks mostly identifies asymptomatic Latin American carriers, a disproportionately high number of Spaniards and Africans are unveiled too late, that is, they already suffer from classic HTLV-1 illnesses.