Health inequities and HTLV-1
Authors: Carolina Rosadas, Graham P Taylor
Journal: The Lancet Microbe (2022)

WHO defines health inequities as "systematic differences in the health status of different population groups. These inequities have significant social and economic costs both to individuals and societies".1WHOHealth inequities and their causes.https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causesDate accessed: November 15, 2021Google Scholar By definition, health inequities are unfair and potentially avoidable with the implementation of adequate policies.1WHOHealth inequities and their causes.https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causesDate accessed: November 15, 2021Google Scholar Despite the effect of human T-cell leukaemia virus type-1 (HTLV-1) on patients' lives and the number of affected individuals (minimum 5–10 million worldwide), health policies worldwide targeting HTLV-1 have either advanced slowly or not at all since the discovery of the virus in 1980. Some progress has been observed since the publication of a call for action to WHO.2Martin F Tagaya Y Gallo R Time to eradicate HTLV-1: an open letter to WHO.Lancet. 2018; 391: 1893-1894Google Scholar The response from WHO included a global consultation and publication of a technical report and fact sheet.3WHOHuman T-lymphotropic virus type 1: technical report.https://www.who.int/publications/i/item/9789240020221Date: 2021Date accessed: November 11, 2021Google Scholar More recently, the Pan American Health Organization, WHO, and the HTLV Channel co-organised a webinar to discuss HTLV-1 health policies.The understanding of health inequities is essential for the implementation of effective measures to reduce each population's burden of disease. Analysing data on HTLV-1 prevalence in pregnant women,4Rosadas C Taylor GP Mother-to-child HTLV-1 transmission: unmet research needs.Front Microbiol. 2019; 10: 999Google Scholar gross domestic product per capita, and Gini index shows a clear correlation between low income and high HTLV-1 prevalence. Strikingly, HTLV-1 prevalence increases as economic inequality increases (appendix). It is also clear from the literature that the people most affected by HTLV-1 are non-White, female, and have low income and lower educational level. Vulnerable groups, such as sex workers, people who use recreational drugs, indigenous people, and migrants are also disproportionately burdened. HTLV-1 increases all-cause mortality (adjusted risk 1·56 [95% CI 1·37–1·80])5Schierhout G McGregor S Gessain A Einsiedel L Martinello M Kaldor J Association between HTLV-1 infection and adverse health outcomes: a systematic review and meta-analysis of epidemiological studies.Lancet Infect Dis. 2020; 20: 133-143Google Scholar and causes a broad range of high mortality and morbidity diseases, including adult T-cell leukaemia and lymphoma, HTLV-1-associated myelopathy, infective dermatitis, and uveitis. HTLV-1 negatively affects co-infections (eg, Strongyloides stercoralis and tuberculosis) that also affect the most vulnerable people in low-income and middle-income countries.5Schierhout G McGregor S Gessain A Einsiedel L Martinello M Kaldor J Association between HTLV-1 infection and adverse health outcomes: a systematic review and meta-analysis of epidemiological studies.Lancet Infect Dis. 2020; 20: 133-143Google Scholar Thus, HTLV-1 infection results in productivity loss for those affected and their family members. This loss of productivity might be temporary (time off work to receive medical care) or permanent (early retirement). Patients and their caregivers might also become less productive while at work (presenteeism). Because a proportion of patients with HTLV-1 will die before their retirement age, productivity is also lost due to premature mortality. People's unpaid productivity (such as for daily household activities and childcare) is also vital to society and is equally affected by HTLV-1. This individual loss of productivity translates to society. Therefore, the scarcity of policies to prevent new infections and to allow adequate care for those living with HTLV-1 contributes to increased socio-economic disparity between and within countries. As WHO recognises health equity as a priority, more support should be given to the elimination of HTLV-1. WHO defines health inequities as "systematic differences in the health status of different population groups. These inequities have significant social and economic costs both to individuals and societies".1WHOHealth inequities and their causes.https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causesDate accessed: November 15, 2021Google Scholar By definition, health inequities are unfair and potentially avoidable with the implementation of adequate policies.1WHOHealth inequities and their causes.https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causesDate accessed: November 15, 2021Google Scholar Despite the effect of human T-cell leukaemia virus type-1 (HTLV-1) on patients' lives and the number of affected individuals (minimum 5–10 million worldwide), health policies worldwide targeting HTLV-1 have either advanced slowly or not at all since the discovery of the virus in 1980. Some progress has been observed since the publication of a call for action to WHO.2Martin F Tagaya Y Gallo R Time to eradicate HTLV-1: an open letter to WHO.Lancet. 2018; 391: 1893-1894Google Scholar The response from WHO included a global consultation and publication of a technical report and fact sheet.3WHOHuman T-lymphotropic virus type 1: technical report.https://www.who.int/publications/i/item/9789240020221Date: 2021Date accessed: November 11, 2021Google Scholar More recently, the Pan American Health Organization, WHO, and the HTLV Channel co-organised a webinar to discuss HTLV-1 health policies. The understanding of health inequities is essential for the implementation of effective measures to reduce each population's burden of disease. Analysing data on HTLV-1 prevalence in pregnant women,4Rosadas C Taylor GP Mother-to-child HTLV-1 transmission: unmet research needs.Front Microbiol. 2019; 10: 999Google Scholar gross domestic product per capita, and Gini index shows a clear correlation between low income and high HTLV-1 prevalence. Strikingly, HTLV-1 prevalence increases as economic inequality increases (appendix). It is also clear from the literature that the people most affected by HTLV-1 are non-White, female, and have low income and lower educational level. Vulnerable groups, such as sex workers, people who use recreational drugs, indigenous people, and migrants are also disproportionately burdened. HTLV-1 increases all-cause mortality (adjusted risk 1·56 [95% CI 1·37–1·80])5Schierhout G McGregor S Gessain A Einsiedel L Martinello M Kaldor J Association between HTLV-1 infection and adverse health outcomes: a systematic review and meta-analysis of epidemiological studies.Lancet Infect Dis. 2020; 20: 133-143Google Scholar and causes a broad range of high mortality and morbidity diseases, including adult T-cell leukaemia and lymphoma, HTLV-1-associated myelopathy, infective dermatitis, and uveitis. HTLV-1 negatively affects co-infections (eg, Strongyloides stercoralis and tuberculosis) that also affect the most vulnerable people in low-income and middle-income countries.5Schierhout G McGregor S Gessain A Einsiedel L Martinello M Kaldor J Association between HTLV-1 infection and adverse health outcomes: a systematic review and meta-analysis of epidemiological studies.Lancet Infect Dis. 2020; 20: 133-143Google Scholar Thus, HTLV-1 infection results in productivity loss for those affected and their family members. This loss of productivity might be temporary (time off work to receive medical care) or permanent (early retirement). Patients and their caregivers might also become less productive while at work (presenteeism). Because a proportion of patients with HTLV-1 will die before their retirement age, productivity is also lost due to premature mortality. People's unpaid productivity (such as for daily household activities and childcare) is also vital to society and is equally affected by HTLV-1. This individual loss of productivity translates to society. Therefore, the scarcity of policies to prevent new infections and to allow adequate care for those living with HTLV-1 contributes to increased socio-economic disparity between and within countries. As WHO recognises health equity as a priority, more support should be given to the elimination of HTLV-1. We declare no conflict of interest. This Correspondence received no specific funding. GPT is supported by Imperial National Institute for Health Research Biomedical Research Centre. Supplementary Material Download .pdf (.16 MB) Help with pdf files Supplementary appendix Download .pdf (.16 MB) Help with pdf files Supplementary appendix