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September 08, 2009; 73 (10) Articles

Neurologic abnormalities in HTLV-I– and HTLV-II–infected individuals without overt myelopathy

H. H. Biswas, J. W. Engstrom, Z. Kaidarova, G. Garratty, J. W. Gibble, B. H. Newman, J. W. Smith, A. Ziman, J. L. Fridey, R. A. Sacher, E. L. Murphy
First published September 8, 2009, DOI: https://doi.org/10.1212/WNL.0b013e3181b6bba9
H. H. Biswas
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J. W. Engstrom
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Z. Kaidarova
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G. Garratty
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J. W. Gibble
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B. H. Newman
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J. W. Smith
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A. Ziman
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J. L. Fridey
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R. A. Sacher
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E. L. Murphy
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Citation
Neurologic abnormalities in HTLV-I– and HTLV-II–infected individuals without overt myelopathy
H. H. Biswas, J. W. Engstrom, Z. Kaidarova, G. Garratty, J. W. Gibble, B. H. Newman, J. W. Smith, A. Ziman, J. L. Fridey, R. A. Sacher, E. L. Murphy
Neurology Sep 2009, 73 (10) 781-789; DOI: 10.1212/WNL.0b013e3181b6bba9

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Abstract

Background: Human T-lymphotropic virus (HTLV) type I is the causative agent of HTLV-associated myelopathy (HAM)/tropical spastic paraparesis, and a number of HAM cases with HTLV-II infection have also been reported. However, despite some reports, it is unclear whether HTLV-I or -II infection is associated with other neurologic manifestations.

Methods: An analysis of medical histories and screening neurologic examinations from a prospective cohort of 153 HTLV-I, 388 HTLV-II, and 810 HTLV-seronegative individuals followed up for means of 11.5, 12.0, and 12.2 years was performed. Participants diagnosed with HAM were excluded. We calculated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for age, sex, race or ethnicity, income, educational attainment, body mass index, alcohol and cigarette consumption, injection drug use, diabetes, and hepatitis C virus status, using generalized estimating equations for repeated measures.

Results: HTLV-I and -II participants were more likely than seronegative participants to have leg weakness (ORs 1.67 [95% CI 1.28–2.18] and 1.44 [1.16–1.78]), impaired tandem gait (ORs 1.25 [95% CI 1.07–1.47] and 1.45 [1.27–1.64]), Babinski sign (ORs 1.54 [95% CI 1.13–2.08] and 1.51 [1.18–1.93]), impaired vibration sense (ORs 1.16 [95% CI 1.01–1.33] and 1.27 [1.14–1.42]), and urinary incontinence (ORs 1.45 [95% CI 1.23–1.72] and 1.70 [1.50–1.93]). For both HTLV-I and -II participants, higher odds of sensory neuropathy by monofilament examination were no longer significant after adjustment for confounding.

Conclusions: These results provide strong evidence that human T-lymphotropic virus (HTLV)-I and -II are associated with a spectrum of predominantly motor abnormalities in patients without overt HTLV-associated myelopathy. Further investigation of the clinical course and etiology of these abnormalities is warranted.

Glossary

ATL=
adult T-cell leukemia/lymphoma;
CI=
confidence interval;
HAM=
human T-lymphotropic virus–associated myelopathy;
HOST=
HTLV Outcomes Study;
HTLV=
human T-lymphotropic virus;
OR=
odds ratio;
ORa=
adjusted odds ratio.
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