Treatment Evaluation of HTLV infection

treatment of asymptomatic

HTLV carriers is not indicated.

why? ( 1)

Although drugs such as zidovudine and lamivudine, have long been recognized to have activity against HTLV in

vitro, there is little clinical evidence of their efficacy in

vivo.

(2)the asymptomatic

natureof HTLV-I and -II and

the low penetrance of HTLV diseases

( 3)the exact role of HTLV-I

in disease pathogenesis has not been clearly defined

In ATL, active viral replication does not appear to play a role in established

malignant disease and tumor cells harbor

oncogenic mutations in cell-regulatory genes that may

not be reversible by treating the virus.

In ATL Substantial improvements in therapy have

been achieved withnewer regimens combining

zidovudine and interferon-a. this combination produces

a high rate of complete responses and prolongs

survival.

HAM with its high viral load would appear to be a

better candidate for antiviral treatment.

A combination of zidovudine and lamivudine was used in a clinical trial

of HAM treatment, but no clinical improvement was seen.

recently, interferon-a and interferon-b1a. have shown some clinical

benefit. In HAM Experimental

studies, such as the use of anti-TAC antibodies

May be useful. concurrently with zidovudine

.

Evaluation of asymptomatic HTLV-I and

HTLV-II carriers.

The first step

is to confirm HTLV infection,either by review of positive

screening EIA and confirmatory tests

or by submission of anotherspecimen

The second stepTyping of the infection

as HTLV-I or HTLV-II is important because of the different

disease outcomes associated with the two viral types. This

can be doneeither by type-specific WB or

immunoassay,or PCR.

The third step

A clinical history regarding risk factors for HTLVInfection

It is important in establishing the pretest probability infection and can be helpful in

typing the infection -Familial or sexual contact with people from

HTLV-I endemic areas favors that infection -a history of injection drug use or sex with an

injection drug user is more consistent with HTLV-II infection.

The fourth step

Medical history should elicit symptoms of neurologic disease or leukemia, (lymphoma),

. Physical examination is directed

at theskin, lymph nodes, and neurologic system to detect manifestations of HTLV dermatitis, ATL, or HAM.

The fifth step

Laboratory evaluation may be

limited to a complete blood count.

Whereas increases in the absolutelymphocyte and platelet counts have

been described in prospectivestudies of HTLV-I and -II carriers, there is

no indication that thesehave clinical significance.

It is more important to rule out subclinical

leukemia by a normal lymphocyte count and absence of flower cell

morphology.

Asymptomatic seropositive patients should be followed by

theirprimary care or infectious disease physician with

annual to biannualreturn visits.

In general, asymptomatic carriers or those with

nonspecificsymptoms should be

reassured by reminding them of the low

penetrance of hematologic and neurologic disease.

Attention shouldbe devoted to counseling

regarding the prevention of further HTLVtransmission

THANK

YOU