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 Volume 73, Number 10, September 8, 2009
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NEUROLOGY 2009;73:781-789
© 2009 American Academy of Neurology

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

H. H. Biswas, ScM, J. W. Engstrom, MD, Z. Kaidarova, MA, MBA, G. Garratty, PhD, FRCPath, J. W. Gibble, MD, B. H. Newman, MD, J. W. Smith, MD, A. Ziman, MD, J. L. Fridey, MD, MBA, R. A. Sacher, MD, E. L. Murphy, MD, MPH For the HTLV Outcomes Study (HOST)*

From the Blood Systems Research Institute (H.H.B., Z.K., E.L.M.), San Francisco, CA; Department of Neurology (J.W.E.), University of California, San Francisco, CA; American Red Cross Blood Services, Southern California Region (G.G.), Pomona, CA; American Red Cross Blood Services, Greater Chesapeake and Potomac Region (J.W.G.), Baltimore, MD; American Red Cross Blood Services, Southeastern Michigan Region (B.H.N.), Detroit, MI; Sylvan N. Goldman Center (J.W.S.), Oklahoma Blood Institute, Oklahoma City, OK; University of California, Los Angeles Medical Center (A.Z.), CA; Children’s Hospital Los Angeles (J.L.F.), CA; Hoxworth Blood Center (R.A.S.), University of Cincinnati, OH; and Departments of Laboratory Medicine and Epidemiology/Biostatistics (E.L.M.), University of California, San Francisco, CA.

Address correspondence and reprint requests to Dr. Edward L. Murphy, UCSF Departments of Laboratory Medicine and Epidemiology/Biostatistics and Blood Systems Research Institute, 270 Masonic Ave., San Francisco, CA 94118 murphy{at}ucsf.edu

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.

Abbreviations: 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.

Supplemental data at www.neurology.org

*See the appendix for HOST Investigators.

Supported by National Heart, Lung, and Blood Institute grant 2R01-HL-62235 and by career award K24-HL-75036 to Dr. Murphy.

Disclosure: Author disclosures are provided at the end of the article.

Presented in part at the International HTLV Conference, Hakone, Japan, May 2007, and the HTLV European Research Network Conference, Bruges, Belgium, June 2008.

Received January 26, 2009. Accepted in final form June 10, 2009.






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