Cargando…

Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil

Background: Despite its relatively low incidence of associated diseases, Human T-cell Leukemia Virus-1 (HTLV-1) infection was reported to carry a significant risk of mortality in several endemic areas. HTLV-1-associated diseases, adult T-cell leukemia/lymphoma (ATLL) and HTLV-1-associated myelopathy...

Descripción completa

Detalles Bibliográficos
Autores principales: Marcusso, Rosa Maria N., Van Weyenbergh, Johan, de Moura, João Victor Luisi, Dahy, Flávia Esper, de Moura Brasil Matos, Aline, Haziot, Michel E. J., Vidal, Jose E., Fonseca, Luiz Augusto M., Smid, Jerusa, Assone, Tatiane, Casseb, Jorge, de Oliveira, Augusto César Penalva
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168659/
https://www.ncbi.nlm.nih.gov/pubmed/31888093
http://dx.doi.org/10.3390/pathogens9010025
_version_ 1783523689692659712
author Marcusso, Rosa Maria N.
Van Weyenbergh, Johan
de Moura, João Victor Luisi
Dahy, Flávia Esper
de Moura Brasil Matos, Aline
Haziot, Michel E. J.
Vidal, Jose E.
Fonseca, Luiz Augusto M.
Smid, Jerusa
Assone, Tatiane
Casseb, Jorge
de Oliveira, Augusto César Penalva
author_facet Marcusso, Rosa Maria N.
Van Weyenbergh, Johan
de Moura, João Victor Luisi
Dahy, Flávia Esper
de Moura Brasil Matos, Aline
Haziot, Michel E. J.
Vidal, Jose E.
Fonseca, Luiz Augusto M.
Smid, Jerusa
Assone, Tatiane
Casseb, Jorge
de Oliveira, Augusto César Penalva
author_sort Marcusso, Rosa Maria N.
collection PubMed
description Background: Despite its relatively low incidence of associated diseases, Human T-cell Leukemia Virus-1 (HTLV-1) infection was reported to carry a significant risk of mortality in several endemic areas. HTLV-1-associated diseases, adult T-cell leukemia/lymphoma (ATLL) and HTLV-1-associated myelopathy/tropical spastic paraperesis (HAM/TSP), as well as frequent coinfections with human immunodeficiency virus (HIV), hepatitis C virus (HCV), and Strongyloides stercoralis were associated to increased morbidity and mortality of HTLV-1 infection. Objective: To determine the mortality rate and its associated variables from an open cohort started in July 1997 at the HTLV Clinic, Emilio Ribas Institute (IIER), a major infectious disease hospital in São Paulo, Brazil. Methods: Since inception up to September 2018, we admitted 727 HTLV-1-infected individuals, with a rate of 30–50 new admissions per year. All patient data, including clinical and laboratory data, were regularly updated throughout the 21-year period, using a dedicated REDCap database. The Ethical Board of IIER approved the protocol. Results: During 21 years of clinical care to people living with HTLV-1 in the São Paulo region, we recruited 479 asymptomatic HTLV-1-infected individuals and 248 HAM/TSP patients, of which 632 remained under active follow-up. During a total of 3800 person-years of follow-up (maximum follow-up 21.5 years, mean follow-up 6.0 years), 27 individuals died (median age of 51.5 years), of which 12 were asymptomatic, one ATLL patient and 14 HAM/TSP patients. HAM/TSP diagnosis (but neither age nor gender) was a significant predictor of increased mortality by univariate and multivariate (hazard ratio (HR) 5.03, 95% CI [1.96–12.91], p = 0.001) Cox regression models. Coinfection with HIV/HCV was an independent predictor of increased mortality (HR 15.08; 95% CI [5.50–41.32]; p < 0.001), with AIDS-related infections as a more frequent cause of death in asymptomatics (6/13; p = 0.033). HIV/HCV-negative fatal HAM/TSP cases were all female, with urinary tract infection and decubitus ulcer-associated sepsis as the main cause of death (8/14, p = 0.002). Conclusions: All-cause mortality among people living with HTLV-1 in São Paulo differs between asymptomatic (2.9%) and HAM/TSP patients (7.3%), independent of age and gender. We observe a dichotomy in fatal cases, with HAM/TSP and HIV/HCV coinfection as independent risk factors for death. Our findings reveal an urgent need for public health actions, as the major causes of death, infections secondary to decubitus ulcers, and immune deficiency syndrome (AIDS)-related infections, can be targeted by preventive measures.
format Online
Article
Text
id pubmed-7168659
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-71686592020-04-20 Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil Marcusso, Rosa Maria N. Van Weyenbergh, Johan de Moura, João Victor Luisi Dahy, Flávia Esper de Moura Brasil Matos, Aline Haziot, Michel E. J. Vidal, Jose E. Fonseca, Luiz Augusto M. Smid, Jerusa Assone, Tatiane Casseb, Jorge de Oliveira, Augusto César Penalva Pathogens Article Background: Despite its relatively low incidence of associated diseases, Human T-cell Leukemia Virus-1 (HTLV-1) infection was reported to carry a significant risk of mortality in several endemic areas. HTLV-1-associated diseases, adult T-cell leukemia/lymphoma (ATLL) and HTLV-1-associated myelopathy/tropical spastic paraperesis (HAM/TSP), as well as frequent coinfections with human immunodeficiency virus (HIV), hepatitis C virus (HCV), and Strongyloides stercoralis were associated to increased morbidity and mortality of HTLV-1 infection. Objective: To determine the mortality rate and its associated variables from an open cohort started in July 1997 at the HTLV Clinic, Emilio Ribas Institute (IIER), a major infectious disease hospital in São Paulo, Brazil. Methods: Since inception up to September 2018, we admitted 727 HTLV-1-infected individuals, with a rate of 30–50 new admissions per year. All patient data, including clinical and laboratory data, were regularly updated throughout the 21-year period, using a dedicated REDCap database. The Ethical Board of IIER approved the protocol. Results: During 21 years of clinical care to people living with HTLV-1 in the São Paulo region, we recruited 479 asymptomatic HTLV-1-infected individuals and 248 HAM/TSP patients, of which 632 remained under active follow-up. During a total of 3800 person-years of follow-up (maximum follow-up 21.5 years, mean follow-up 6.0 years), 27 individuals died (median age of 51.5 years), of which 12 were asymptomatic, one ATLL patient and 14 HAM/TSP patients. HAM/TSP diagnosis (but neither age nor gender) was a significant predictor of increased mortality by univariate and multivariate (hazard ratio (HR) 5.03, 95% CI [1.96–12.91], p = 0.001) Cox regression models. Coinfection with HIV/HCV was an independent predictor of increased mortality (HR 15.08; 95% CI [5.50–41.32]; p < 0.001), with AIDS-related infections as a more frequent cause of death in asymptomatics (6/13; p = 0.033). HIV/HCV-negative fatal HAM/TSP cases were all female, with urinary tract infection and decubitus ulcer-associated sepsis as the main cause of death (8/14, p = 0.002). Conclusions: All-cause mortality among people living with HTLV-1 in São Paulo differs between asymptomatic (2.9%) and HAM/TSP patients (7.3%), independent of age and gender. We observe a dichotomy in fatal cases, with HAM/TSP and HIV/HCV coinfection as independent risk factors for death. Our findings reveal an urgent need for public health actions, as the major causes of death, infections secondary to decubitus ulcers, and immune deficiency syndrome (AIDS)-related infections, can be targeted by preventive measures. MDPI 2019-12-26 /pmc/articles/PMC7168659/ /pubmed/31888093 http://dx.doi.org/10.3390/pathogens9010025 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Marcusso, Rosa Maria N.
Van Weyenbergh, Johan
de Moura, João Victor Luisi
Dahy, Flávia Esper
de Moura Brasil Matos, Aline
Haziot, Michel E. J.
Vidal, Jose E.
Fonseca, Luiz Augusto M.
Smid, Jerusa
Assone, Tatiane
Casseb, Jorge
de Oliveira, Augusto César Penalva
Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil
title Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil
title_full Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil
title_fullStr Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil
title_full_unstemmed Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil
title_short Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil
title_sort dichotomy in fatal outcomes in a large cohort of people living with htlv-1 in são paulo, brazil
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168659/
https://www.ncbi.nlm.nih.gov/pubmed/31888093
http://dx.doi.org/10.3390/pathogens9010025
work_keys_str_mv AT marcussorosamarian dichotomyinfataloutcomesinalargecohortofpeoplelivingwithhtlv1insaopaulobrazil
AT vanweyenberghjohan dichotomyinfataloutcomesinalargecohortofpeoplelivingwithhtlv1insaopaulobrazil
AT demourajoaovictorluisi dichotomyinfataloutcomesinalargecohortofpeoplelivingwithhtlv1insaopaulobrazil
AT dahyflaviaesper dichotomyinfataloutcomesinalargecohortofpeoplelivingwithhtlv1insaopaulobrazil
AT demourabrasilmatosaline dichotomyinfataloutcomesinalargecohortofpeoplelivingwithhtlv1insaopaulobrazil
AT haziotmichelej dichotomyinfataloutcomesinalargecohortofpeoplelivingwithhtlv1insaopaulobrazil
AT vidaljosee dichotomyinfataloutcomesinalargecohortofpeoplelivingwithhtlv1insaopaulobrazil
AT fonsecaluizaugustom dichotomyinfataloutcomesinalargecohortofpeoplelivingwithhtlv1insaopaulobrazil
AT smidjerusa dichotomyinfataloutcomesinalargecohortofpeoplelivingwithhtlv1insaopaulobrazil
AT assonetatiane dichotomyinfataloutcomesinalargecohortofpeoplelivingwithhtlv1insaopaulobrazil
AT cassebjorge dichotomyinfataloutcomesinalargecohortofpeoplelivingwithhtlv1insaopaulobrazil
AT deoliveiraaugustocesarpenalva dichotomyinfataloutcomesinalargecohortofpeoplelivingwithhtlv1insaopaulobrazil