Einsiedel, Lloyd

Spelman T

Goeman E

Cassar O

Arundell, Mick

Gessain A

2014-01-01

In resource-poor areas, infectious diseases may be important causes of morbidity among individuals infected with the Human T-Lymphotropic Virus type 1 (HTLV-1). We report the clinical associations of HTLV-1 infection among socially disadvantaged Indigenous adults in central Australia. HTLV-1 serological results for Indigenous adults admitted 1(st) January 2000 to 31(st) December 2010 were obtained from the Alice Springs Hospital pathology database. Infections, comorbid conditions and HTLV-1 related diseases were identified using ICD-10 AM discharge morbidity codes. Relevant pathology and imaging results were reviewed. Disease associations, admission rates and risk factors for death were compared according to HTLV-1 serostatus. HTLV-1 western blots were positive for 531 (33.3%) of 1595 Indigenous adults tested. Clinical associations of HTLV-1 infection included bronchiectasis (adjusted Risk Ratio, 1.35; 95% CI, 1.14-1.60), blood stream infections (BSI) with enteric organisms (aRR, 1.36; 95% CI, 1.05-1.77) and admission with strongyloidiasis (aRR 1.38; 95% CI, 1.16-1.64). After adjusting for covariates, HTLV-1 infection remained associated with increased numbers of BSI episodes (adjusted negative binomial regression, coefficient, 0.21; 95% CI, 0.02-0.41) and increased admission numbers with strongyloidiasis (coefficient, 0.563; 95% CI, 0.17-0.95) and respiratory conditions including asthma (coefficient, 0.99; 95% CI, 0.27-1.7), lower respiratory tract infections (coefficient, 0.19; 95% CI, 0.04-0.34) and bronchiectasis (coefficient, 0.60; 95% CI, 0.02-1.18). Two patients were admitted with adult T-cell Leukemia/Lymphoma, four with probable HTLV-1 associated myelopathy and another with infective dermatitis. Independent predictors of mortality included BSI with enteric organisms (aRR 1.78; 95% CI, 1.15-2.74) and bronchiectasis (aRR 2.07; 95% CI, 1.45-2.98). HTLV-1 infection contributes to morbidity among socially disadvantaged Indigenous adults in central Australia. This is largely due to an increased risk of other infections and respiratory disease. The spectrum of HTLV-1 related diseases may vary according to the social circumstances of the affected population.

Flinders University/Northern Territory Rural Clinical School, Alice Springs Hospital, Alice Springs, Northern Territory, Australia ; SAPathology, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia..

Flinders University/Northern Territory Rural Clinical School, Alice Springs Hospital, Alice Springs, Northern Territory, Australia..

Remote Health, Alice Springs, Northern Territory, Australia..

Institut Pasteur, Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, Paris, France ; CNRS, UMR 3569, Paris, France..

Clinical Information Analyst, Central Australian Health Network, Alice Springs Hospital, Alice Springs, Northern Territory, Australia..

Institut Pasteur, Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, Paris, France ; CNRS, UMR 3569, Paris, France..

PLoS Negl Trop Dis . 2014 Jan 16;8(1):e2643. doi: 10.1371/journal.pntd.0002643. eCollection 2014.

https://pubmed.ncbi.nlm.nih.gov/24454973/?otool=iaurydwlib

https://hdl.handle.net/10137/5621

Adult

Australia

Comorbidity

Female

HTLV-I Infections

Hospitalization

Human T-lymphotropic virus 1

Humans

Male

Middle Aged

Seroepidemiologic Studies

Survival Analysis

Population Groups

Clinical associations of Human T-Lymphotropic Virus type 1 infection in an indigenous Australian population.

Journal Article

Publication