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

摘要: 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 mortality in several endemic areas. HTLV-1-associated adult leukemia/lymphoma (ATLL) and myelopathy/tropical spastic paraperesis (HAM/TSP), as well frequent coinfections with human immunodeficiency virus (HIV), hepatitis C (HCV), Strongyloides stercoralis were increased morbidity HTLV-1 infection. Objective: To determine the rate variables from an open cohort started July 1997 at HTLV Clinic, Emilio Ribas Institute (IIER), major infectious disease hospital Sao Paulo, Brazil. Methods: Since inception up September 2018, we admitted 727 HTLV-1-infected individuals, 30–50 new admissions per year. All patient data, including clinical laboratory regularly updated throughout 21-year period, using dedicated REDCap database. The Ethical Board IIER approved protocol. Results: During 21 years care people living Paulo region, recruited 479 asymptomatic individuals 248 HAM/TSP patients, which 632 remained under active follow-up. total 3800 person-years follow-up (maximum 21.5 years, mean 6.0 years), 27 died (median age 51.5 12 asymptomatic, one ATLL 14 patients. diagnosis (but neither nor gender) predictor by univariate multivariate (hazard ratio (HR) 5.03, 95% CI [1.96–12.91], p = 0.001) Cox regression models. Coinfection HIV/HCV independent (HR 15.08; [5.50–41.32]; < 0.001), AIDS-related infections more cause death asymptomatics (6/13; 0.033). HIV/HCV-negative fatal cases all female, urinary tract decubitus ulcer-associated sepsis main (8/14, 0.002). Conclusions: All-cause among differs between (2.9%) patients (7.3%), gender. We observe dichotomy cases, coinfection factors for death. Our findings reveal urgent need public health actions, causes death, secondary ulcers, immune deficiency syndrome (AIDS)-related infections, can be targeted preventive measures.