Human T-Lymphotropic Virus type 1 infection in an Indigenous Australian population: epidemiological insights from a hospital-based cohort study
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Date
2016-08
Authors
Einsiedel, Lloyd John
Woodman, Richard John
Flynn, Maria
Wilson, Kim
Cassar, O
Gessain, Antoine
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Rights
Copyright © 2016 The Author(s).
Rights Holder
The Author(s).
Abstract
Background: The Human T Lymphotropic Virus type 1 (HTLV-1) subtype C is endemic to central Australia where
each of the major sequelae of HTLV-1 infection has been documented in the socially disadvantaged Indigenous
population. Nevertheless, available epidemiological information relating to HTLV-1c infection is very limited, risk
factors for transmission are unknown and no coordinated program has been implemented to reduce transmission
among Indigenous Australians. Identifying risk factors for HTLV-1 infection is essential to direct strategies that could
control HTLV-1 transmission.
Methods: Risk factors for HTLV-1 infection were retrospectively determined for a cohort of Indigenous Australians
who were tested for HTLV-1 at Alice Springs Hospital (ASH), 1st January 2000 to 30th June 2013. Demographic
details were obtained from the ASH patient management database and the results of tests for sexually transmitted
infections (STI) were obtained from the ASH pathology database.
Results: Among 1889 Indigenous patients whose HTLV-1 serostatus was known, 635 (33.6 %) were HTLV-1 Western
blot positive. Only one of 77 (1.3 %) children tested was HTLV-1 infected. Thereafter, rates progressively increased
with age (15–29 years, 17.3 %; 30–49 years, 36.2 %; 50–64 years, 41.7 %) reaching 48.5 % among men aged 50–64
years. In a multivariable model, increasing age (OR, 1.04; 95 % CI, 1.03–1.04), male gender (OR, 1.41; 95 % CI, 1.08–1.
85), residence in the south (OR, 10.7; 95 % CI, 7.4–15.6) or west (OR, 4.4; 95 % CI, 3.1–6.3) of central Australia and
previous STI (OR, 1.42; 95 % CI, 1.04–1.95) were associated with HTLV-1 infection. Infection was acquired by three of
351 adults who were tested more than once during the study period (seroconversion rate, 0.24 (95 % CI = 0.18–2.48)
per 100 person-years).
Conclusions: This study confirms that HTLV-1 is highly endemic to central Australia. Although childhood infection was
documented, HTLV-1 infection in adults was closely associated with increasing age, male gender and STI history.
Multiple modes of transmission are therefore likely to contribute to high rates of HTLV-1 infection in the Indigenous
Australian population. Future strategies to control HTLV-1 transmission in this population require careful community
engagement, cultural understanding and Indigenous leadership.
Description
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keywords
HTLV-1, Sexually transmitted infections, Epidemiology, Indigenous, Australia
Citation
Einsiedel L, Woodman RJ, Flynn M, Wilson K, Cassar O, Gessain A. Human T-Lymphotropic Virus type 1 infection in an Indigenous Australian population: epidemiological insights from a hospital-based cohort study. BMC Public Health. 2016;16:787. doi:10.1186/s12889-016-3366-5.