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HTLV-1 infection increased risk for bronchiectasis
Einsiedel L. Clin Infect Dis. 2011;doi:10.1093/cid/cir766.
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The presence of human T-lymphotropic virus 1 infection was associated with an increased risk for bronchiectasis and increased the rate for morbidity and disease-specific mortality among an indigenous Australian population.
For the retrospective cohort study, Lloyd Einsiedel, PhD, of Flinders Medical Centre in Australia, and colleagues compared the clinical characteristics and outcomes of bronchiectasis among indigenous adults admitted to the Alice Springs Hospital in central Australia from 2000 to 2006 with a known human T-lymphotropic virus 1 (HTLV-1) serologic status.
Eighty-nine adults had confirmed HTLV-1 serologic status; 58.4% were HTLV-1 seropositive.
HTLV-1 infection was associated with an increased number of bronchiectatic lobes (OR=1.51; 95% CI, 1.03-2.20) and ground-glass opacities at high-resolution computed tomography of the chest (OR=8.54; 95% CI, 1.04-70.03), according to the researchers.
Moreover, seropositive adults were more likely to have frequent cor pulmonale and higher disease-specific mortality (OR=5.78; 95% CI, 1.17-26.75). Mortality was more common among those admitted for infected skin lesions (multivariable OR=6.77; 95% CI, 1.46-31.34).
“Although genetic and viral factors may contribute to this risk, the possibility that environmental factors are major determinants of the clinical expression of human T-lymphotropic virus 1–associated disease warrants further study,” the researchers wrote. “The outcome of such work may have major health benefits for the indigenous people of central Australia and for nearly 20 million persons living with human T-lymphotropic virus 1 infection in resource-poor endemic regions elsewhere.”
Disclosure: This study received funding from the Northern Territory Rural Clinical School, which is an initiative of the Australian Department of Health and Ageing.
The role of HTLV-1 infections in human disease is still largely unexplored beyond the original associations with unusual lymphomas and tropical spastic paraparesis. Prevalence of HTLV-1 infection varies considerably in different geographic regions but has been reported to be very high in the Australian indigenous population. Bronchiectasis is also common in indigenous Australians and the current study was a pilot exploration for a potential relationship between these two seemingly unrelated conditions: HTLV-1 infection and bronchiectasis. The authors performed a retrospective review of admissions for bronchiectasis at Alice Springs Hospital in Central Australia and compared the patient demographics and clinical outcomes between those with and without coincident HTLV-1 seropositivity. In patients with bronchiectasis, HTLV-1 prevalence was high-nearly 60% and infected persons tended to have a more aggressive clinical course than those uninfected by this virus. The authors admit that the retrospective design limits the strength of any conclusions but nevertheless these are intriguing findings. HTLV-1 can certainly trigger local inflammation as witnessed by the neurologic and ocular manifestations and this is a plausible explanation for the reported association with pulmonary disease. Clearly this finding supports further research with stronger design and appropriate controls. Such research will quite possibly shed additional light on the clinical consequences of a virus infecting millions worldwide.
- Paul Volberding, MD
Infectious Disease News Chief Medical Editor
Disclosure: Dr. Volberding reports no relevant financial disclosures.
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