Histórico - Retrovirustelessaude.ba.gov.br/wp-content/uploads/2018/10/Web... · 2018-10-02 ·...
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Transcript of Histórico - Retrovirustelessaude.ba.gov.br/wp-content/uploads/2018/10/Web... · 2018-10-02 ·...
Histoacuterico - Retrovirus
bull 1908 - Ellermann e Bang leucose aviaacuteria agentes UV
bull 1911 - Peyton Rous (Viacuterus do Sarcoma de Rous)
bull 1970 ndash Temin amp Baltimore enz TR replicaccedilatildeo RV r
bull 1980 ndash Bishop amp Varmus det seq nucl de oncogenes
bull 1980 - Poiesz et al HTLV-1
bull 1981 - AIDS
bull 1982 ndash Kalyanaram et al HTLV-2
bull 1983 - Barreacute-Sinoussi amp Montagnier HIV
bull 2005 - Calattini et al HTLV-3
bull 2005 -Wolfe et al HTLV- 4
Linfoacutecitos T CD4
Ativaccedilatildeo e Proliferaccedilatildeo celular
HTLV-1
Famiacutelia Retroviridae
Subfamiacutelia Orthoretrovirinae
Gecircnero Deltaretrovirus
Bangham et al 2015 (apud A Gessain amp O Cassar 2012 )
Epidemiologia
Kitakawa et al 1986 - imigrantes do Japatildeo
Lee et al 1989 - 042 prevalecircncia no RJ
Galvatildeo-Castro et al 1997 - Inqueacuterito nacionalbd
maior prevalecircncia (135) em Salvador
Proietti et al 2002 -Brasil gt portadores de HTLV-1 no mundo
HTLV-1 e as doenccedilas relacionadas tem sido amplamente descritas
em regiotildees do Brasil
Epidemiologia no Brasil
Salvador 20 em mulheres aumentando progressivamente com a idade
(Dourado et al 2003 Catalan-Soares et al 2005 Gessain e Cassar 2012)
BRASIL 800 mil infectados
Transmissatildeo
PARENTERAL
VERTICAL
AmamentaccedilatildeoTransplacentaacuteriaCanal de parto
SEXUAL
Carga ProviralExposiccedilatildeoUlceraccedilotildees
Transfusatildeo de componentes celularesAgulhas Contaminadas
Diagnoacutestico laboratorial
Teste de triagem soroloacutegica para HTLV-1 e 2 (anticorpos) ELISA ou
Quimioluminescecircncia
Teste confirmatoacuterio (anticorpos discriminatoacuterio) Western Blot (WB)
Testes moleculares (quantificaccedilatildeo da carga proviral discriminatoacuterio)
PCR em tempo real
Diagnoacutestico precoce da transmissatildeo matildee-filho em crianccedilas de
ateacute dois anos
Casos indeterminados nos testes de WB
ANVISA (Resoluccedilatildeo da Diretoria Colegiada ndash RDC 153 de 14 de julho de 2004)
Gessain e Mahieux 2012
HAMTSP mielopatia associada ao HTLV-1Paraparesia espaacutestica tropical
Doenccedila inflamatoacuteria Crocircnica
Lesatildeo e desmielinizaccedilatildeo da medula espinhal
Fraqueza e rigidez muscular
Hiperreflexia
Espasticidade
Distuacuterbios urinaacuterios e sexuais
Constipaccedilatildeo
Membros inferiores
FATORES DETERMINANTES P HAMTSP
CADERNOS HEMOMINASHTLV 2015
Criteacuterios Diagnoacutesticos HAM TSP
Sintomas Tratamento
Espasticidade Baclofeno Tizanidina Toxina botuliacutenica Fisioterapia
Bexiga neurogecircnicaOxibutinina Doxazosina Imipramina Betanecol Auto-cateterizaccedilatildeo intermitente Toxina botuliacutenica intra-vesical Fisioterapia Estimuladores sacrais ()
Profilaxia de infecccedilotildees urinaacuterias
Auto-cateterizaccedilatildeo intermitente Cranberry () natildeo tratar bacteriuacuterias assintomaacuteticas
ConstipaccedilatildeoDieta rica em fibra hidrataccedilatildeo adequada Muciloacuteide psylium Oacuteleo mineral Lactulose Prucalopride Lubiprostonasupositoacuterios e enemas intermitentes Fisioterapia
Dor neuropaacutetica Antidepressivos triciacuteclicos Gabapentina Pregabalina
Dores natildeo-neuropaacuteticas
Anti-inflamatoacuterios natildeo-hormonais
Fraqueza muscular Fisioterapia Dalfampridina (Ampyrareg)
Arq Neuropsiquiatr 201775(4)221-227
Conclusatildeo O meacutetodo Pilates eacute uma ferramenta uacutetil no aliacutevio dossintomas de dor lombar e tem e melhora significativamente aqualidade de pessoas vivendo com HTLV-1
Borges J1 Baptista AF2 Santana N3 Souza I4 Kruschewsky RA5 Galvatildeo-Castro B6 Saacute KNPilates exercises improve low back pain and quality of life in patients with HTLV-1 virus a randomized crossover clinical trial J Bodyw Mov Ther 2014 Jan18(1)68-74
Leucemia Linfoma T do Adulto
bull Forma grave e rara de leucemialinfoma (2-5 dos portadores do HTLV-1)
bull Ocorre na vida adulta (50 anos no Brasil) pouco responsiva agrave quimioterapia
bull Quatro formas cliacutenicas aguda crocircnica linfomatosa e indolente (smoldering)
Fonte RHC -inca
TIPOS Linfocitose Linfoacutecitosanormais
Ceacutelulasem flor
NiacuteveisLDH
Hiper-calcemia
Envolvimento
INDOLENTE
1Leucecircmica
2Natildeo-leucecircmica
Ausente
Ausente
ge 5lt 5
AusenteAusente
le15 times N
le15 times N
AusenteAusente
Pele eou pulmotildeesPele
TUMORAL
PRIMAacuteRIA DA PELE
Ausente lt 5 Ausente variaacutevel Ausente Pele
CROcircNICA Presente Presente Ocasional le2 times N Ausente Qualquer oacutergatildeo menos
osso SNCe TGI
LINFOMA Ausente le 1 Ausente Variaacutevel Podeocorrer
Linfonodo e qualquer oacutergatildeo
AGUDA Elevada Presente Presente Elevada Presente Qualquer oacutergatildeo derrames cavitaacuterios
Shimoyama et al Br J Hematol 1991 Bittencourt et al Am J Clin Pathol 2007
Classificaccedilatildeo cliacutenica de ATLL
Diagnoacutestico
bull Presenccedila de anticorpos anti-HTLV-1
bull Comprovaccedilatildeo citoloacutegica ou histopatoloacutegica de leucemia e oulinfoma de ceacutelulas T maduras com antiacutegenos de superfiacutecieCD4+CD25+
bull Presenccedila de linfoacutecitos T anormais em sangue perifeacutericoprincipalmente das ceacutelulas ldquoem florrdquo
bull Demonstraccedilatildeo da integraccedilatildeo monoclonal do HTLV-1
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Linfoacutecitos T CD4
Ativaccedilatildeo e Proliferaccedilatildeo celular
HTLV-1
Famiacutelia Retroviridae
Subfamiacutelia Orthoretrovirinae
Gecircnero Deltaretrovirus
Bangham et al 2015 (apud A Gessain amp O Cassar 2012 )
Epidemiologia
Kitakawa et al 1986 - imigrantes do Japatildeo
Lee et al 1989 - 042 prevalecircncia no RJ
Galvatildeo-Castro et al 1997 - Inqueacuterito nacionalbd
maior prevalecircncia (135) em Salvador
Proietti et al 2002 -Brasil gt portadores de HTLV-1 no mundo
HTLV-1 e as doenccedilas relacionadas tem sido amplamente descritas
em regiotildees do Brasil
Epidemiologia no Brasil
Salvador 20 em mulheres aumentando progressivamente com a idade
(Dourado et al 2003 Catalan-Soares et al 2005 Gessain e Cassar 2012)
BRASIL 800 mil infectados
Transmissatildeo
PARENTERAL
VERTICAL
AmamentaccedilatildeoTransplacentaacuteriaCanal de parto
SEXUAL
Carga ProviralExposiccedilatildeoUlceraccedilotildees
Transfusatildeo de componentes celularesAgulhas Contaminadas
Diagnoacutestico laboratorial
Teste de triagem soroloacutegica para HTLV-1 e 2 (anticorpos) ELISA ou
Quimioluminescecircncia
Teste confirmatoacuterio (anticorpos discriminatoacuterio) Western Blot (WB)
Testes moleculares (quantificaccedilatildeo da carga proviral discriminatoacuterio)
PCR em tempo real
Diagnoacutestico precoce da transmissatildeo matildee-filho em crianccedilas de
ateacute dois anos
Casos indeterminados nos testes de WB
ANVISA (Resoluccedilatildeo da Diretoria Colegiada ndash RDC 153 de 14 de julho de 2004)
Gessain e Mahieux 2012
HAMTSP mielopatia associada ao HTLV-1Paraparesia espaacutestica tropical
Doenccedila inflamatoacuteria Crocircnica
Lesatildeo e desmielinizaccedilatildeo da medula espinhal
Fraqueza e rigidez muscular
Hiperreflexia
Espasticidade
Distuacuterbios urinaacuterios e sexuais
Constipaccedilatildeo
Membros inferiores
FATORES DETERMINANTES P HAMTSP
CADERNOS HEMOMINASHTLV 2015
Criteacuterios Diagnoacutesticos HAM TSP
Sintomas Tratamento
Espasticidade Baclofeno Tizanidina Toxina botuliacutenica Fisioterapia
Bexiga neurogecircnicaOxibutinina Doxazosina Imipramina Betanecol Auto-cateterizaccedilatildeo intermitente Toxina botuliacutenica intra-vesical Fisioterapia Estimuladores sacrais ()
Profilaxia de infecccedilotildees urinaacuterias
Auto-cateterizaccedilatildeo intermitente Cranberry () natildeo tratar bacteriuacuterias assintomaacuteticas
ConstipaccedilatildeoDieta rica em fibra hidrataccedilatildeo adequada Muciloacuteide psylium Oacuteleo mineral Lactulose Prucalopride Lubiprostonasupositoacuterios e enemas intermitentes Fisioterapia
Dor neuropaacutetica Antidepressivos triciacuteclicos Gabapentina Pregabalina
Dores natildeo-neuropaacuteticas
Anti-inflamatoacuterios natildeo-hormonais
Fraqueza muscular Fisioterapia Dalfampridina (Ampyrareg)
Arq Neuropsiquiatr 201775(4)221-227
Conclusatildeo O meacutetodo Pilates eacute uma ferramenta uacutetil no aliacutevio dossintomas de dor lombar e tem e melhora significativamente aqualidade de pessoas vivendo com HTLV-1
Borges J1 Baptista AF2 Santana N3 Souza I4 Kruschewsky RA5 Galvatildeo-Castro B6 Saacute KNPilates exercises improve low back pain and quality of life in patients with HTLV-1 virus a randomized crossover clinical trial J Bodyw Mov Ther 2014 Jan18(1)68-74
Leucemia Linfoma T do Adulto
bull Forma grave e rara de leucemialinfoma (2-5 dos portadores do HTLV-1)
bull Ocorre na vida adulta (50 anos no Brasil) pouco responsiva agrave quimioterapia
bull Quatro formas cliacutenicas aguda crocircnica linfomatosa e indolente (smoldering)
Fonte RHC -inca
TIPOS Linfocitose Linfoacutecitosanormais
Ceacutelulasem flor
NiacuteveisLDH
Hiper-calcemia
Envolvimento
INDOLENTE
1Leucecircmica
2Natildeo-leucecircmica
Ausente
Ausente
ge 5lt 5
AusenteAusente
le15 times N
le15 times N
AusenteAusente
Pele eou pulmotildeesPele
TUMORAL
PRIMAacuteRIA DA PELE
Ausente lt 5 Ausente variaacutevel Ausente Pele
CROcircNICA Presente Presente Ocasional le2 times N Ausente Qualquer oacutergatildeo menos
osso SNCe TGI
LINFOMA Ausente le 1 Ausente Variaacutevel Podeocorrer
Linfonodo e qualquer oacutergatildeo
AGUDA Elevada Presente Presente Elevada Presente Qualquer oacutergatildeo derrames cavitaacuterios
Shimoyama et al Br J Hematol 1991 Bittencourt et al Am J Clin Pathol 2007
Classificaccedilatildeo cliacutenica de ATLL
Diagnoacutestico
bull Presenccedila de anticorpos anti-HTLV-1
bull Comprovaccedilatildeo citoloacutegica ou histopatoloacutegica de leucemia e oulinfoma de ceacutelulas T maduras com antiacutegenos de superfiacutecieCD4+CD25+
bull Presenccedila de linfoacutecitos T anormais em sangue perifeacutericoprincipalmente das ceacutelulas ldquoem florrdquo
bull Demonstraccedilatildeo da integraccedilatildeo monoclonal do HTLV-1
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Bangham et al 2015 (apud A Gessain amp O Cassar 2012 )
Epidemiologia
Kitakawa et al 1986 - imigrantes do Japatildeo
Lee et al 1989 - 042 prevalecircncia no RJ
Galvatildeo-Castro et al 1997 - Inqueacuterito nacionalbd
maior prevalecircncia (135) em Salvador
Proietti et al 2002 -Brasil gt portadores de HTLV-1 no mundo
HTLV-1 e as doenccedilas relacionadas tem sido amplamente descritas
em regiotildees do Brasil
Epidemiologia no Brasil
Salvador 20 em mulheres aumentando progressivamente com a idade
(Dourado et al 2003 Catalan-Soares et al 2005 Gessain e Cassar 2012)
BRASIL 800 mil infectados
Transmissatildeo
PARENTERAL
VERTICAL
AmamentaccedilatildeoTransplacentaacuteriaCanal de parto
SEXUAL
Carga ProviralExposiccedilatildeoUlceraccedilotildees
Transfusatildeo de componentes celularesAgulhas Contaminadas
Diagnoacutestico laboratorial
Teste de triagem soroloacutegica para HTLV-1 e 2 (anticorpos) ELISA ou
Quimioluminescecircncia
Teste confirmatoacuterio (anticorpos discriminatoacuterio) Western Blot (WB)
Testes moleculares (quantificaccedilatildeo da carga proviral discriminatoacuterio)
PCR em tempo real
Diagnoacutestico precoce da transmissatildeo matildee-filho em crianccedilas de
ateacute dois anos
Casos indeterminados nos testes de WB
ANVISA (Resoluccedilatildeo da Diretoria Colegiada ndash RDC 153 de 14 de julho de 2004)
Gessain e Mahieux 2012
HAMTSP mielopatia associada ao HTLV-1Paraparesia espaacutestica tropical
Doenccedila inflamatoacuteria Crocircnica
Lesatildeo e desmielinizaccedilatildeo da medula espinhal
Fraqueza e rigidez muscular
Hiperreflexia
Espasticidade
Distuacuterbios urinaacuterios e sexuais
Constipaccedilatildeo
Membros inferiores
FATORES DETERMINANTES P HAMTSP
CADERNOS HEMOMINASHTLV 2015
Criteacuterios Diagnoacutesticos HAM TSP
Sintomas Tratamento
Espasticidade Baclofeno Tizanidina Toxina botuliacutenica Fisioterapia
Bexiga neurogecircnicaOxibutinina Doxazosina Imipramina Betanecol Auto-cateterizaccedilatildeo intermitente Toxina botuliacutenica intra-vesical Fisioterapia Estimuladores sacrais ()
Profilaxia de infecccedilotildees urinaacuterias
Auto-cateterizaccedilatildeo intermitente Cranberry () natildeo tratar bacteriuacuterias assintomaacuteticas
ConstipaccedilatildeoDieta rica em fibra hidrataccedilatildeo adequada Muciloacuteide psylium Oacuteleo mineral Lactulose Prucalopride Lubiprostonasupositoacuterios e enemas intermitentes Fisioterapia
Dor neuropaacutetica Antidepressivos triciacuteclicos Gabapentina Pregabalina
Dores natildeo-neuropaacuteticas
Anti-inflamatoacuterios natildeo-hormonais
Fraqueza muscular Fisioterapia Dalfampridina (Ampyrareg)
Arq Neuropsiquiatr 201775(4)221-227
Conclusatildeo O meacutetodo Pilates eacute uma ferramenta uacutetil no aliacutevio dossintomas de dor lombar e tem e melhora significativamente aqualidade de pessoas vivendo com HTLV-1
Borges J1 Baptista AF2 Santana N3 Souza I4 Kruschewsky RA5 Galvatildeo-Castro B6 Saacute KNPilates exercises improve low back pain and quality of life in patients with HTLV-1 virus a randomized crossover clinical trial J Bodyw Mov Ther 2014 Jan18(1)68-74
Leucemia Linfoma T do Adulto
bull Forma grave e rara de leucemialinfoma (2-5 dos portadores do HTLV-1)
bull Ocorre na vida adulta (50 anos no Brasil) pouco responsiva agrave quimioterapia
bull Quatro formas cliacutenicas aguda crocircnica linfomatosa e indolente (smoldering)
Fonte RHC -inca
TIPOS Linfocitose Linfoacutecitosanormais
Ceacutelulasem flor
NiacuteveisLDH
Hiper-calcemia
Envolvimento
INDOLENTE
1Leucecircmica
2Natildeo-leucecircmica
Ausente
Ausente
ge 5lt 5
AusenteAusente
le15 times N
le15 times N
AusenteAusente
Pele eou pulmotildeesPele
TUMORAL
PRIMAacuteRIA DA PELE
Ausente lt 5 Ausente variaacutevel Ausente Pele
CROcircNICA Presente Presente Ocasional le2 times N Ausente Qualquer oacutergatildeo menos
osso SNCe TGI
LINFOMA Ausente le 1 Ausente Variaacutevel Podeocorrer
Linfonodo e qualquer oacutergatildeo
AGUDA Elevada Presente Presente Elevada Presente Qualquer oacutergatildeo derrames cavitaacuterios
Shimoyama et al Br J Hematol 1991 Bittencourt et al Am J Clin Pathol 2007
Classificaccedilatildeo cliacutenica de ATLL
Diagnoacutestico
bull Presenccedila de anticorpos anti-HTLV-1
bull Comprovaccedilatildeo citoloacutegica ou histopatoloacutegica de leucemia e oulinfoma de ceacutelulas T maduras com antiacutegenos de superfiacutecieCD4+CD25+
bull Presenccedila de linfoacutecitos T anormais em sangue perifeacutericoprincipalmente das ceacutelulas ldquoem florrdquo
bull Demonstraccedilatildeo da integraccedilatildeo monoclonal do HTLV-1
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Kitakawa et al 1986 - imigrantes do Japatildeo
Lee et al 1989 - 042 prevalecircncia no RJ
Galvatildeo-Castro et al 1997 - Inqueacuterito nacionalbd
maior prevalecircncia (135) em Salvador
Proietti et al 2002 -Brasil gt portadores de HTLV-1 no mundo
HTLV-1 e as doenccedilas relacionadas tem sido amplamente descritas
em regiotildees do Brasil
Epidemiologia no Brasil
Salvador 20 em mulheres aumentando progressivamente com a idade
(Dourado et al 2003 Catalan-Soares et al 2005 Gessain e Cassar 2012)
BRASIL 800 mil infectados
Transmissatildeo
PARENTERAL
VERTICAL
AmamentaccedilatildeoTransplacentaacuteriaCanal de parto
SEXUAL
Carga ProviralExposiccedilatildeoUlceraccedilotildees
Transfusatildeo de componentes celularesAgulhas Contaminadas
Diagnoacutestico laboratorial
Teste de triagem soroloacutegica para HTLV-1 e 2 (anticorpos) ELISA ou
Quimioluminescecircncia
Teste confirmatoacuterio (anticorpos discriminatoacuterio) Western Blot (WB)
Testes moleculares (quantificaccedilatildeo da carga proviral discriminatoacuterio)
PCR em tempo real
Diagnoacutestico precoce da transmissatildeo matildee-filho em crianccedilas de
ateacute dois anos
Casos indeterminados nos testes de WB
ANVISA (Resoluccedilatildeo da Diretoria Colegiada ndash RDC 153 de 14 de julho de 2004)
Gessain e Mahieux 2012
HAMTSP mielopatia associada ao HTLV-1Paraparesia espaacutestica tropical
Doenccedila inflamatoacuteria Crocircnica
Lesatildeo e desmielinizaccedilatildeo da medula espinhal
Fraqueza e rigidez muscular
Hiperreflexia
Espasticidade
Distuacuterbios urinaacuterios e sexuais
Constipaccedilatildeo
Membros inferiores
FATORES DETERMINANTES P HAMTSP
CADERNOS HEMOMINASHTLV 2015
Criteacuterios Diagnoacutesticos HAM TSP
Sintomas Tratamento
Espasticidade Baclofeno Tizanidina Toxina botuliacutenica Fisioterapia
Bexiga neurogecircnicaOxibutinina Doxazosina Imipramina Betanecol Auto-cateterizaccedilatildeo intermitente Toxina botuliacutenica intra-vesical Fisioterapia Estimuladores sacrais ()
Profilaxia de infecccedilotildees urinaacuterias
Auto-cateterizaccedilatildeo intermitente Cranberry () natildeo tratar bacteriuacuterias assintomaacuteticas
ConstipaccedilatildeoDieta rica em fibra hidrataccedilatildeo adequada Muciloacuteide psylium Oacuteleo mineral Lactulose Prucalopride Lubiprostonasupositoacuterios e enemas intermitentes Fisioterapia
Dor neuropaacutetica Antidepressivos triciacuteclicos Gabapentina Pregabalina
Dores natildeo-neuropaacuteticas
Anti-inflamatoacuterios natildeo-hormonais
Fraqueza muscular Fisioterapia Dalfampridina (Ampyrareg)
Arq Neuropsiquiatr 201775(4)221-227
Conclusatildeo O meacutetodo Pilates eacute uma ferramenta uacutetil no aliacutevio dossintomas de dor lombar e tem e melhora significativamente aqualidade de pessoas vivendo com HTLV-1
Borges J1 Baptista AF2 Santana N3 Souza I4 Kruschewsky RA5 Galvatildeo-Castro B6 Saacute KNPilates exercises improve low back pain and quality of life in patients with HTLV-1 virus a randomized crossover clinical trial J Bodyw Mov Ther 2014 Jan18(1)68-74
Leucemia Linfoma T do Adulto
bull Forma grave e rara de leucemialinfoma (2-5 dos portadores do HTLV-1)
bull Ocorre na vida adulta (50 anos no Brasil) pouco responsiva agrave quimioterapia
bull Quatro formas cliacutenicas aguda crocircnica linfomatosa e indolente (smoldering)
Fonte RHC -inca
TIPOS Linfocitose Linfoacutecitosanormais
Ceacutelulasem flor
NiacuteveisLDH
Hiper-calcemia
Envolvimento
INDOLENTE
1Leucecircmica
2Natildeo-leucecircmica
Ausente
Ausente
ge 5lt 5
AusenteAusente
le15 times N
le15 times N
AusenteAusente
Pele eou pulmotildeesPele
TUMORAL
PRIMAacuteRIA DA PELE
Ausente lt 5 Ausente variaacutevel Ausente Pele
CROcircNICA Presente Presente Ocasional le2 times N Ausente Qualquer oacutergatildeo menos
osso SNCe TGI
LINFOMA Ausente le 1 Ausente Variaacutevel Podeocorrer
Linfonodo e qualquer oacutergatildeo
AGUDA Elevada Presente Presente Elevada Presente Qualquer oacutergatildeo derrames cavitaacuterios
Shimoyama et al Br J Hematol 1991 Bittencourt et al Am J Clin Pathol 2007
Classificaccedilatildeo cliacutenica de ATLL
Diagnoacutestico
bull Presenccedila de anticorpos anti-HTLV-1
bull Comprovaccedilatildeo citoloacutegica ou histopatoloacutegica de leucemia e oulinfoma de ceacutelulas T maduras com antiacutegenos de superfiacutecieCD4+CD25+
bull Presenccedila de linfoacutecitos T anormais em sangue perifeacutericoprincipalmente das ceacutelulas ldquoem florrdquo
bull Demonstraccedilatildeo da integraccedilatildeo monoclonal do HTLV-1
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Salvador 20 em mulheres aumentando progressivamente com a idade
(Dourado et al 2003 Catalan-Soares et al 2005 Gessain e Cassar 2012)
BRASIL 800 mil infectados
Transmissatildeo
PARENTERAL
VERTICAL
AmamentaccedilatildeoTransplacentaacuteriaCanal de parto
SEXUAL
Carga ProviralExposiccedilatildeoUlceraccedilotildees
Transfusatildeo de componentes celularesAgulhas Contaminadas
Diagnoacutestico laboratorial
Teste de triagem soroloacutegica para HTLV-1 e 2 (anticorpos) ELISA ou
Quimioluminescecircncia
Teste confirmatoacuterio (anticorpos discriminatoacuterio) Western Blot (WB)
Testes moleculares (quantificaccedilatildeo da carga proviral discriminatoacuterio)
PCR em tempo real
Diagnoacutestico precoce da transmissatildeo matildee-filho em crianccedilas de
ateacute dois anos
Casos indeterminados nos testes de WB
ANVISA (Resoluccedilatildeo da Diretoria Colegiada ndash RDC 153 de 14 de julho de 2004)
Gessain e Mahieux 2012
HAMTSP mielopatia associada ao HTLV-1Paraparesia espaacutestica tropical
Doenccedila inflamatoacuteria Crocircnica
Lesatildeo e desmielinizaccedilatildeo da medula espinhal
Fraqueza e rigidez muscular
Hiperreflexia
Espasticidade
Distuacuterbios urinaacuterios e sexuais
Constipaccedilatildeo
Membros inferiores
FATORES DETERMINANTES P HAMTSP
CADERNOS HEMOMINASHTLV 2015
Criteacuterios Diagnoacutesticos HAM TSP
Sintomas Tratamento
Espasticidade Baclofeno Tizanidina Toxina botuliacutenica Fisioterapia
Bexiga neurogecircnicaOxibutinina Doxazosina Imipramina Betanecol Auto-cateterizaccedilatildeo intermitente Toxina botuliacutenica intra-vesical Fisioterapia Estimuladores sacrais ()
Profilaxia de infecccedilotildees urinaacuterias
Auto-cateterizaccedilatildeo intermitente Cranberry () natildeo tratar bacteriuacuterias assintomaacuteticas
ConstipaccedilatildeoDieta rica em fibra hidrataccedilatildeo adequada Muciloacuteide psylium Oacuteleo mineral Lactulose Prucalopride Lubiprostonasupositoacuterios e enemas intermitentes Fisioterapia
Dor neuropaacutetica Antidepressivos triciacuteclicos Gabapentina Pregabalina
Dores natildeo-neuropaacuteticas
Anti-inflamatoacuterios natildeo-hormonais
Fraqueza muscular Fisioterapia Dalfampridina (Ampyrareg)
Arq Neuropsiquiatr 201775(4)221-227
Conclusatildeo O meacutetodo Pilates eacute uma ferramenta uacutetil no aliacutevio dossintomas de dor lombar e tem e melhora significativamente aqualidade de pessoas vivendo com HTLV-1
Borges J1 Baptista AF2 Santana N3 Souza I4 Kruschewsky RA5 Galvatildeo-Castro B6 Saacute KNPilates exercises improve low back pain and quality of life in patients with HTLV-1 virus a randomized crossover clinical trial J Bodyw Mov Ther 2014 Jan18(1)68-74
Leucemia Linfoma T do Adulto
bull Forma grave e rara de leucemialinfoma (2-5 dos portadores do HTLV-1)
bull Ocorre na vida adulta (50 anos no Brasil) pouco responsiva agrave quimioterapia
bull Quatro formas cliacutenicas aguda crocircnica linfomatosa e indolente (smoldering)
Fonte RHC -inca
TIPOS Linfocitose Linfoacutecitosanormais
Ceacutelulasem flor
NiacuteveisLDH
Hiper-calcemia
Envolvimento
INDOLENTE
1Leucecircmica
2Natildeo-leucecircmica
Ausente
Ausente
ge 5lt 5
AusenteAusente
le15 times N
le15 times N
AusenteAusente
Pele eou pulmotildeesPele
TUMORAL
PRIMAacuteRIA DA PELE
Ausente lt 5 Ausente variaacutevel Ausente Pele
CROcircNICA Presente Presente Ocasional le2 times N Ausente Qualquer oacutergatildeo menos
osso SNCe TGI
LINFOMA Ausente le 1 Ausente Variaacutevel Podeocorrer
Linfonodo e qualquer oacutergatildeo
AGUDA Elevada Presente Presente Elevada Presente Qualquer oacutergatildeo derrames cavitaacuterios
Shimoyama et al Br J Hematol 1991 Bittencourt et al Am J Clin Pathol 2007
Classificaccedilatildeo cliacutenica de ATLL
Diagnoacutestico
bull Presenccedila de anticorpos anti-HTLV-1
bull Comprovaccedilatildeo citoloacutegica ou histopatoloacutegica de leucemia e oulinfoma de ceacutelulas T maduras com antiacutegenos de superfiacutecieCD4+CD25+
bull Presenccedila de linfoacutecitos T anormais em sangue perifeacutericoprincipalmente das ceacutelulas ldquoem florrdquo
bull Demonstraccedilatildeo da integraccedilatildeo monoclonal do HTLV-1
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Transmissatildeo
PARENTERAL
VERTICAL
AmamentaccedilatildeoTransplacentaacuteriaCanal de parto
SEXUAL
Carga ProviralExposiccedilatildeoUlceraccedilotildees
Transfusatildeo de componentes celularesAgulhas Contaminadas
Diagnoacutestico laboratorial
Teste de triagem soroloacutegica para HTLV-1 e 2 (anticorpos) ELISA ou
Quimioluminescecircncia
Teste confirmatoacuterio (anticorpos discriminatoacuterio) Western Blot (WB)
Testes moleculares (quantificaccedilatildeo da carga proviral discriminatoacuterio)
PCR em tempo real
Diagnoacutestico precoce da transmissatildeo matildee-filho em crianccedilas de
ateacute dois anos
Casos indeterminados nos testes de WB
ANVISA (Resoluccedilatildeo da Diretoria Colegiada ndash RDC 153 de 14 de julho de 2004)
Gessain e Mahieux 2012
HAMTSP mielopatia associada ao HTLV-1Paraparesia espaacutestica tropical
Doenccedila inflamatoacuteria Crocircnica
Lesatildeo e desmielinizaccedilatildeo da medula espinhal
Fraqueza e rigidez muscular
Hiperreflexia
Espasticidade
Distuacuterbios urinaacuterios e sexuais
Constipaccedilatildeo
Membros inferiores
FATORES DETERMINANTES P HAMTSP
CADERNOS HEMOMINASHTLV 2015
Criteacuterios Diagnoacutesticos HAM TSP
Sintomas Tratamento
Espasticidade Baclofeno Tizanidina Toxina botuliacutenica Fisioterapia
Bexiga neurogecircnicaOxibutinina Doxazosina Imipramina Betanecol Auto-cateterizaccedilatildeo intermitente Toxina botuliacutenica intra-vesical Fisioterapia Estimuladores sacrais ()
Profilaxia de infecccedilotildees urinaacuterias
Auto-cateterizaccedilatildeo intermitente Cranberry () natildeo tratar bacteriuacuterias assintomaacuteticas
ConstipaccedilatildeoDieta rica em fibra hidrataccedilatildeo adequada Muciloacuteide psylium Oacuteleo mineral Lactulose Prucalopride Lubiprostonasupositoacuterios e enemas intermitentes Fisioterapia
Dor neuropaacutetica Antidepressivos triciacuteclicos Gabapentina Pregabalina
Dores natildeo-neuropaacuteticas
Anti-inflamatoacuterios natildeo-hormonais
Fraqueza muscular Fisioterapia Dalfampridina (Ampyrareg)
Arq Neuropsiquiatr 201775(4)221-227
Conclusatildeo O meacutetodo Pilates eacute uma ferramenta uacutetil no aliacutevio dossintomas de dor lombar e tem e melhora significativamente aqualidade de pessoas vivendo com HTLV-1
Borges J1 Baptista AF2 Santana N3 Souza I4 Kruschewsky RA5 Galvatildeo-Castro B6 Saacute KNPilates exercises improve low back pain and quality of life in patients with HTLV-1 virus a randomized crossover clinical trial J Bodyw Mov Ther 2014 Jan18(1)68-74
Leucemia Linfoma T do Adulto
bull Forma grave e rara de leucemialinfoma (2-5 dos portadores do HTLV-1)
bull Ocorre na vida adulta (50 anos no Brasil) pouco responsiva agrave quimioterapia
bull Quatro formas cliacutenicas aguda crocircnica linfomatosa e indolente (smoldering)
Fonte RHC -inca
TIPOS Linfocitose Linfoacutecitosanormais
Ceacutelulasem flor
NiacuteveisLDH
Hiper-calcemia
Envolvimento
INDOLENTE
1Leucecircmica
2Natildeo-leucecircmica
Ausente
Ausente
ge 5lt 5
AusenteAusente
le15 times N
le15 times N
AusenteAusente
Pele eou pulmotildeesPele
TUMORAL
PRIMAacuteRIA DA PELE
Ausente lt 5 Ausente variaacutevel Ausente Pele
CROcircNICA Presente Presente Ocasional le2 times N Ausente Qualquer oacutergatildeo menos
osso SNCe TGI
LINFOMA Ausente le 1 Ausente Variaacutevel Podeocorrer
Linfonodo e qualquer oacutergatildeo
AGUDA Elevada Presente Presente Elevada Presente Qualquer oacutergatildeo derrames cavitaacuterios
Shimoyama et al Br J Hematol 1991 Bittencourt et al Am J Clin Pathol 2007
Classificaccedilatildeo cliacutenica de ATLL
Diagnoacutestico
bull Presenccedila de anticorpos anti-HTLV-1
bull Comprovaccedilatildeo citoloacutegica ou histopatoloacutegica de leucemia e oulinfoma de ceacutelulas T maduras com antiacutegenos de superfiacutecieCD4+CD25+
bull Presenccedila de linfoacutecitos T anormais em sangue perifeacutericoprincipalmente das ceacutelulas ldquoem florrdquo
bull Demonstraccedilatildeo da integraccedilatildeo monoclonal do HTLV-1
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Diagnoacutestico laboratorial
Teste de triagem soroloacutegica para HTLV-1 e 2 (anticorpos) ELISA ou
Quimioluminescecircncia
Teste confirmatoacuterio (anticorpos discriminatoacuterio) Western Blot (WB)
Testes moleculares (quantificaccedilatildeo da carga proviral discriminatoacuterio)
PCR em tempo real
Diagnoacutestico precoce da transmissatildeo matildee-filho em crianccedilas de
ateacute dois anos
Casos indeterminados nos testes de WB
ANVISA (Resoluccedilatildeo da Diretoria Colegiada ndash RDC 153 de 14 de julho de 2004)
Gessain e Mahieux 2012
HAMTSP mielopatia associada ao HTLV-1Paraparesia espaacutestica tropical
Doenccedila inflamatoacuteria Crocircnica
Lesatildeo e desmielinizaccedilatildeo da medula espinhal
Fraqueza e rigidez muscular
Hiperreflexia
Espasticidade
Distuacuterbios urinaacuterios e sexuais
Constipaccedilatildeo
Membros inferiores
FATORES DETERMINANTES P HAMTSP
CADERNOS HEMOMINASHTLV 2015
Criteacuterios Diagnoacutesticos HAM TSP
Sintomas Tratamento
Espasticidade Baclofeno Tizanidina Toxina botuliacutenica Fisioterapia
Bexiga neurogecircnicaOxibutinina Doxazosina Imipramina Betanecol Auto-cateterizaccedilatildeo intermitente Toxina botuliacutenica intra-vesical Fisioterapia Estimuladores sacrais ()
Profilaxia de infecccedilotildees urinaacuterias
Auto-cateterizaccedilatildeo intermitente Cranberry () natildeo tratar bacteriuacuterias assintomaacuteticas
ConstipaccedilatildeoDieta rica em fibra hidrataccedilatildeo adequada Muciloacuteide psylium Oacuteleo mineral Lactulose Prucalopride Lubiprostonasupositoacuterios e enemas intermitentes Fisioterapia
Dor neuropaacutetica Antidepressivos triciacuteclicos Gabapentina Pregabalina
Dores natildeo-neuropaacuteticas
Anti-inflamatoacuterios natildeo-hormonais
Fraqueza muscular Fisioterapia Dalfampridina (Ampyrareg)
Arq Neuropsiquiatr 201775(4)221-227
Conclusatildeo O meacutetodo Pilates eacute uma ferramenta uacutetil no aliacutevio dossintomas de dor lombar e tem e melhora significativamente aqualidade de pessoas vivendo com HTLV-1
Borges J1 Baptista AF2 Santana N3 Souza I4 Kruschewsky RA5 Galvatildeo-Castro B6 Saacute KNPilates exercises improve low back pain and quality of life in patients with HTLV-1 virus a randomized crossover clinical trial J Bodyw Mov Ther 2014 Jan18(1)68-74
Leucemia Linfoma T do Adulto
bull Forma grave e rara de leucemialinfoma (2-5 dos portadores do HTLV-1)
bull Ocorre na vida adulta (50 anos no Brasil) pouco responsiva agrave quimioterapia
bull Quatro formas cliacutenicas aguda crocircnica linfomatosa e indolente (smoldering)
Fonte RHC -inca
TIPOS Linfocitose Linfoacutecitosanormais
Ceacutelulasem flor
NiacuteveisLDH
Hiper-calcemia
Envolvimento
INDOLENTE
1Leucecircmica
2Natildeo-leucecircmica
Ausente
Ausente
ge 5lt 5
AusenteAusente
le15 times N
le15 times N
AusenteAusente
Pele eou pulmotildeesPele
TUMORAL
PRIMAacuteRIA DA PELE
Ausente lt 5 Ausente variaacutevel Ausente Pele
CROcircNICA Presente Presente Ocasional le2 times N Ausente Qualquer oacutergatildeo menos
osso SNCe TGI
LINFOMA Ausente le 1 Ausente Variaacutevel Podeocorrer
Linfonodo e qualquer oacutergatildeo
AGUDA Elevada Presente Presente Elevada Presente Qualquer oacutergatildeo derrames cavitaacuterios
Shimoyama et al Br J Hematol 1991 Bittencourt et al Am J Clin Pathol 2007
Classificaccedilatildeo cliacutenica de ATLL
Diagnoacutestico
bull Presenccedila de anticorpos anti-HTLV-1
bull Comprovaccedilatildeo citoloacutegica ou histopatoloacutegica de leucemia e oulinfoma de ceacutelulas T maduras com antiacutegenos de superfiacutecieCD4+CD25+
bull Presenccedila de linfoacutecitos T anormais em sangue perifeacutericoprincipalmente das ceacutelulas ldquoem florrdquo
bull Demonstraccedilatildeo da integraccedilatildeo monoclonal do HTLV-1
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Gessain e Mahieux 2012
HAMTSP mielopatia associada ao HTLV-1Paraparesia espaacutestica tropical
Doenccedila inflamatoacuteria Crocircnica
Lesatildeo e desmielinizaccedilatildeo da medula espinhal
Fraqueza e rigidez muscular
Hiperreflexia
Espasticidade
Distuacuterbios urinaacuterios e sexuais
Constipaccedilatildeo
Membros inferiores
FATORES DETERMINANTES P HAMTSP
CADERNOS HEMOMINASHTLV 2015
Criteacuterios Diagnoacutesticos HAM TSP
Sintomas Tratamento
Espasticidade Baclofeno Tizanidina Toxina botuliacutenica Fisioterapia
Bexiga neurogecircnicaOxibutinina Doxazosina Imipramina Betanecol Auto-cateterizaccedilatildeo intermitente Toxina botuliacutenica intra-vesical Fisioterapia Estimuladores sacrais ()
Profilaxia de infecccedilotildees urinaacuterias
Auto-cateterizaccedilatildeo intermitente Cranberry () natildeo tratar bacteriuacuterias assintomaacuteticas
ConstipaccedilatildeoDieta rica em fibra hidrataccedilatildeo adequada Muciloacuteide psylium Oacuteleo mineral Lactulose Prucalopride Lubiprostonasupositoacuterios e enemas intermitentes Fisioterapia
Dor neuropaacutetica Antidepressivos triciacuteclicos Gabapentina Pregabalina
Dores natildeo-neuropaacuteticas
Anti-inflamatoacuterios natildeo-hormonais
Fraqueza muscular Fisioterapia Dalfampridina (Ampyrareg)
Arq Neuropsiquiatr 201775(4)221-227
Conclusatildeo O meacutetodo Pilates eacute uma ferramenta uacutetil no aliacutevio dossintomas de dor lombar e tem e melhora significativamente aqualidade de pessoas vivendo com HTLV-1
Borges J1 Baptista AF2 Santana N3 Souza I4 Kruschewsky RA5 Galvatildeo-Castro B6 Saacute KNPilates exercises improve low back pain and quality of life in patients with HTLV-1 virus a randomized crossover clinical trial J Bodyw Mov Ther 2014 Jan18(1)68-74
Leucemia Linfoma T do Adulto
bull Forma grave e rara de leucemialinfoma (2-5 dos portadores do HTLV-1)
bull Ocorre na vida adulta (50 anos no Brasil) pouco responsiva agrave quimioterapia
bull Quatro formas cliacutenicas aguda crocircnica linfomatosa e indolente (smoldering)
Fonte RHC -inca
TIPOS Linfocitose Linfoacutecitosanormais
Ceacutelulasem flor
NiacuteveisLDH
Hiper-calcemia
Envolvimento
INDOLENTE
1Leucecircmica
2Natildeo-leucecircmica
Ausente
Ausente
ge 5lt 5
AusenteAusente
le15 times N
le15 times N
AusenteAusente
Pele eou pulmotildeesPele
TUMORAL
PRIMAacuteRIA DA PELE
Ausente lt 5 Ausente variaacutevel Ausente Pele
CROcircNICA Presente Presente Ocasional le2 times N Ausente Qualquer oacutergatildeo menos
osso SNCe TGI
LINFOMA Ausente le 1 Ausente Variaacutevel Podeocorrer
Linfonodo e qualquer oacutergatildeo
AGUDA Elevada Presente Presente Elevada Presente Qualquer oacutergatildeo derrames cavitaacuterios
Shimoyama et al Br J Hematol 1991 Bittencourt et al Am J Clin Pathol 2007
Classificaccedilatildeo cliacutenica de ATLL
Diagnoacutestico
bull Presenccedila de anticorpos anti-HTLV-1
bull Comprovaccedilatildeo citoloacutegica ou histopatoloacutegica de leucemia e oulinfoma de ceacutelulas T maduras com antiacutegenos de superfiacutecieCD4+CD25+
bull Presenccedila de linfoacutecitos T anormais em sangue perifeacutericoprincipalmente das ceacutelulas ldquoem florrdquo
bull Demonstraccedilatildeo da integraccedilatildeo monoclonal do HTLV-1
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
HAMTSP mielopatia associada ao HTLV-1Paraparesia espaacutestica tropical
Doenccedila inflamatoacuteria Crocircnica
Lesatildeo e desmielinizaccedilatildeo da medula espinhal
Fraqueza e rigidez muscular
Hiperreflexia
Espasticidade
Distuacuterbios urinaacuterios e sexuais
Constipaccedilatildeo
Membros inferiores
FATORES DETERMINANTES P HAMTSP
CADERNOS HEMOMINASHTLV 2015
Criteacuterios Diagnoacutesticos HAM TSP
Sintomas Tratamento
Espasticidade Baclofeno Tizanidina Toxina botuliacutenica Fisioterapia
Bexiga neurogecircnicaOxibutinina Doxazosina Imipramina Betanecol Auto-cateterizaccedilatildeo intermitente Toxina botuliacutenica intra-vesical Fisioterapia Estimuladores sacrais ()
Profilaxia de infecccedilotildees urinaacuterias
Auto-cateterizaccedilatildeo intermitente Cranberry () natildeo tratar bacteriuacuterias assintomaacuteticas
ConstipaccedilatildeoDieta rica em fibra hidrataccedilatildeo adequada Muciloacuteide psylium Oacuteleo mineral Lactulose Prucalopride Lubiprostonasupositoacuterios e enemas intermitentes Fisioterapia
Dor neuropaacutetica Antidepressivos triciacuteclicos Gabapentina Pregabalina
Dores natildeo-neuropaacuteticas
Anti-inflamatoacuterios natildeo-hormonais
Fraqueza muscular Fisioterapia Dalfampridina (Ampyrareg)
Arq Neuropsiquiatr 201775(4)221-227
Conclusatildeo O meacutetodo Pilates eacute uma ferramenta uacutetil no aliacutevio dossintomas de dor lombar e tem e melhora significativamente aqualidade de pessoas vivendo com HTLV-1
Borges J1 Baptista AF2 Santana N3 Souza I4 Kruschewsky RA5 Galvatildeo-Castro B6 Saacute KNPilates exercises improve low back pain and quality of life in patients with HTLV-1 virus a randomized crossover clinical trial J Bodyw Mov Ther 2014 Jan18(1)68-74
Leucemia Linfoma T do Adulto
bull Forma grave e rara de leucemialinfoma (2-5 dos portadores do HTLV-1)
bull Ocorre na vida adulta (50 anos no Brasil) pouco responsiva agrave quimioterapia
bull Quatro formas cliacutenicas aguda crocircnica linfomatosa e indolente (smoldering)
Fonte RHC -inca
TIPOS Linfocitose Linfoacutecitosanormais
Ceacutelulasem flor
NiacuteveisLDH
Hiper-calcemia
Envolvimento
INDOLENTE
1Leucecircmica
2Natildeo-leucecircmica
Ausente
Ausente
ge 5lt 5
AusenteAusente
le15 times N
le15 times N
AusenteAusente
Pele eou pulmotildeesPele
TUMORAL
PRIMAacuteRIA DA PELE
Ausente lt 5 Ausente variaacutevel Ausente Pele
CROcircNICA Presente Presente Ocasional le2 times N Ausente Qualquer oacutergatildeo menos
osso SNCe TGI
LINFOMA Ausente le 1 Ausente Variaacutevel Podeocorrer
Linfonodo e qualquer oacutergatildeo
AGUDA Elevada Presente Presente Elevada Presente Qualquer oacutergatildeo derrames cavitaacuterios
Shimoyama et al Br J Hematol 1991 Bittencourt et al Am J Clin Pathol 2007
Classificaccedilatildeo cliacutenica de ATLL
Diagnoacutestico
bull Presenccedila de anticorpos anti-HTLV-1
bull Comprovaccedilatildeo citoloacutegica ou histopatoloacutegica de leucemia e oulinfoma de ceacutelulas T maduras com antiacutegenos de superfiacutecieCD4+CD25+
bull Presenccedila de linfoacutecitos T anormais em sangue perifeacutericoprincipalmente das ceacutelulas ldquoem florrdquo
bull Demonstraccedilatildeo da integraccedilatildeo monoclonal do HTLV-1
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
FATORES DETERMINANTES P HAMTSP
CADERNOS HEMOMINASHTLV 2015
Criteacuterios Diagnoacutesticos HAM TSP
Sintomas Tratamento
Espasticidade Baclofeno Tizanidina Toxina botuliacutenica Fisioterapia
Bexiga neurogecircnicaOxibutinina Doxazosina Imipramina Betanecol Auto-cateterizaccedilatildeo intermitente Toxina botuliacutenica intra-vesical Fisioterapia Estimuladores sacrais ()
Profilaxia de infecccedilotildees urinaacuterias
Auto-cateterizaccedilatildeo intermitente Cranberry () natildeo tratar bacteriuacuterias assintomaacuteticas
ConstipaccedilatildeoDieta rica em fibra hidrataccedilatildeo adequada Muciloacuteide psylium Oacuteleo mineral Lactulose Prucalopride Lubiprostonasupositoacuterios e enemas intermitentes Fisioterapia
Dor neuropaacutetica Antidepressivos triciacuteclicos Gabapentina Pregabalina
Dores natildeo-neuropaacuteticas
Anti-inflamatoacuterios natildeo-hormonais
Fraqueza muscular Fisioterapia Dalfampridina (Ampyrareg)
Arq Neuropsiquiatr 201775(4)221-227
Conclusatildeo O meacutetodo Pilates eacute uma ferramenta uacutetil no aliacutevio dossintomas de dor lombar e tem e melhora significativamente aqualidade de pessoas vivendo com HTLV-1
Borges J1 Baptista AF2 Santana N3 Souza I4 Kruschewsky RA5 Galvatildeo-Castro B6 Saacute KNPilates exercises improve low back pain and quality of life in patients with HTLV-1 virus a randomized crossover clinical trial J Bodyw Mov Ther 2014 Jan18(1)68-74
Leucemia Linfoma T do Adulto
bull Forma grave e rara de leucemialinfoma (2-5 dos portadores do HTLV-1)
bull Ocorre na vida adulta (50 anos no Brasil) pouco responsiva agrave quimioterapia
bull Quatro formas cliacutenicas aguda crocircnica linfomatosa e indolente (smoldering)
Fonte RHC -inca
TIPOS Linfocitose Linfoacutecitosanormais
Ceacutelulasem flor
NiacuteveisLDH
Hiper-calcemia
Envolvimento
INDOLENTE
1Leucecircmica
2Natildeo-leucecircmica
Ausente
Ausente
ge 5lt 5
AusenteAusente
le15 times N
le15 times N
AusenteAusente
Pele eou pulmotildeesPele
TUMORAL
PRIMAacuteRIA DA PELE
Ausente lt 5 Ausente variaacutevel Ausente Pele
CROcircNICA Presente Presente Ocasional le2 times N Ausente Qualquer oacutergatildeo menos
osso SNCe TGI
LINFOMA Ausente le 1 Ausente Variaacutevel Podeocorrer
Linfonodo e qualquer oacutergatildeo
AGUDA Elevada Presente Presente Elevada Presente Qualquer oacutergatildeo derrames cavitaacuterios
Shimoyama et al Br J Hematol 1991 Bittencourt et al Am J Clin Pathol 2007
Classificaccedilatildeo cliacutenica de ATLL
Diagnoacutestico
bull Presenccedila de anticorpos anti-HTLV-1
bull Comprovaccedilatildeo citoloacutegica ou histopatoloacutegica de leucemia e oulinfoma de ceacutelulas T maduras com antiacutegenos de superfiacutecieCD4+CD25+
bull Presenccedila de linfoacutecitos T anormais em sangue perifeacutericoprincipalmente das ceacutelulas ldquoem florrdquo
bull Demonstraccedilatildeo da integraccedilatildeo monoclonal do HTLV-1
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Criteacuterios Diagnoacutesticos HAM TSP
Sintomas Tratamento
Espasticidade Baclofeno Tizanidina Toxina botuliacutenica Fisioterapia
Bexiga neurogecircnicaOxibutinina Doxazosina Imipramina Betanecol Auto-cateterizaccedilatildeo intermitente Toxina botuliacutenica intra-vesical Fisioterapia Estimuladores sacrais ()
Profilaxia de infecccedilotildees urinaacuterias
Auto-cateterizaccedilatildeo intermitente Cranberry () natildeo tratar bacteriuacuterias assintomaacuteticas
ConstipaccedilatildeoDieta rica em fibra hidrataccedilatildeo adequada Muciloacuteide psylium Oacuteleo mineral Lactulose Prucalopride Lubiprostonasupositoacuterios e enemas intermitentes Fisioterapia
Dor neuropaacutetica Antidepressivos triciacuteclicos Gabapentina Pregabalina
Dores natildeo-neuropaacuteticas
Anti-inflamatoacuterios natildeo-hormonais
Fraqueza muscular Fisioterapia Dalfampridina (Ampyrareg)
Arq Neuropsiquiatr 201775(4)221-227
Conclusatildeo O meacutetodo Pilates eacute uma ferramenta uacutetil no aliacutevio dossintomas de dor lombar e tem e melhora significativamente aqualidade de pessoas vivendo com HTLV-1
Borges J1 Baptista AF2 Santana N3 Souza I4 Kruschewsky RA5 Galvatildeo-Castro B6 Saacute KNPilates exercises improve low back pain and quality of life in patients with HTLV-1 virus a randomized crossover clinical trial J Bodyw Mov Ther 2014 Jan18(1)68-74
Leucemia Linfoma T do Adulto
bull Forma grave e rara de leucemialinfoma (2-5 dos portadores do HTLV-1)
bull Ocorre na vida adulta (50 anos no Brasil) pouco responsiva agrave quimioterapia
bull Quatro formas cliacutenicas aguda crocircnica linfomatosa e indolente (smoldering)
Fonte RHC -inca
TIPOS Linfocitose Linfoacutecitosanormais
Ceacutelulasem flor
NiacuteveisLDH
Hiper-calcemia
Envolvimento
INDOLENTE
1Leucecircmica
2Natildeo-leucecircmica
Ausente
Ausente
ge 5lt 5
AusenteAusente
le15 times N
le15 times N
AusenteAusente
Pele eou pulmotildeesPele
TUMORAL
PRIMAacuteRIA DA PELE
Ausente lt 5 Ausente variaacutevel Ausente Pele
CROcircNICA Presente Presente Ocasional le2 times N Ausente Qualquer oacutergatildeo menos
osso SNCe TGI
LINFOMA Ausente le 1 Ausente Variaacutevel Podeocorrer
Linfonodo e qualquer oacutergatildeo
AGUDA Elevada Presente Presente Elevada Presente Qualquer oacutergatildeo derrames cavitaacuterios
Shimoyama et al Br J Hematol 1991 Bittencourt et al Am J Clin Pathol 2007
Classificaccedilatildeo cliacutenica de ATLL
Diagnoacutestico
bull Presenccedila de anticorpos anti-HTLV-1
bull Comprovaccedilatildeo citoloacutegica ou histopatoloacutegica de leucemia e oulinfoma de ceacutelulas T maduras com antiacutegenos de superfiacutecieCD4+CD25+
bull Presenccedila de linfoacutecitos T anormais em sangue perifeacutericoprincipalmente das ceacutelulas ldquoem florrdquo
bull Demonstraccedilatildeo da integraccedilatildeo monoclonal do HTLV-1
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Sintomas Tratamento
Espasticidade Baclofeno Tizanidina Toxina botuliacutenica Fisioterapia
Bexiga neurogecircnicaOxibutinina Doxazosina Imipramina Betanecol Auto-cateterizaccedilatildeo intermitente Toxina botuliacutenica intra-vesical Fisioterapia Estimuladores sacrais ()
Profilaxia de infecccedilotildees urinaacuterias
Auto-cateterizaccedilatildeo intermitente Cranberry () natildeo tratar bacteriuacuterias assintomaacuteticas
ConstipaccedilatildeoDieta rica em fibra hidrataccedilatildeo adequada Muciloacuteide psylium Oacuteleo mineral Lactulose Prucalopride Lubiprostonasupositoacuterios e enemas intermitentes Fisioterapia
Dor neuropaacutetica Antidepressivos triciacuteclicos Gabapentina Pregabalina
Dores natildeo-neuropaacuteticas
Anti-inflamatoacuterios natildeo-hormonais
Fraqueza muscular Fisioterapia Dalfampridina (Ampyrareg)
Arq Neuropsiquiatr 201775(4)221-227
Conclusatildeo O meacutetodo Pilates eacute uma ferramenta uacutetil no aliacutevio dossintomas de dor lombar e tem e melhora significativamente aqualidade de pessoas vivendo com HTLV-1
Borges J1 Baptista AF2 Santana N3 Souza I4 Kruschewsky RA5 Galvatildeo-Castro B6 Saacute KNPilates exercises improve low back pain and quality of life in patients with HTLV-1 virus a randomized crossover clinical trial J Bodyw Mov Ther 2014 Jan18(1)68-74
Leucemia Linfoma T do Adulto
bull Forma grave e rara de leucemialinfoma (2-5 dos portadores do HTLV-1)
bull Ocorre na vida adulta (50 anos no Brasil) pouco responsiva agrave quimioterapia
bull Quatro formas cliacutenicas aguda crocircnica linfomatosa e indolente (smoldering)
Fonte RHC -inca
TIPOS Linfocitose Linfoacutecitosanormais
Ceacutelulasem flor
NiacuteveisLDH
Hiper-calcemia
Envolvimento
INDOLENTE
1Leucecircmica
2Natildeo-leucecircmica
Ausente
Ausente
ge 5lt 5
AusenteAusente
le15 times N
le15 times N
AusenteAusente
Pele eou pulmotildeesPele
TUMORAL
PRIMAacuteRIA DA PELE
Ausente lt 5 Ausente variaacutevel Ausente Pele
CROcircNICA Presente Presente Ocasional le2 times N Ausente Qualquer oacutergatildeo menos
osso SNCe TGI
LINFOMA Ausente le 1 Ausente Variaacutevel Podeocorrer
Linfonodo e qualquer oacutergatildeo
AGUDA Elevada Presente Presente Elevada Presente Qualquer oacutergatildeo derrames cavitaacuterios
Shimoyama et al Br J Hematol 1991 Bittencourt et al Am J Clin Pathol 2007
Classificaccedilatildeo cliacutenica de ATLL
Diagnoacutestico
bull Presenccedila de anticorpos anti-HTLV-1
bull Comprovaccedilatildeo citoloacutegica ou histopatoloacutegica de leucemia e oulinfoma de ceacutelulas T maduras com antiacutegenos de superfiacutecieCD4+CD25+
bull Presenccedila de linfoacutecitos T anormais em sangue perifeacutericoprincipalmente das ceacutelulas ldquoem florrdquo
bull Demonstraccedilatildeo da integraccedilatildeo monoclonal do HTLV-1
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Arq Neuropsiquiatr 201775(4)221-227
Conclusatildeo O meacutetodo Pilates eacute uma ferramenta uacutetil no aliacutevio dossintomas de dor lombar e tem e melhora significativamente aqualidade de pessoas vivendo com HTLV-1
Borges J1 Baptista AF2 Santana N3 Souza I4 Kruschewsky RA5 Galvatildeo-Castro B6 Saacute KNPilates exercises improve low back pain and quality of life in patients with HTLV-1 virus a randomized crossover clinical trial J Bodyw Mov Ther 2014 Jan18(1)68-74
Leucemia Linfoma T do Adulto
bull Forma grave e rara de leucemialinfoma (2-5 dos portadores do HTLV-1)
bull Ocorre na vida adulta (50 anos no Brasil) pouco responsiva agrave quimioterapia
bull Quatro formas cliacutenicas aguda crocircnica linfomatosa e indolente (smoldering)
Fonte RHC -inca
TIPOS Linfocitose Linfoacutecitosanormais
Ceacutelulasem flor
NiacuteveisLDH
Hiper-calcemia
Envolvimento
INDOLENTE
1Leucecircmica
2Natildeo-leucecircmica
Ausente
Ausente
ge 5lt 5
AusenteAusente
le15 times N
le15 times N
AusenteAusente
Pele eou pulmotildeesPele
TUMORAL
PRIMAacuteRIA DA PELE
Ausente lt 5 Ausente variaacutevel Ausente Pele
CROcircNICA Presente Presente Ocasional le2 times N Ausente Qualquer oacutergatildeo menos
osso SNCe TGI
LINFOMA Ausente le 1 Ausente Variaacutevel Podeocorrer
Linfonodo e qualquer oacutergatildeo
AGUDA Elevada Presente Presente Elevada Presente Qualquer oacutergatildeo derrames cavitaacuterios
Shimoyama et al Br J Hematol 1991 Bittencourt et al Am J Clin Pathol 2007
Classificaccedilatildeo cliacutenica de ATLL
Diagnoacutestico
bull Presenccedila de anticorpos anti-HTLV-1
bull Comprovaccedilatildeo citoloacutegica ou histopatoloacutegica de leucemia e oulinfoma de ceacutelulas T maduras com antiacutegenos de superfiacutecieCD4+CD25+
bull Presenccedila de linfoacutecitos T anormais em sangue perifeacutericoprincipalmente das ceacutelulas ldquoem florrdquo
bull Demonstraccedilatildeo da integraccedilatildeo monoclonal do HTLV-1
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Conclusatildeo O meacutetodo Pilates eacute uma ferramenta uacutetil no aliacutevio dossintomas de dor lombar e tem e melhora significativamente aqualidade de pessoas vivendo com HTLV-1
Borges J1 Baptista AF2 Santana N3 Souza I4 Kruschewsky RA5 Galvatildeo-Castro B6 Saacute KNPilates exercises improve low back pain and quality of life in patients with HTLV-1 virus a randomized crossover clinical trial J Bodyw Mov Ther 2014 Jan18(1)68-74
Leucemia Linfoma T do Adulto
bull Forma grave e rara de leucemialinfoma (2-5 dos portadores do HTLV-1)
bull Ocorre na vida adulta (50 anos no Brasil) pouco responsiva agrave quimioterapia
bull Quatro formas cliacutenicas aguda crocircnica linfomatosa e indolente (smoldering)
Fonte RHC -inca
TIPOS Linfocitose Linfoacutecitosanormais
Ceacutelulasem flor
NiacuteveisLDH
Hiper-calcemia
Envolvimento
INDOLENTE
1Leucecircmica
2Natildeo-leucecircmica
Ausente
Ausente
ge 5lt 5
AusenteAusente
le15 times N
le15 times N
AusenteAusente
Pele eou pulmotildeesPele
TUMORAL
PRIMAacuteRIA DA PELE
Ausente lt 5 Ausente variaacutevel Ausente Pele
CROcircNICA Presente Presente Ocasional le2 times N Ausente Qualquer oacutergatildeo menos
osso SNCe TGI
LINFOMA Ausente le 1 Ausente Variaacutevel Podeocorrer
Linfonodo e qualquer oacutergatildeo
AGUDA Elevada Presente Presente Elevada Presente Qualquer oacutergatildeo derrames cavitaacuterios
Shimoyama et al Br J Hematol 1991 Bittencourt et al Am J Clin Pathol 2007
Classificaccedilatildeo cliacutenica de ATLL
Diagnoacutestico
bull Presenccedila de anticorpos anti-HTLV-1
bull Comprovaccedilatildeo citoloacutegica ou histopatoloacutegica de leucemia e oulinfoma de ceacutelulas T maduras com antiacutegenos de superfiacutecieCD4+CD25+
bull Presenccedila de linfoacutecitos T anormais em sangue perifeacutericoprincipalmente das ceacutelulas ldquoem florrdquo
bull Demonstraccedilatildeo da integraccedilatildeo monoclonal do HTLV-1
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Leucemia Linfoma T do Adulto
bull Forma grave e rara de leucemialinfoma (2-5 dos portadores do HTLV-1)
bull Ocorre na vida adulta (50 anos no Brasil) pouco responsiva agrave quimioterapia
bull Quatro formas cliacutenicas aguda crocircnica linfomatosa e indolente (smoldering)
Fonte RHC -inca
TIPOS Linfocitose Linfoacutecitosanormais
Ceacutelulasem flor
NiacuteveisLDH
Hiper-calcemia
Envolvimento
INDOLENTE
1Leucecircmica
2Natildeo-leucecircmica
Ausente
Ausente
ge 5lt 5
AusenteAusente
le15 times N
le15 times N
AusenteAusente
Pele eou pulmotildeesPele
TUMORAL
PRIMAacuteRIA DA PELE
Ausente lt 5 Ausente variaacutevel Ausente Pele
CROcircNICA Presente Presente Ocasional le2 times N Ausente Qualquer oacutergatildeo menos
osso SNCe TGI
LINFOMA Ausente le 1 Ausente Variaacutevel Podeocorrer
Linfonodo e qualquer oacutergatildeo
AGUDA Elevada Presente Presente Elevada Presente Qualquer oacutergatildeo derrames cavitaacuterios
Shimoyama et al Br J Hematol 1991 Bittencourt et al Am J Clin Pathol 2007
Classificaccedilatildeo cliacutenica de ATLL
Diagnoacutestico
bull Presenccedila de anticorpos anti-HTLV-1
bull Comprovaccedilatildeo citoloacutegica ou histopatoloacutegica de leucemia e oulinfoma de ceacutelulas T maduras com antiacutegenos de superfiacutecieCD4+CD25+
bull Presenccedila de linfoacutecitos T anormais em sangue perifeacutericoprincipalmente das ceacutelulas ldquoem florrdquo
bull Demonstraccedilatildeo da integraccedilatildeo monoclonal do HTLV-1
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Fonte RHC -inca
TIPOS Linfocitose Linfoacutecitosanormais
Ceacutelulasem flor
NiacuteveisLDH
Hiper-calcemia
Envolvimento
INDOLENTE
1Leucecircmica
2Natildeo-leucecircmica
Ausente
Ausente
ge 5lt 5
AusenteAusente
le15 times N
le15 times N
AusenteAusente
Pele eou pulmotildeesPele
TUMORAL
PRIMAacuteRIA DA PELE
Ausente lt 5 Ausente variaacutevel Ausente Pele
CROcircNICA Presente Presente Ocasional le2 times N Ausente Qualquer oacutergatildeo menos
osso SNCe TGI
LINFOMA Ausente le 1 Ausente Variaacutevel Podeocorrer
Linfonodo e qualquer oacutergatildeo
AGUDA Elevada Presente Presente Elevada Presente Qualquer oacutergatildeo derrames cavitaacuterios
Shimoyama et al Br J Hematol 1991 Bittencourt et al Am J Clin Pathol 2007
Classificaccedilatildeo cliacutenica de ATLL
Diagnoacutestico
bull Presenccedila de anticorpos anti-HTLV-1
bull Comprovaccedilatildeo citoloacutegica ou histopatoloacutegica de leucemia e oulinfoma de ceacutelulas T maduras com antiacutegenos de superfiacutecieCD4+CD25+
bull Presenccedila de linfoacutecitos T anormais em sangue perifeacutericoprincipalmente das ceacutelulas ldquoem florrdquo
bull Demonstraccedilatildeo da integraccedilatildeo monoclonal do HTLV-1
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
TIPOS Linfocitose Linfoacutecitosanormais
Ceacutelulasem flor
NiacuteveisLDH
Hiper-calcemia
Envolvimento
INDOLENTE
1Leucecircmica
2Natildeo-leucecircmica
Ausente
Ausente
ge 5lt 5
AusenteAusente
le15 times N
le15 times N
AusenteAusente
Pele eou pulmotildeesPele
TUMORAL
PRIMAacuteRIA DA PELE
Ausente lt 5 Ausente variaacutevel Ausente Pele
CROcircNICA Presente Presente Ocasional le2 times N Ausente Qualquer oacutergatildeo menos
osso SNCe TGI
LINFOMA Ausente le 1 Ausente Variaacutevel Podeocorrer
Linfonodo e qualquer oacutergatildeo
AGUDA Elevada Presente Presente Elevada Presente Qualquer oacutergatildeo derrames cavitaacuterios
Shimoyama et al Br J Hematol 1991 Bittencourt et al Am J Clin Pathol 2007
Classificaccedilatildeo cliacutenica de ATLL
Diagnoacutestico
bull Presenccedila de anticorpos anti-HTLV-1
bull Comprovaccedilatildeo citoloacutegica ou histopatoloacutegica de leucemia e oulinfoma de ceacutelulas T maduras com antiacutegenos de superfiacutecieCD4+CD25+
bull Presenccedila de linfoacutecitos T anormais em sangue perifeacutericoprincipalmente das ceacutelulas ldquoem florrdquo
bull Demonstraccedilatildeo da integraccedilatildeo monoclonal do HTLV-1
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Diagnoacutestico
bull Presenccedila de anticorpos anti-HTLV-1
bull Comprovaccedilatildeo citoloacutegica ou histopatoloacutegica de leucemia e oulinfoma de ceacutelulas T maduras com antiacutegenos de superfiacutecieCD4+CD25+
bull Presenccedila de linfoacutecitos T anormais em sangue perifeacutericoprincipalmente das ceacutelulas ldquoem florrdquo
bull Demonstraccedilatildeo da integraccedilatildeo monoclonal do HTLV-1
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
1 Eczema do couro cabeludo pavilhotildees auriculares axilas virilhas conduto auditivo externo regiotildees paacutelpebras pele paranasal e ou pescoccedilo
2 Rinorreacuteia crocircnica e ou lesotildees crostosas na porccedilatildeo anterior das fossas nasais
3 Dermatite crocircnica recidivante com resposta imediata agrave antibioticoterapia e recidiva apoacutes suspensatildeo
4 Iniacutecio precoce na infacircncia
5 Positividade para HTLV-1
Dos 5 criteacuterios principais 04 satildeo requeridos Obrigatoacuteria a inclusatildeo dos
iacutetens 1 2 e 5 e envolvimento de pelo menos 2 aacutereas para preenchimento do
criteacuterio 1 (La Grenade et al 1998)
Criteacuterios diagnoacutesticos principaisDermatite infecciosa associada ao HTLV-1 (DIH)
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Uveiacutete associada ao HTLV-1
bull Ocorre em 1-3 dos pacientes (gt Japatildeo)
bull Iniacutecio insidioso mono ou binocular localizaccedilatildeointermediaacuteria e bom prognoacutestico visual com o uso dacorticoterapia
bull Assintomaacuteticas
bull Sintomas principais moscas volantes e visatildeo turva
bull Sinais irite vitreiacutete com opacidades viacutetreas e vasculitesretinianas
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Ceratoconjuntivite seca (Olho seco)
bull Ocorre em 30 a 40 dos pacientes (mais frequente em HASMTSP)
bull Processo inflamatoacuterio da glacircndula lacrimal com deficiecircncia na lubrificaccedilatildeoocular
bull Assintomaacuteticas
bull Sintomas principais irritaccedilatildeo corpo estranho queimaccedilatildeo visatildeo turva
bull Diagnoacutestico positividade de 2 dos 3 testes
Teste de SchirmerBUT Rosa Bengala
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Tuberculose x HTLV
bull Marinho J et al Increased risk of tuberculosis with human T-
lymphotropic virus-1 infection a case-control study J Acquir Immune
Defic Syndr 2005
bull Grassi MF et al Tuberculosis incidence in a cohort of individuals infected
with human T-lymphotropic virus type 1 (HTLV-1) in Salvador Brazil
BMC Infect Dis 2016
bull Souza A et al Association of Tuberculosis Status with Neurologic
Disease and Immune Response in HTLV-1 Infection AIDS Res Hum
Retroviruses 2017
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Tuberculosis
Manual do Manejo Cliacutenico de HTLV Ministeacuterio da Sauacutede
Simpotamas respiratoacuterios
Pesquisa ativa
PPD
Rx de Toacuterax
Exame se escarro
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Nuacutemero de indiviacuteduos =1946
Mulheres ndash 1385 (712) x homens ndash 561 (282)
Meacutedia de idade 498 anos (5 ndash 93 anos)
Salvador - 1462 (751)
Outras cidades ndash 475 (243)
Pardos = 883
Renda mensal le 1 salaacuterio miacutenimo
Anos de estudo le 8 anos
Gestante 110
Renda e niacuteveis educacionais baixos
CHTLV da EBMSP caracteriacutesticas sociodemograacuteficas
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
bull HTLV-1 = 991 HTLV-2 = 089
bull HAMTSP 257 pacientes
bull Depressatildeo 30 (ASS) e 48 (HAMTSP)
bull Ceratoconjuntivite - 31
bull Alteraccedilotildees urinaacuterias 70
bull Disfunccedilatildeo sexual em mulheres 80 (HAMTSP)
bull Disfunccedilatildeo ereacutetil
CTHLVEBMSP Caracteristicas virais e cliacutenicas
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Laboratorial
bull Carga proviralbull Exames complementares
Sorologia para HTLV
Grupo PsicoeducativoEntrega do resultado e
aconselhamento
Resultado negativo
Resultado positivo
Matriacutecula do paciente
Consulta de EnfermagemColeta de dados soacuteciodemograacuteficos e anamnese
Avaliaccedilotildees
Meacutedica
bull Infectologista
bull Cliacutenico Geral
bull Neurologistabull Urologistabull Dermatologistabull Ginecologista obstetrabull Oftalmologista
Psicoloacutegica
bull Diagnoacutestico de Depressatildeo e Estresse Psiacutequico
bull Formas de Enfrentamentobull Rede de apoio
Fisioterapecircutica
bull Funccedilatildeobull Dorbull Sensoacuterio motor Intervenccedilotildees
Resultado positivo
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Avaliaccedilatildeo Cliacutenica
Testagem soroloacutegica para HTLV outras IST
Matildee - Irmatildeos Pai
Filhos Parceiros sexuaisTeste para outras IST no paciente
Exame Fiacutesico
Completo Exame neuroloacutegico inicial
Anamnese Completa
Histoacuteria da doenccedila atualInterrogatoacuterio
SistemaacuteticoAntecedentes Pessoais e
familiaresHaacutebitos de vida
Confirmaccedilatildeo diagnoacutestica
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Avaliaccedilatildeo Meacutedica Inicial
Assintomaacutetico Sintomaacutetico
Avaliaccedilatildeo Meacutedica Anual ou se apresentar alteraccedilatildeo
Avaliaccedilatildeo especialistabullOftalmologistabullNeurologistabullUrologista
bullHematologiaoncologiabullDermatologiaReabilitaccedilatildeobullFisioterapia
bullTerapia ocupacionalbullPsicologia
Avaliaccedilatildeo Meacutedica Mensal ou a depender do quadro
apresentado
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Exames Laboratoriais
bull Biomarcadores de evoluccedilatildeo
-Linfoacutecitos T CD4+
-Carga proviralNuacutemero de coacutepias de DNA proviral integrado ao genoma das ceacutelulas (proporccedilatildeo de ceacutelulas infectadas que carregam um proviacuterus)
bull Maior em pacientes com HAMTSPbull Maior em portadores assintomaacuteticos com familiares com
HAMTSP que os que natildeo tecircmbull Relacionada a transmissatildeo
Cadernos Hemominas ndash HTLV vol XVI Acesso chrome-extensionoemmndcbldboiebfnladdacbdfmadadmfileDMeus_DocumentosDownloadslivro_htlv-201520(1)20(1)pdf
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
HTLV-1 em gestantes na Bahia
Barmpas DBS 2014
Gadelha et al
2014
Sul da Bahia 2766 105 (070-150) NA NA
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Evidecircncias de novos focos de HTLV no Estado da Bahia
bull Felicidade Mota Pereira15 Maria da Conceiccedilatildeo Almeida
Chagas5 Roberto Perez Carreiro3 Bernardo Galvatildeo Castro2
Maria Fernanda Rios Grassi12
bull Seroprevalence of the Human T-cell lymphotropic virus in
Bahia State Brazil (em preparaccedilatildeo)
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
417 municiacutepios 15203934 habitantes (httpwwwibgegovbr )
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Study design
Retrospective ecological study using data obtained from theCentral Laboratory of Public Health of Bahia (LACEN-BA) which isresponsible for infectious disease surveillance throughout thestate via laboratory analysis (~1 milllionyear)
All serological tests for HTLV were included among the 32 Bahia microregions from 2004 to 2013
Chemiluminescence followed by Western blotting for confirmation Serological HTLV tests lacking confirmatory results were excluded
Target population blood donors pregnant women and individuals exhibiting symptoms of infectious disease referred by blood banks prenatal physicians or clinicians in the public health system
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Studied population
Median age 31 years (IQR) 25 - 39)
Ratio female male was 81
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
144 per 100000 inhabitants
Cumulative mean rate of HTLV-positive cases
in Bahia
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Median age 46 years (IQR 33 - 59 years)
75 (14851978) women
42 positive individuals aged 15 years or younger from all of the mesoregions
Three children (two male and one female) younger than 48 months of age
Distribution of HTLV-positive cases throughout the mesoregions
of the State of Bahia stratified according to sex and age (2004-
2013)
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Conclusotildees
O HTLV estaacute disseminado na Bahia com uma taxa global de 144 100000 habitantes
O HTLV-1 eacute predominante e corresponde a 912 de todos os casos seguido por 54 coinfecccedilatildeo do HTLV-12 e 29 de HTLV-2
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
Conclusotildees
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
New clusters of HTLV infection
As expected the Salvador microregion which includes 10 municipalitiespresented a high overall rate of HTLV-infection (2290100000 inhabitants)
One important cluster of HTLV infection comprising four microregionssurrounding the Salvador microregion (Entre Rios Santo Antonio de Jesus andCatu)This cluster consists of 43 cities and concentrates almost a third of thestates population
Three other endemic clusters were Identified
Southernmost region (comprising four microregions 86 municipalities ~27 million inhabitants)
Central region (two microregions 33 municipalities ~750000 inhabitants)
Westernmost region (comprising one microregions 7 municipalities~280000 inhabitants)
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
42 individuals under 15 years indicating that in addition to sexual transmission the vertical route may be an important route
Considering 084 (1978233876) the overall prevalence of HTLV in Bahia we would estimate that sim130000 individuals are infected with HTLV
Further studies are needed to better describe the epidemiological profile of the infected population and to reinforce public policies to stop the transmission of the virus especially in pregnant women
New clusters of HTLV infection
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Enfrentando o HTLV-1
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Desafios
Inclusatildeo do HTLV na Agenda do Ministeacuterio da Sauacutede do Brasil
Inclusatildeo do HTLV na Agenda da Organizaccedilatildeo Mundial de Sauacutede
Melhorar a linha de cuidado
Proporcionar ensaios cliacutenicos na busca de novas drogas
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
Natildeo existe cura mas existe tratamento (Abelardo Arauacutejo)
Avanccedilamos porque trabalhamos juntos (Anna Barbara Carneiro-Proeitti)
Continuemos juntos
