The Reasons to Include the Serology of Human T-lymphotropic Virus Types 1 and 2 (HTLV-1 and HTLV-2) in the Clinical Follow-Up of Patients With Viral Hepatitis B and C in Brazil

PLoS Negl Trop Dis. 2020 May 26;14(5):e0008245. doi: 10.1371/journal.pntd.0008245. eCollection 2020 May.

Abstract

Background: The WHO established targets for 2030 to globally reduce new viral hepatitis B and C infections by 90% and deaths by 65% and recommends searching for coinfections that increase the progression of chronic liver infections towards cirrhosis and hepatocellular carcinoma.

Aims and methodology: This study aimed to add information concerning the influence of human T-lymphotropic virus type 1 (HTLV-1) and type 2 (HTLV-2) infections in hepatitis B and C, since in Brazil, these human retroviruses are endemic but neglected. Serum samples from 1,910 patients with hepatitis B and 1,315 with hepatitis C from São Paulo, southeast Brazil, that were previously tested and grouped for HIV and HTLV-1/-2 coinfections were analyzed for hepatitis B virus (HBV) and hepatitis C virus (HCV) loads measurements and subsequent clearance using data from laboratory records.

Key results: Briefly, the lowest HBV viral load (VL) was detected in HBV/HTLV-2 coinfected patients, regardless of whether they were infected with HIV (all comparisons p<0.05). In contrast, higher HCV VL was detected in HCV/HIV, HCV/HIV/HTLV-1/-2 coinfected patients (all p<0.05), and the lowest HCV VL was detected in HCV/HTLV-2 coinfected patients. Curiously, 61.1% of the patients with HBV/HTLV-2 coinfection had an undetectable HBV VL at the beginning of the study versus 21.4% in the patients with HBV/HTLV-1 coinfection. Although the percentages of undetectable HCV loads in HCV/HTLV-1 and HCV/HTLV-2 coinfected patients were quite similar, during follow-up, more HCV clearance was detected in patients with HCV/HTLV-2 coinfection [OR 2.65; 95% IC (1.17-5.99)].

Major conclusions: HTLV-2 positively impacts HBV and HCV viral loads and HCV clearance, while HIV and/or HTLV-1 negatively impacts HCV viral load. Thus, the search for HTLV-1/-2 in viral hepatitis B and C infected patients has virological prognostic value, which is a strong reason to suggest including HTLV serology in the follow-up of patients.

Grant support

ACA received grants from Fundação de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP grants N° 2016/03654-0) https://bv.fapesp.br/pt/auxilios/93408/marcadores-geneticos-virais-e-do-hospedeiro-que-podem-influenciar-o-curso-da-infeccao-pelo-hiv-1-e-d/. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.