HTLV-I associated bronchioloalveolar disorder (HABA): disease concept and differential diagnosis of an unsolved disease entity

Expert Rev Anti Infect Ther. 2023 Jan;21(1):57-63. doi: 10.1080/14787210.2023.2151437. Epub 2022 Nov 27.

Abstract

Introduction: Human T-cell leukemia virus type 1 (HTLV-I) associated bronchioloalveolar disorder (HABA) is a chronic and progressive bronchiolar/alveolar disorder related to HTLV-1 infection. Clinical knowledge and guidance are lacking for the diagnosis and management of this condition.

Areas covered: This work aimed to review the latest information and challenges regarding HABA diagnosis and treatment.

Expert opinion: HABA is an immune-mediated state induced by HTLV-1. For diagnosis of HABA, other infectious diseases and pulmonary infiltration of adult T-cell leukemia should be excluded by investigations such as computed tomography (CT), transbronchial biopsy, and bronchoalveolar lavage fluid (BALF) analysis. Typical CT findings in HABA include diffuse panbronchiolitis-like or bronchiectasis patterns, whereas cases with other abnormalities, including interstitial pneumonia, have also been reported. A high rate of polyclonal CD4+ and CD25+ lymphocytes is detected in BALF of patients with HABA, reflecting the infiltration of HTLV-1 infected T-cells in the lung. Current treatment options are not HABA specific, and include corticosteroids, macrolide antibiotics, and pirfenidone. Mitigation of the adverse effects of HTLV-1 infection requires the establishment of diagnostic criteria for the disease, screening programs for HABA in HTLV-1 infected individuals, and the development of effective disease treatment strategies.

Keywords: BALF; HABA; HAM/TSP; HTLV-I; bronchiectasis; panbronchiolitis.

MeSH terms

  • Adult
  • Bronchiolitis*
  • Diagnosis, Differential
  • HTLV-I Infections* / diagnosis
  • HTLV-I Infections* / pathology
  • Human T-lymphotropic virus 1*
  • Humans
  • Lung Diseases*