Advances in the treatment of human T-cell lymphotropic virus type-I associated myelopathy

ABSTRACT

Introduction

Nearly 2–3% of those 10 to 20 million individuals infected with the Human T-cell lymphotropic virus type-1 (HTLV-1); are predisposed to developing HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). It is a neuro-inflammatory disease; differentiated from multiple sclerosis based on the presence of typical neurologic symptoms, confirmation of HTLV-1 infection, and other molecular biomarkers.

Areas covered

A brief review of the epidemiology, host immune responses, and molecular pathogenesis of HAM/TSP is followed by detailed discussions about the host-related risk factors for developing HAM/TSP and success/failure stories of the attempted management strategies.

Expert opinion

Currently, there is no effective treatment for HAM/TSP. Anti-retroviral therapy, peculiar cytokines (IFN-α), some anti-oxidants, and allograft bone marrow transplantation have been used for treating these patients with limited success. Under current conditions, asymptomatic carriers should be examined periodically by a neurologist for early signs of spinal cord injury. Then it is crucial to determine the progress rate to adapt the best management plan for each patient. Corticosteroid therapy is most beneficial in those with acute myelitis. However, slow-progressing patients are best managed using a combination of symptomatic and physical therapy. Additionally, preventive measures should be taken to decrease further spread of HTLV-1 infection.

KEYWORDS:

• Human T-cell lymphotropic virus type-I
• HAM/TSP risk factors
• HAM/TSP management
• tropical spastic paraparesis
• HTLV-1-associated myelopathy

Article highlights

• There is no cure for HAM/TSP.

• Preventive measures should be taken seriously to decrease HTLV-1 transmission.

• Corticosteroid therapy is more effective in managing rapidly progressing HAM/TSP.

• Symptomatic therapy should be an essential part of management plan for HAM/TSP patients.

• Anti-cholinergic drugs are useful for improving urinary symptoms.

• Antispastic agents are effective in relieving lower limb spasticity.

• Rehabilitation (exercise program, electrotherapeutic modalities, and massage) have shown promising effects on improving quality of life for HAM/TSP patients.

Declaration of interest

The authors are all employees of the Mashhad University of Medical Sciences, Mashhad, Iran. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.