Publications
518 results found
Alagaratnam J, 2020, An observational study of initial HIV RNA decay following initiation of combination antiretroviral treatment during pregnancy, AIDS Research and Therapy, Vol: 17, Pages: 1-9, ISSN: 1742-6405
BackgroundIn pregnancy, reduction of HIV plasma viral load (pVL) for the prevention of vertical transmission is time-constrained. The study primary objective is to investigate factors associated with faster initial HIV RNA half-life decay when combination antiretroviral treatment (cART) is initiated in pregnancy.MethodsThis was a multicentre, retrospective, observational study, conducted in south England, United Kingdom, between August 2001 and February 2018. Data were extracted from case notes of eligible women initiating cART during the index pregnancy. Anonymised data were collated and analysed centrally. Regression analyses were conducted to determine factors associated with faster HIV RNA half-life decay in the first 14 days after commencing cART (first-phase), and with achieving an undetectable maternal pVL by 36 weeks’ gestation. We then assessed whether HIV- and obstetric- related parameters differed by antiretroviral third agent class and whether the proportions of women with undetectable pVL at 36 weeks’ gestation and at delivery differed by antiretroviral third agent class.ResultsBaseline pVL was the only independent factor associated with faster first-phase HIV RNA half-life decay on commencing cART. Lower pVL on day 14 after starting cART was associated with an increased likelihood of achieving an undetectable pVL by 36 weeks’ gestation. Integrase inhibitor-based cART was associated with a faster first-phase HIV RNA half-life decay on commencing cART. Overall, 73% and 85% of women had an undetectable pVL at 36 weeks’ gestation and at delivery respectively, with no significant difference by antiretroviral third agent class.ConclusionsOnly high baseline pVL independently contributed to a faster rate of first-phase viral half-life decay. pVL at 14 days after initiating cART allows early identification of treatment failure. In the first 14 days after initiating cART in pregnancy, integrase inhibitor-based cART reduced maternal pVL fa
Yamakawa N, Yagishita N, Matsuo T, et al., 2020, Creation and validation of a bladder dysfunction symptom score for HTLV-1-associated myelopathy/tropical spastic paraparesis, Orphanet Journal of Rare Diseases, Vol: 15, Pages: 175-175, ISSN: 1750-1172
BACKGROUND: Urinary dysfunction is one of the main features of human T-cell leukemia virus type 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). However, a comprehensive assessment of the severity is difficult because a standardized assessment measure is unavailable. Therefore, this study aimed to develop a novel symptom score for the assessment of urinary dysfunction in HAM/TSP. We interviewed 449 patients with HAM/TSP using four internationally validated questionnaires for assessment of urinary symptoms (27 question items in total): the International Prostate Symptom Score; the International Consultation on Incontinence Questionnaire-Short Form; the Overactive Bladder Symptom Score; and the Nocturia Quality-of-Life questionnaire. We developed a symptom score based on the data of 322 patients who did not use urinary catheters by selecting question items from questionnaires focused on descriptive statistics, correlation analysis, and exploratory factor analysis. The score distribution, reliability, and validity of the developed score were evaluated. RESULTS: First, 16 questions related to quality of life, situations, or subjective assessment were omitted from the 27 questions. Exploratory factor analysis revealed that the remaining 11 questions pertained to three factors: frequent urination, urinary incontinence, and voiding symptoms. Three questions, which had similar questions with larger factor loading, were deleted. Finally, we selected eight question items for inclusion in the novel score. The score distribution exhibited no ceiling or floor effect. The Cronbach's alpha (0.737) demonstrated reliable internal consistency. The new score comprised two subscales with acceptable factorial validity (inter-factor correlation coefficient, 0.322): storage symptoms (frequent urination plus urinary incontinence) and voiding symptoms. The correlation between each item and the subscales suggested acceptable construct validity. CONCLUSIONS: We developed a nove
Aanensen DM, Abudahab K, Adams A, et al., 2020, An integrated national scale SARS-CoV-2 genomic surveillance network, The Lancet Microbe, Vol: 1, Pages: E99-E100, ISSN: 2666-5247
Khan M, Tosswill J, Haddow J, et al., 2020, Virological and immunological evaluation of individuals with spontaneous persistent viral control without ART, Publisher: JOHN WILEY & SONS LTD, Pages: 2-3
Rowan AG, Dillon R, Witkover A, et al., 2020, Evolution of retrovirus-infected premalignant T-cell clones prior to Adult T-cell leukemia/lymphoma diagnosis, Blood, Vol: 135, Pages: 2023-2032, ISSN: 0006-4971
Adult T cell leukemia/lymphoma (ATL) is an aggressive hematological malignancy caused by Human T-cell leukemia virus type-1 (HTLV-1). ATL is preceded by decades of chronic HTLV-1 infection, and the tumors carry both somatic mutations and proviral DNA integrated into the tumor genome. In order to gain insight into the oncogenic process, we used targeted sequencing to track the evolution of the malignant clone in six individuals, 2-10 years before the diagnosis of ATL. Clones of premalignant HTLV-1-infected cells bearing known driver mutations were detected in the blood up to 10 years before individuals developed acute and lymphoma subtype ATL. Six months before diagnosis, the total number and variant allele fraction of mutations increased in the blood. Peripheral blood mononuclear cells from premalignant cases (1 year pre-diagnosis) had significantly higher mutational burden in genes frequently mutated in ATL than did high risk, age-matched HTLV-1-carriers who remained ATL-free after a median of 10 years of follow up. These data show that HTLV-1-infected T cell clones carrying key oncogenic driver mutations can be detected in cases of ATL years before the onset of symptoms. Early detection of such mutations may enable earlier and more effective intervention to prevent the development of ATL.
Cassar O, Desrames A, Marçais A, et al., 2020, Multiple recombinant events in human T-Cell leukemia virus type 1: complete sequences of recombinant African strains., Emerging Microbes and Infections, Vol: 9, Pages: 913-923, ISSN: 2222-1751
Africa is the largest known endemic area for HTLV-1, with a high diversity of molecular genotypes. We previously demonstrated that some HTLV-1 strains from North Africa (the a-NA clade) are the result of a recombinant event between Senegalese and West African strains. To better characterize these recombinants and their distribution, we sequenced the LTR region and/or a env gene fragment of a series of 52 HTLV-1 strains from 13 different countries in North and West Africa. Four samples from descendants of African slaves and native to French Guiana were also added. Furthermore, we characterized the complete sequence for 7 viral strains, from the different genotypes. Until now, no complete sequence was available for a-NA clade. Phylogenetic analysis demonstrates that most of the new African strains belong to the Cosmopolitan a-genotype. Ten new strains from the recombinant North African (a-NA) clade could be found in Morocco, Western Sahara, Mali, Guinea, Côte d'Ivoire, and Ghana. We also identified a new clade (named a-G-Rec) comprising 4 strains from Guinea and Ghana that arose from a distinct recombination event between strains from Senegal and West Africa. The analyses of complete sequences suggest that recombination does not only occur in the LTR but also in other regions (env/pol) of the genome. Our data strongly suggest that a-NA and a-G-Rec strains have a mosaic profile with genetic segments deriving from either a-WA or a-Sen strains. In conclusion, our work demonstrates that recombination in HTLV-1 may not be such a rare event as previously proposed.
Saeed Z, Rowan A, Greiller C, et al., 2020, Enhanced T-cell maturation and monocyte aggregation are features of cellular inflammation in human T-lymphotropic virus type-1-associated myelopathy, Clinical Infectious Diseases, Vol: 70, Pages: 1326-1335, ISSN: 1058-4838
BackgroundHuman T-lymphotropic virus type-1 (HTLV-1) associated myelopathy (HAM), is an inflammatory condition characterised by severe disability and high levels of infected white blood cells. The circulating cellular inflammatory changes that distinguish this condition from asymptomatic infection are not well understood.MethodsTo investigate the immune characteristics of individuals with low or high HTLV-1 proviral load (pVL), symptomatic disease and the impact of immunosuppressive therapy, thirty-eight women living with HTLV-1 infection, with a median age 59 (52-68) years were studied. Nineteen were asymptomatic carriers, with low or high pVL, and nineteen were diagnosed with HAM, with ten receiving anti-inflammatory therapy. Peripheral blood mononuclear cells were stained and analysed for frequency distribution and activation of innate and adaptive immune cell subsets using multi-parameter flow cytometry.ResultsInflation of the CD4:CD8 ratio (>2) was observed amongst all groups irrespective of pVL. The frequency of naïve CD4+ T-cells correlated inversely with HTLV-1 pVL (rs=-0.344, p=0.026). Mature TEM CD4+ T-cells were expanded in patients with untreated HAM compared with asymptomatic carriers (p<0.001), but less so in those on therapy. High levels of exhausted (PD-1+) and senescent (CD28null) CD4+ and CD8+ T-cells were observed in all individuals particularly in those with HAM, whilst monocytes showed increased aggregation, and CD14+CD56- monocytes were less frequent.ConclusionsCD4:CD8 ratio inflation is a feature of HTLV-1 infection, whereas enhanced CD4+ T-cell maturation and monocyte aggregation are features of HAM reflecting widespread inflammatory change, which may be detectable pre-symptomatically, and be amenable to anti-inflammatory treatment.
Wolf S, Haddow J, Greiller C, et al., 2020, Finding the five percent: predicting adult T-cell leukaemia/lymphoma (ATLL) in human T-cell leukaemia virus-1 (HTLV-1) carriers using a novel flow cytometric method, 60th Annual Scientific Meeting of the British-Society-for-Haematology (BSH), Publisher: WILEY, Pages: 105-106, ISSN: 0007-1048
Araujo A, Bangham CRM, Casseb J, et al., 2020, The management of HAM/TSP: Systematic review and consensus-based recommendations 2019, Neurology: Clinical Practice, Vol: 11, Pages: 49-56, ISSN: 2163-0402
Purpose of Review: To provide an evidence-based approach to the use of therapies that are prescribed to improve the natural history of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) – a rare disease.Recent Findings: All 41 articles on the clinical outcome of disease-modifying therapy for HAM/TSP were included in a systematic review by members of the International Retrovirology Association; we report here the consensus assessment and recommendations. The quality of available evidence is low, being based for the most part on observational studies, with only one double-masked placebo-controlled randomised trial. Summary: There is evidence to support the use of both high-dose pulsed methyl prednisolone for induction and low-dose (5mg) oral prednisolone as maintenance therapy for progressive disease. There is no evidence to support the use of antiretroviral therapy. There is insufficient evidence to support the use of interferon-α as a first-line therapy.
Rosadas C, Puccioni-Sohler M, Oliveira AP, et al., 2020, Adult T-cell leukaemia/lymphoma in Brazil: a rare disease or rarely diagnosed?, British Journal of Haematology, Vol: 188, Pages: e46-e49, ISSN: 1365-2141
Cook LMB, Taylor GP, 2020, HTLV-1: The silent impact revealed, Lancet Infectious Diseases, Vol: 20, Pages: 12-14, ISSN: 1473-3099
Cook L, Demontis MA, Sagawe S, et al., 2019, Molecular remissions are observed in chronic adult T cell leukemia/lymphoma in patients treated with mogamulizumab, Haematologica, Vol: 104, Pages: e566-e569, ISSN: 0390-6078
Woo T, Rosadas C, Ijaz S, et al., 2019, Noninvasive detection of antibodies to human T-Cell lymphotropic virus Types 1 and 2 by use of oral fluid, Journal of Clinical Microbiology, Vol: 57, Pages: 1-11, ISSN: 0095-1137
Human T-lymphotropic viruses type 1 and 2 (HTLV-1/2) are prevalent in endemic clusters globally, and HTLV-1 infects at least 5 to 10 million individuals. Infection can lead to inflammation in the spinal cord, resulting in HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), or adult T cell leukaemia/lymphoma (ATL). Obtaining venous blood for serological screening, typically performed using enzyme immunoassays (EIAs), is invasive, sometimes socially unacceptable and has restricted large-scale seroprevalence studies. Collecting oral fluid (OF) is a non-invasive alternative to venesection. In this study an IgG antibody-capture EIA was developed and validated to detect anti-HTLV-1/2 IgG in OF. OF and plasma specimens were obtained from seropositive HTLV-1/2-infected patients attending the National Centre for Human Retrovirology (n = 131) and from HTLV-1/2 uninfected individuals (n = 64). The assay showed good reproducibility and high diagnostic sensitivity (100%) and specificity (100%) using both OF and plasma. The Murex HTLV I+II commercial assay was evaluated and did not detect anti-HTLV-1/2 IgG in 14% (5/36) of OF specimens from seropositive donors. The reactivities of OF and plasma in the IgG-capture correlated strongly (r = 0.9290) and were not significantly affected by delayed extraction when held between 3°C and 45°C for up to 7 days to simulate field testing. The use of OF serological screening for HTLV-1/2 infection could facilitate large-scale seroprevalence studies enabling active surveillance of infection on a population level.
Bukkems V, Bollen P, Freriksen J, et al., 2019, No evidence for induced glucuronidation of dolutegravir in HIV-infected pregnant women, Publisher: WILEY, Pages: 205-205, ISSN: 1464-2662
Cole M, Saeed Z, Shaw A, et al., 2019, Responses to quadrivalent influenza vaccine reveal distinct circulating CD4+CXCR5+ T cell subsets in men living with HIV, Scientific Reports, Vol: 9, ISSN: 2045-2322
T cell help for B cells may be perturbed in people living with HIV (PLWH), even when HIV is suppressed, as evidenced by reports of suboptimal responses to influenza vaccination. We investigated cTFH responses to the 2017–18 inactivated quadrivalent influenza vaccine (QIV) in men living with antiretroviral therapy (ART)-suppressed HIV infection who were treated in the early or chronic phase of infection, and control subjects. Here we show that seroprotective antibody responses in serum and oral fluid correlated with cTFH activation and were equivalent in all three groups, irrespective of when ART was started. These responses were attenuated in those reporting immunisation with influenza vaccine in the preceding three years, independent of HIV infection. Measurement of influenza-specific IgG in oral fluid was closely correlated with haemagglutination inhibition titre. T-SNE and two-dimensional analysis revealed a subset of CD4+CXCR3+CXCR5+ cTFH activated at one week after vaccination. This was distinguishable from cTFH not activated by vaccination, and a rare, effector memory CD4+CXCR5hiCD32hi T cell subset. The data support the use of QIV for immunisation of PLWH, reveal distinct circulating CD4+CXCR5+ T cell subsets and demonstrate oral fluid sampling for influenza-specific IgG is an alternative to phlebotomy.
Rosadas C, Tosswill JH, Tedder R, et al., 2019, Pregnancy does not adversely impact diagnostic tests for HTLV-1/2 infection, PLoS Neglected Tropical Diseases, Vol: 13, ISSN: 1935-2727
Mother-to-child-transmission (MTCT) of human T-cell lymphotropic virus type-1(HTLV-1) contributes disproportionately to the burden of HTLV-1 associated diseases. All preventive measures to avoid MTCT rely on the identification of infected mothers. However, the impact of pregnancy on HTLV-1 diagnosis has not been clearly assessed. Paired samples from 21 HTLV-1 infected women taken during pregnancy and while not pregnant were analysed by CMIA and PCR. The signal-to-cut-off values (S/CO) were higher during pregnancy than in the paired non-pregnant samples. HTLV-1 proviral load did not alter significantly by pregnant state. S/CO positively correlated with HTLV proviral load. Pregnancy does not impair the diagnosis of HTLV-1/2, by either immunological (CMIA) or molecular (qPCR/nPCR) tests.
Ferretti F, Mackie NE, Singh GKJ, et al., 2019, Characterization of low level viraemia in HIV-infected patients receiving boosted protease inhibitor-based antiretroviral regimens, HIV RESEARCH & CLINICAL PRACTICE, Vol: 20, Pages: 107-110, ISSN: 2578-7489
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Caswell RJ, Nall P, Boothby M, et al., 2019, Rapid onset and progression of myelopathy following an STI: a case for screening?, SEXUALLY TRANSMITTED INFECTIONS, Vol: 95, Pages: 244-245, ISSN: 1368-4973
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Rosadas C, Taylor GP, 2019, Mother-to-child HTLV-1 transmission: unmet research needs, Frontiers in Microbiology, Vol: 10, ISSN: 1664-302X
Mother-to-child transmission (MTCT) of Human T-cell lymphotropic virus type 1 (HTLV-1) causes lifelong infection. At least 5–10 million individuals worldwide are currently living with HTLV-1. Studies of regional variation are required to better understand the contribution of MTCT to the global burden of infection. Although most infected individuals remain asymptomatic ∼10% develop high morbidity, high mortality disease. Infection early in life is associated with a higher risk of disease development. Adult T-cell leukemia (ATL), which is caused by HTLV-1 and has a median survival of 8 months is linked to MTCT, indeed evidence of ATL following infection as an adult is sparse. Infective dermatitis also only occurs following neonatal infection. Whilst HTLV-1-associated myelopathy (HAM) follows sexual and iatrogenic infection approximately 30% of patients presenting with HAM/TSP acquired the infection through their mothers. HAM/TSP is a disabling neurodegenerative disease that greatly impact patient’s quality of life. To date there is no cure for HTLV-1 infection other than bone marrow transplantation for ATL nor any measure to prevent HTLV-1 associated diseases in an infected individual. In this context, prevention of MTCT is expected to contribute disproportionately to reducing both the incidence of HTLV-1 and the burden of HTLV-1 associated diseases. In order to successfully avoid HTLV-1 MTCT, it is important to understand all the variables involved in this route of infection. Questions remain regarding frequency and risk factors for in utero peri-partum transmission whilst little is known about the efficacy of pre-labor cesarean section to reduce these infections. Understanding the contribution of peripartum infection to the burden of disease will be important to gauge the risk-benefit of interventions in this area. Few studies have examined the impact of HTLV-1 infection on fertility or pregnancy outcomes nor the susceptibility of the mother to infec
Phillips AA, Fields PA, Hermine O, et al., 2019, Mogamulizumab versus investigator choice of chemotherapy regimen in relapsed/refractory adult T-cell leukemia/lymphoma, Haematologica, Vol: 104, Pages: 993-1003, ISSN: 0390-6078
Mogamulizumab, a humanized defucosylated anti C-C chemokine receptor 4 monoclonal antibody, has been approved in Japan for the treatment of C-C chemokine receptor 4-positive adult T-cell leukemia/lymphoma. This phase 2 study evaluated efficacy and safety of mogamulizumab in adult T-cell leukemia/lymphoma patients with acute, lymphoma, and chronic subtypes with relapsed/refractory, aggressive disease in the United States, Europe, and Latin America. With stratification by subtype, patients were randomized 2:1 to intravenous mogamulizumab 1.0 mg/kg once weekly for 4 weeks and biweekly thereafter (n = 47) or investigator choice of chemotherapy (n = 24). The primary endpoint, overall response rate confirmed on a subsequent assessment at 8 weeks by blinded independent review, was 11% (95% CI, 4% to 23%) and 0% (95% CI, 0% to 14%) in the mogamulizumab and chemotherapy arms, respectively. Best response was 28% and 8% in the respective arms. The observed hazard ratio for progression-free survival was 0.71 (95% CI, 0.41-1.21) and, after post hoc adjustment for performance status imbalance, 0.57 (95% CI, 0.337-0.983). The most frequent treatment-related adverse events grade ≥3 with mogamulizumab were infusion-related reaction and thrombocytopenia (each 9%). Relapsed/refractory adult T-cell leukemia/lymphoma is an aggressive, poor prognosis disease with a high unmet need. Investigator choice chemotherapy did not result in tumor response in this trial; however, mogamulizumab treatment resulted in 11% confirmed overall response rate, with a tolerable safety profile. This trial was registered at www.clinicaltrials.gov as NCT01626664.
Tang AR, Taylor G, Dhasmana D, 2019, Self-flagellation as a possible route of Human T-cell Lymphotropic virus type 1 transmission, Emerging Infectious Diseases, Vol: 25, Pages: 811-813, ISSN: 1080-6040
We report human T-cell lymphotropic virus type 1 infection associated with self-flagellation in 10 UK residents. These persons were heterosexual men from Pakistan, India, and Iraq. One person showed seroconversion in adulthood; 1 was co-infected with hepatitis C virus. No other risk factors for bloodborne virus acquisition were identified. Onward sexual transmission has occurred.
Subramanian K, Dierckx T, Khouri R, et al., 2019, Decreased RORC expression and downstream signaling in HTLV-1-associated Adult T-cell Lymphoma/Leukemia uncovers an antiproliferative IL17 link: a potential target for immunotherapy?, International Journal of Cancer, Vol: 144, Pages: 1664-1675, ISSN: 0020-7136
Retinoic acid-related drugs have shown promising pre-clinical activity in Adult T-cell Leukemia/Lymphoma, but RORC signaling has not been explored. Therefore, we investigated transcriptome-wide interactions of the RORC pathway in HTLV-1 and ATL, using our own and publicly available gene expression data for ATL and other leukemias. Gene expression data from ATL patients were analyzed using WGCNA to determine gene modules and their correlation to clinical and molecular data. Both PBMCs and CD4+ T-cells showed decreased RORC expression in four different ATL cohorts. A small subset of RORChi ATL patients was identified with significantly lower pathognomonic CADM1 and HBZ levels but similar levels of other ATL markers (CD4/CD25/CCR4), hinting at a less aggressive ATL subtype. An age-dependent decrease in RORC expression was found in HTLV-1-infected individuals, but not in healthy controls, suggesting an early molecular event predisposing to leukemogenesis. Genes upstream of RORC signaling were members of a proliferative gene module (containing proliferation markers PCNA/Ki67), whereas downstream members clustered in an anti-proliferative gene module. IL17C transcripts showed the strongest negative correlation to PCNA in both ATL cohorts, which was replicated in two large cohorts of T- and B-cell acute lymphoid leukemia (ALL). Finally, IL17C expression in purified CD4+CCR4+CD26-CD7- 'ATL-like' cells from HTLV-1-infected individuals and ATL patients was negatively correlated with clonality, underscoring a possible antileukemic/antiproliferative role. In conclusion, decreased RORC expression and downstream signaling might represent an early event in ATL pathogenesis. An antiproliferative IL17C/PCNA link is shared between ATL, T-ALL and B-ALL, suggesting (immuno)therapeutic benefit of boosting RORC/IL17 signaling.
Prendergast AJ, Goga AE, Waitt C, et al., 2019, Transmission of CMV, HTLV-1, and HIV through breastmilk, Lancet Child and Adolescent Health, Vol: 3, Pages: 264-273, ISSN: 2352-4642
Breastfeeding is a crucial child survival intervention. However, the potential for transmission of viral infections from mother to child presents the dilemma of how best to interpret the benefits and risks of breastfeeding in different settings. In this Review, we compare the transmission dynamics, risk factors, and outcomes of infection with three chronic viruses transmitted through breastmilk: cytomegalovirus, human T-cell lymphotropic virus type 1, and HIV. We provide an overview of intervention approaches and discuss scientific, policy, and programming gaps in the understanding of these major global infections.
Cole M, Saeed Z, Shaw AT, et al., 2019, Responses to quadrivalent influenza vaccine reveal the landscape of CD32 expression on circulating T-follicular helper cells in men living with HIV infection, Publisher: WILEY, Pages: 25-25, ISSN: 1464-2662
Cole M, Saeed Z, Shaw AT, et al., 2019, Equivalent responses to quadrivalent influenza vaccine are detectable in blood and oral fluid in healthcare workers and men living with HIV on ART, Publisher: WILEY, Pages: 10-10, ISSN: 1464-2662
Cook LB, Fuji S, Hermine O, et al., 2019, Revised adult T-cell Leukemia-Lymphoma international consensus meeting report, Journal of Clinical Oncology, Vol: 37, Pages: 677-687, ISSN: 0732-183X
PURPOSE: Adult T-cell leukemia-lymphoma (ATL) is a distinct mature T-cell malignancy caused by chronic infection with human T-lymphotropic virus type 1 with diverse clinical features and prognosis. ATL remains a challenging disease as a result of its diverse clinical features, multidrug resistance of malignant cells, frequent large tumor burden, hypercalcemia, and/or frequent opportunistic infection. In 2009, we published a consensus report to define prognostic factors, clinical subclassifications, treatment strategies, and response criteria. The 2009 consensus report has become the standard reference for clinical trials in ATL and a guide for clinical management. Since the last consensus there has been progress in the understanding of the molecular pathophysiology of ATL and risk-adapted treatment approaches. METHODS: Reflecting these advances, ATL researchers and clinicians joined together at the 18th International Conference on Human Retrovirology-Human T-Lymphotropic Virus and Related Retroviruses-in Tokyo, Japan, March, 2017, to review evidence for current clinical practice and to update the consensus with a new focus on the subtype classification of cutaneous ATL, CNS lesions in aggressive ATL, management of elderly or transplantation-ineligible patients, and treatment strategies that incorporate up-front allogeneic hematopoietic stem-cell transplantation and novel agents. RESULTS: As a result of lower-quality clinical evidence, a best practice approach was adopted and consensus statements agreed on by coauthors (> 90% agreement). CONCLUSION: This expert consensus highlights the need for additional clinical trials to develop novel standard therapies for the treatment of ATL.
Cook L, Demontis MA, Sagawe S, et al., 2019, Molecular remissions are observed in chronic adult T-cell leukaemia/lymphoma in patients treated with mogamulizumab, BRITISH JOURNAL OF HAEMATOLOGY, Vol: 185, Pages: 172-173, ISSN: 0007-1048
Malik B, Taylor GP, 2019, Can we reduce the incidence of adult T-cell leukaemia/lymphoma? Cost-effectiveness of human T-lymphotropic virus type 1 (HTLV-1) antenatal screening in the United Kingdom, British Journal of Haematology, Vol: 184, Pages: 1040-1043, ISSN: 1365-2141
van Tienen C, Visser O, Lugtenberg P, et al., 2019, Overrepresentation of patients from HTLV-1 endemic countries among T cell Non-Hodgkin lymphomas in the Netherlands: an indication of under-diagnosis of Adult T cell leukaemia/lymphoma, British Journal of Haematology, Vol: 184, Pages: 688-689, ISSN: 1365-2141
Prendergast AJ, Goga AE, Waitt C, et al., 2019, Viral infections transmitted through breast milk: science, policy and unknowns, Lancet Child and Adolescent Health, ISSN: 2352-4642
Breastfeeding is a critical child survival intervention. The potential for transmission of some viral infections from mother-to-child, however, presents the dilemma of how best to interpret the benefits and risks of breastfeeding in different settings. Here, we compare the transmission dynamics, risk factors and outcomes of infection with three chronic viruses transmitted through breast milk: cytomegalovirus (CMV), human T-cell lymphotropic virus type 1 (HTLV-1), and human immunodeficiency virus (HIV). We provide an overview of current intervention approaches and discuss scientific, policy and programming gaps in our understanding of these major global infections.
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