FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

[READER'S HTLV-1 RELATED TO HIV, BUT MUCH LESS SERIOUS ]

Question: I have donated blood through the Red Cross for several years. I received a letter from them saying that I have HTLV-1 and should never donate blood again. My family doctor doesn't know anything about this infection. Can you give some information about it in your column?

Answer: The name HTLV-1 refers to a specific type of viral infection produced by the "Human T-cell Lymphocyte Virus type 1." HTLV - classifed as a "retrovirus" - is in the same biological category as the HIV virus. Fortunately, though, HTLV causes much less serious infections than its better known cousin, HIV.

The HTLV-1 virus was first identified in 1980, largely as a consequence of AIDS research. Some individuals who had cancers of the blood and immune system, specifically T-cell leukemias and lymphomas, had initial symptoms similar to AIDS. However, it was discovered that these people were infected with HTLV and not HIV. This led to the development of reliable blood tests that could readily distinquish between these two types of retrovirus infections. Researchers have now been able to identify several groups who have a high prevalence of infection.

Residents of Japan, the Caribbean basin, Melanesia and some areas of Africa have a high incidence of HTLV-1 infection. Further investigations showed that this virus sometimes produces a type of progressive nervous system disorder that causes problems with use of the muscles, particularly use of the legs and urinary bladder. This specific condition is called TSP/HAM. HTLV can also cause T-cell leukemia or lymphoma in some cases.

Now, that is the bad news about HTLV-1 infections. The good news is that it isn't as bleak as it sounds. Less than 1 percent of those with the virus develop the TSP/HAM condition, and only 2 to 4 percent develop T-cell leukemia or lymphoma. All of these illnesses have a very long latency period - perhaps 40 to 60 years - from the time of infection to the development of disease.

The HTLV infection can be acquired in several ways. It is passed from an infected mother to her baby 20 percent of the time. This transmission occurs through breast milk and, therefore, is easily avoided by bottle feeding the baby. This is a concern in the parts of the world where the infection is common, but not here in the United States.

HTLV can also be acquired in the same way as AIDS or hepatitis: intercourse with an infected partner, drug users sharing needles, or transfusions. To protect the public blood supply, blood banks routinely screen for this infection. Occasionally they identify an individual who has this, only 0.025 percent of all US donors are positive for this virus, just as happened to you. Though the risk of developing a serious illness as a consequence of HTLV infection from a blood transfusion is low, it is still an avoidable risk. That is why the Red Cross has told you to never give blood again.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.