Page 24 - AIDSBK23C

Page 24

retention. Additional problems include back pain, constipation, sexual dysfunction, and lower
extremity sensory symptoms. The microscopic pathologic findings include chronic
meningomyelitis of white and grey matter with subsequent axonal degeneration that
preferentially affects the lower thoracic cord. There is perivascular and parenchymal infiltration
of T lymphocytes. Lesions become less cellular and more atrophic later in the course of the
disease.[110]
Laboratory findings with HTLV-1 include atypical lymphocytes seen on peripheral blood
films, hypergammaglobulinemia, and a false positive VDRL. Examination of CSF may reveal a
mild lymphocyte pleocytosis, a mild to moderately increased protein, and oligoclonal bands.
These findings usually are present in the first few years of disease, but they can persist as long as
10 years after symptom onset. HTLV-1 antibodies are found in the CSF, with higher titers in
symptomatic persons. TheHTLV-1 provirus can be demonstrated in the CSF of HAM/TSP
patients by PCR. Men are more likely to develop ATLL, while HAM/TSP is more common in
women.[110]
HTLV-2 was initially identified as an endemic infection in two distinct populations:
native peoples of the New World and pygmy tribes of Africa. However, most infections now
occur as a result of injection drug use, particularly in metropolitan areas of Europe, the U.S.,
South America, and Asia. There is no clear association between HTLV-2 and ATLL. Chronic
neurologic disease linked to HTLV-2 infection may include tropical spastic paraparesis,
progressive spastic myelopathy, spastic ataxia, spinocerebellar syndrome, and chronic
progressive neurologic disease.[111,112]
HTLV-3 and HTLV-4 agents have been identified in African populations. These agents
belong to the primate T lymphotropic virus group (PTLV). HTLV-1/2 commercial tests are used
for the detection of HTLV-3 and 4. Few cases have been discovered. The long latency of HTLV
will mean that decades can pass before the modes of transmission and pathologic effects become
characterized fully.[113]