Rosadas Carolina, Taylor Graham P
Retrovirology and GU Medicine, Department of Medicine, Imperial College London, London, United Kingdom.
Front Microbiol. 2019 May 8;10:999. doi: 10.3389/fmicb.2019.00999. eCollection 2019.
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 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 infection during pregnancy and lactation. Whilst breast-feeding is strongly associated with transmission and avoidance of breast-feeding a proven intervention little is known about the mechanism of transmission from the breast milk to the infant and there have been no clinical trials of antiretroviral therapy (ARV) to prevent this route of transmission.
人类嗜T淋巴细胞病毒1型（HTLV-1）的母婴传播（MTCT）会导致终身感染。目前全球至少有500万至1000万人感染了HTLV-1。需要开展区域差异研究，以更好地了解母婴传播对全球感染负担的影响。虽然大多数感染者没有症状，但约10%的人会发展为高发病率、高死亡率的疾病。生命早期感染与疾病发展的风险较高相关。由HTLV-1引起的成人T细胞白血病（ATL），中位生存期为8个月，与母婴传播有关，实际上，成人感染后发生ATL的证据很少。感染性皮炎也仅在新生儿感染后发生。虽然HTLV-1相关脊髓病（HAM）可通过性传播和医源性感染，但约30%出现HAM/TSP的患者是通过其母亲感染的。HAM/TSP是一种致残性神经退行性疾病，会极大地影响患者的生活质量。迄今为止，除了针对ATL进行骨髓移植外，尚无治愈HTLV-1感染的方法，也没有任何措施可预防感染者发生HTLV-1相关疾病。在此背景下，预防母婴传播预计将对降低HTLV-1的发病率和HTLV-1相关疾病的负担做出巨大贡献。为了成功避免HTLV-1的母婴传播，了解这条感染途径中涉及的所有变量很重要。关于围产期传播的频率和危险因素仍存在疑问，而对于分娩前剖宫产减少这些感染的效果知之甚少。了解围产期感染对疾病负担的影响对于评估该领域干预措施的风险效益很重要。很少有研究探讨HTLV-1感染对生育力或妊娠结局的影响，也很少有研究探讨母亲在妊娠和哺乳期感染的易感性。虽然母乳喂养与传播密切相关，避免母乳喂养是一种已证实的干预措施，但对于母乳向婴儿传播的机制知之甚少，也没有关于抗逆转录病毒疗法（ARV）预防这种传播途径的临床试验。
