Ishak Ricardo, Guimarães Ishak Marluísa de Oliveira, Azevedo Vânia Nakauth, Machado Luiz Fernando Almeida, Vallinoto Izaura Maria Cayres, Queiroz Maria Alice Freitas, Costa Greice de Lemos Cardoso, Guerreiro João Farias, Vallinoto Antonio Carlos Rosário
Laboratório de Virologia, Instituto de Ciências Biológicas, Universidade Federal do Pará, Rua Augusto Correa no.1, Guama, 66075-110, Belem, Para, Brazil.
Laboratório de Genética Humana e Médica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Rua Augusto Correa no.1, Guama, 66075-110, Belem, Para, Brazil.
Virus Evol. 2020 Jul 24;6(2):veaa053. doi: 10.1093/ve/veaa053. eCollection 2020 Jul.
The description of the first human retrovirus, human T-lymphotropic virus 1 (HTLV-1), was soon associated with an aggressive lymphoma and a chronic inflammatory neurodegenerative disease. Later, other associated clinical manifestations were described, affecting diverse target organs in the human body and showing the enormous burden carried by the virus and the associated diseases. The epidemiology of HTLV-1 and HTLV-2 showed that they were largely distributed around the world, although it is possible to locate geographical areas with pockets of low and very high prevalence and incidence. Aboriginal Australians and indigenous peoples of Brazil are examples of the large spread of HTLV-1 and HTLV-2, respectively. The epidemiological link of both situations is their occurrence among isolated, epidemiologically closed or semi-closed communities. The origin of the viruses in South America shows two different branches with distinct timing of entry. HTLV-1 made its probable entrance in a more recent route through the east coast of Brazil at the beginning of the slave trade from the African continent, starting in the 16th century and lasting for more than 350 years. HTLV-2 followed the ancient route of human migration from the Asian continent, crossing the Behring Strait and then splitting in South America as the population became separated by the Andes Mountains. By that time, HTLV-2c probably arose and became isolated among the indigenous populations in the Brazilian Amazon. The study of epidemiologically closed communities of indigenous populations in Brazil allowed tracing the most likely route of entry, the generation of a new molecular subtype (HTLV-2c), the elucidation of the vertical transmission of HTLV-2, the intrafamilial aggregation of cases and the escape and spread of the virus to other areas in Brazil and abroad. Despite the burden and impact of both viruses, they are maintained as silent infections among human populations because 1, health authorities in most South American countries in which national surveillance is poor have little interest in the disease, 2, the information is commonly lost as indigenous groups do not have specific policies for HTLV and other sexually transmitted infections, and 3, health access is not feasible or properly delivered.
首例人类逆转录病毒——人类嗜T淋巴细胞病毒1型(HTLV-1)的发现,很快便与侵袭性淋巴瘤及一种慢性炎症性神经退行性疾病联系在一起。后来,又发现了其他相关临床表现,这些表现影响人体的不同靶器官,显示出该病毒及相关疾病所带来的巨大负担。HTLV-1和HTLV-2的流行病学研究表明,它们在全球范围内广泛分布,不过在某些地理区域,其患病率和发病率存在低发区和高发区。澳大利亚原住民和巴西原住民分别是HTLV-1和HTLV-2广泛传播的典型例子。这两种情况在流行病学上的关联在于,它们都出现在孤立的、流行病学上封闭或半封闭的社区中。南美洲的这两种病毒起源呈现出两个不同分支,进入时间也有所不同。HTLV-1可能是在16世纪开始的、持续超过350年的非洲大陆奴隶贸易初期,通过巴西东海岸这条较新的路线传入的。HTLV-2则沿着人类从亚洲大陆迁徙的古老路线,穿过白令海峡,然后随着南美洲人口因安第斯山脉而分隔开来,在南美洲分化。那时,HTLV-2c可能已经出现,并在巴西亚马逊地区的原住民中隔离传播。对巴西原住民中流行病学上封闭的社区进行研究,有助于追踪最可能的病毒传入途径、新分子亚型(HTLV-2c)的产生、HTLV-2垂直传播的阐明、病例的家庭内聚集情况以及病毒向巴西其他地区和国外的传播扩散。尽管这两种病毒带来了负担和影响,但它们在人群中仍以潜伏感染的形式存在,原因如下:其一,在大多数国家监测不力的南美洲国家,卫生当局对这种疾病兴趣不大;其二,由于原住民群体没有针对HTLV及其他性传播感染的具体政策,相关信息常常丢失;其三,卫生服务无法实现或提供不当。