Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Human T-lymphotropic virus type I: Disease associations, diagnosis, and treatment

David T Scadden, MD
Andrew R Freedman, FRCP
Paul Robertson, MRCP, FRCPath
Section Editor
Martin S Hirsch, MD
Deputy Editor
Allyson Bloom, MD


The human T-lymphotropic virus type I (HTLV-I) is a retrovirus that infects 10 to 20 million people worldwide, as estimated by seroprevalence studies. However, HTLV-I is associated with disease in only approximately 5 percent of infected individuals [1,2].

The diagnosis and treatment of HTLV-I infection and what is known about the disease associations will be reviewed here. The virology, pathogenesis, and epidemiology of HTLV-I are discussed separately. (See "Human T-lymphotropic virus type I: Virology, pathogenesis, and epidemiology".)


The majority of HTLV-I-infected individuals will remain asymptomatic, but there are two well-recognized disease associations caused by the virus:

Adult T cell leukemia-lymphoma (ATL)

HTLV-I-associated myelopathy (HAM), also known as tropical spastic paraparesis (TSP).


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Feb 16, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Kaplan JE, Osame M, Kubota H, et al. The risk of development of HTLV-I-associated myelopathy/tropical spastic paraparesis among persons infected with HTLV-I. J Acquir Immune Defic Syndr 1990; 3:1096.
  2. Cleghorn FR, Manns A, Falk R, et al. Effect of human T-lymphotropic virus type I infection on non-Hodgkin's lymphoma incidence. J Natl Cancer Inst 1995; 87:1009.
  3. Poiesz BJ, Ruscetti FW, Gazdar AF, et al. Detection and isolation of type C retrovirus particles from fresh and cultured lymphocytes of a patient with cutaneous T-cell lymphoma. Proc Natl Acad Sci U S A 1980; 77:7415.
  4. Kondo T, Kono H, Miyamoto N, et al. Age- and sex-specific cumulative rate and risk of ATLL for HTLV-I carriers. Int J Cancer 1989; 43:1061.
  5. Shimoyama M. Diagnostic criteria and classification of clinical subtypes of adult T-cell leukaemia-lymphoma. A report from the Lymphoma Study Group (1984-87). Br J Haematol 1991; 79:428.
  6. Kamihira S, Atogami S, Sohda H, et al. Significance of soluble interleukin-2 receptor levels for evaluation of the progression of adult T-cell leukemia. Cancer 1994; 73:2753.
  7. Araki K, Harada K, Nakamoto K, et al. Clinical significance of serum soluble IL-2R levels in patients with adult T cell leukaemia (ATL) and HTLV-1 carriers. Clin Exp Immunol 2000; 119:259.
  8. Fujiwara H, Arima N, Ohtsubo H, et al. Clinical significance of serum neuron-specific enolase in patients with adult T-cell leukemia. Am J Hematol 2002; 71:80.
  9. Tsukasaki K, Utsunomiya A, Fukuda H, et al. VCAP-AMP-VECP compared with biweekly CHOP for adult T-cell leukemia-lymphoma: Japan Clinical Oncology Group Study JCOG9801. J Clin Oncol 2007; 25:5458.
  10. Obama K, Tara M, Sao H, et al. Allogenic bone marrow transplantation as a treatment for adult T-cell leukemia. Int J Hematol 1999; 69:203.
  11. Gill PS, Harrington W Jr, Kaplan MH, et al. Treatment of adult T-cell leukemia-lymphoma with a combination of interferon alfa and zidovudine. N Engl J Med 1995; 332:1744.
  12. CRUICKSHANK EK. A neuropathic syndrome of uncertain origin; review of 100 cases. West Indian Med J 1956; 5:147.
  13. Gessain A, Barin F, Vernant JC, et al. Antibodies to human T-lymphotropic virus type-I in patients with tropical spastic paraparesis. Lancet 1985; 2:407.
  14. Gessain A, Francis H, Sonan T, et al. HTLV-I and tropical spastic paraparesis in Africa. Lancet 1986; 2:698.
  15. Osame M, Usuku K, Izumo S, et al. HTLV-I associated myelopathy, a new clinical entity. Lancet 1986; 1:1031.
  16. Maloney EM, Cleghorn FR, Morgan OS, et al. Incidence of HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in Jamaica and Trinidad. J Acquir Immune Defic Syndr Hum Retrovirol 1998; 17:167.
  17. Orland JR, Engstrom J, Fridey J, et al. Prevalence and clinical features of HTLV neurologic disease in the HTLV Outcomes Study. Neurology 2003; 61:1588.
  18. Yoshida M, Osame M, Kawai H, et al. Increased replication of HTLV-I in HTLV-I-associated myelopathy. Ann Neurol 1989; 26:331.
  19. Sabouri AH, Saito M, Lloyd AL, et al. Polymorphism in the interleukin-10 promoter affects both provirus load and the risk of human T lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis. J Infect Dis 2004; 190:1279.
  20. Treviño A, Lopez M, Vispo E, et al. Development of tropical spastic paraparesis in human T-lymphotropic virus type 1 carriers is influenced by interleukin 28B gene polymorphisms. Clin Infect Dis 2012; 55:e1.
  21. Nakagawa M, Izumo S, Ijichi S, et al. HTLV-I-associated myelopathy: analysis of 213 patients based on clinical features and laboratory findings. J Neurovirol 1995; 1:50.
  22. Gotuzzo E, Cabrera J, Deza L, et al. Clinical characteristics of patients in Peru with human T cell lymphotropic virus type 1-associated tropical spastic paraparesis. Clin Infect Dis 2004; 39:939.
  23. Castro NM, Rodrigues W Jr, Freitas DM, et al. Urinary symptoms associated with human T-cell lymphotropic virus type I infection: evidence of urinary manifestations in large group of HTLV-I carriers. Urology 2007; 69:813.
  24. WHO. Virus diseases: Human T lymphotropic virus type I, HTLV-I. Wkly Epidemiol Rec 1989; 64:382.
  25. Lezin A, Olindo S, Oliere S, et al. Human T lymphotropic virus type I (HTLV-I) proviral load in cerebrospinal fluid: a new criterion for the diagnosis of HTLV-I-associated myelopathy/tropical spastic paraparesis? J Infect Dis 2005; 191:1830.
  26. Melo A, Moura L, Rios S, et al. Magnetic resonance imaging in HTLV-I associated myelopathy. Arq Neuropsiquiatr 1993; 51:329.
  27. Kira J, Fujihara K, Itoyama Y, et al. Leukoencephalopathy in HTLV-I-associated myelopathy/tropical spastic paraparesis: MRI analysis and a two year follow-up study after corticosteroid therapy. J Neurol Sci 1991; 106:41.
  28. Milagres AC, Jorge ML, Marchiori PE, Segurado AA. Human T cell lymphotropic virus type 1-associated myelopathy in São Paulo, Brazil. Epidemiologic and clinical features of a university hospital cohort. Neuroepidemiology 2002; 21:153.
  29. Takenouchi N, Yamano Y, Usuku K, et al. Usefulness of proviral load measurement for monitoring of disease activity in individual patients with human T-lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis. J Neurovirol 2003; 9:29.
  30. Nakagawa M, Nakahara K, Maruyama Y, et al. Therapeutic trials in 200 patients with HTLV-I-associated myelopathy/ tropical spastic paraparesis. J Neurovirol 1996; 2:345.
  31. Croda MG, de Oliveira AC, Vergara MP, et al. Corticosteroid therapy in TSP/HAM patients: the results from a 10 years open cohort. J Neurol Sci 2008; 269:133.
  32. Araújo AQ, Afonso CR, Leite AC, Dultra SV. Intravenous methylprednisolone in HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP). Arq Neuropsiquiatr 1993; 51:325.
  33. Harrington WJ Jr, Sheremata WA, Snodgrass SR, et al. Tropical spastic paraparesis/HTLV-1-associated myelopathy (TSP/HAM): treatment with an anabolic steroid danazol. AIDS Res Hum Retroviruses 1991; 7:1031.
  34. Oh U, Yamano Y, Mora CA, et al. Interferon-beta1a therapy in human T-lymphotropic virus type I-associated neurologic disease. Ann Neurol 2005; 57:526.
  35. Olindo S, Cabre P, Lézin A, et al. Natural history of human T-lymphotropic virus 1-associated myelopathy: a 14-year follow-up study. Arch Neurol 2006; 63:1560.
  36. Leite AC, Mendonça GA, Serpa MJ, et al. Neurological manifestations in HTLV-I-infected blood donors. J Neurol Sci 2003; 214:49.
  37. Silva MT, Harab RC, Leite AC, et al. Human T lymphotropic virus type 1 (HTLV-1) proviral load in asymptomatic carriers, HTLV-1-associated myelopathy/tropical spastic paraparesis, and other neurological abnormalities associated with HTLV-1 infection. Clin Infect Dis 2007; 44:689.
  38. Biswas HH, Engstrom JW, Kaidarova Z, et al. Neurologic abnormalities in HTLV-I- and HTLV-II-infected individuals without overt myelopathy. Neurology 2009; 73:781.
  39. Tanajura D, Castro N, Oliveira P, et al. Neurological Manifestations in Human T-Cell Lymphotropic Virus Type 1 (HTLV-1)-Infected Individuals Without HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis: A Longitudinal Cohort Study. Clin Infect Dis 2015; 61:49.
  40. Sweet RD. A pattern of eczema in Jamaica. Br J Dermatol 1966; 78:93.
  41. LaGrenade L, Hanchard B, Fletcher V, et al. Infective dermatitis of Jamaican children: a marker for HTLV-I infection. Lancet 1990; 336:1345.
  42. La Grenade L, Manns A, Fletcher V, et al. Clinical, pathologic, and immunologic features of human T-lymphotrophic virus type I-associated infective dermatitis in children. Arch Dermatol 1998; 134:439.
  43. de Oliveira Mde F, Fatal PL, Primo JR, et al. Infective dermatitis associated with human T-cell lymphotropic virus type 1: evaluation of 42 cases observed in Bahia, Brazil. Clin Infect Dis 2012; 54:1714.
  44. Ohba N, Matsumoto M, Sameshima M, et al. Ocular manifestations in patients infected with human T-lymphotropic virus type I. Jpn J Ophthalmol 1989; 33:1.
  45. Mochizuki M, Tajima K, Watanabe T, Yamaguchi K. Human T lymphotropic virus type 1 uveitis. Br J Ophthalmol 1994; 78:149.
  46. Nishioka K, Maruyama I, Sato K, et al. Chronic inflammatory arthropathy associated with HTLV-I. Lancet 1989; 1:441.
  47. Nakamura H, Eguchi K, Nakamura T, et al. High prevalence of Sjögren's syndrome in patients with HTLV-I associated myelopathy. Ann Rheum Dis 1997; 56:167.
  48. Morgan OS, Rodgers-Johnson P, Mora C, Char G. HTLV-1 and polymyositis in Jamaica. Lancet 1989; 2:1184.
  49. Sugimoto M, Nakashima H, Watanabe S, et al. T-lymphocyte alveolitis in HTLV-I-associated myelopathy. Lancet 1987; 2:1220.
  50. Ono K, Shimamoto Y, Matsuzaki M, et al. Diffuse panbronchiolitis as a pulmonary complication in patients with adult T-cell leukemia. Am J Hematol 1989; 30:86.
  51. Kadota J, Mukae H, Fujii T, et al. Clinical similarities and differences between human T-cell lymphotropic virus type 1-associated bronchiolitis and diffuse panbronchiolitis. Chest 2004; 125:1239.
  52. Fujii M, Sumi Y, Atarashi K, et al. Muscle weakness in extremities and diffuse centrilobular nodules in lungs. HTLV-1-associated bronchiolo-alveolar disorder. Thorax 2011; 66:546.
  53. Okada F, Ando Y, Yoshitake S, et al. Pulmonary CT findings in 320 carriers of human T-lymphotropic virus type 1. Radiology 2006; 240:559.
  54. Yamashiro T, Kamiya H, Miyara T, et al. CT scans of the chest in carriers of human T-cell lymphotropic virus type 1: presence of interstitial pneumonia. Acad Radiol 2012; 19:952.
  55. Einsiedel L, Fernandes L, Spelman T, et al. Bronchiectasis is associated with human T-lymphotropic virus 1 infection in an Indigenous Australian population. Clin Infect Dis 2012; 54:43.
  56. Honarbakhsh S, Taylor GP. High prevalence of bronchiectasis is linked to HTLV-1-associated inflammatory disease. BMC Infect Dis 2015; 15:258.
  57. Matsushita K, Ozaki A, Arima N, Tei C. Human T-lymphotropic virus type I infection and idiopathic thrombocytopnic purpura. Hematology 2005; 10:95.
  58. Matsumoto S, Yamasaki K, Tsuji K, Shirahama S. Human T lymphotropic virus type 1 infection and gastric cancer development in Japan. J Infect Dis 2008; 198:10.
  59. Isomoto H, Mizuta Y, Fukushima K, et al. Low prevalence of Helicobacter pylori in individuals with HTLV-I infection. Eur J Gastroenterol Hepatol 1999; 11:497.
  60. Kline RL, Brothers T, Halsey N, et al. Evaluation of enzyme immunoassays for antibody to human T-lymphotropic viruses type I/II. Lancet 1991; 337:30.
  61. Ikeda M, Fujino R, Matsui T, et al. A new agglutination test for serum antibodies to adult T-cell leukemia virus. Gan 1984; 75:845.
  62. Wiktor SZ, Alexander SS, Shaw GM, et al. Distinguishing between HTLV-I and HTLV-II by western blot. Lancet 1990; 335:1533.
  63. Yao K, Hisada M, Maloney E, et al. Human T lymphotropic virus types I and II western blot seroindeterminate status and its association with exposure to prototype HTLV-I. J Infect Dis 2006; 193:427.
  64. Miley WJ, Suryanarayana K, Manns A, et al. Real-time polymerase chain reaction assay for cell-associated HTLV type I DNA viral load. AIDS Res Hum Retroviruses 2000; 16:665.
  65. Duggan DB, Ehrlich GD, Davey FP, et al. HTLV-I-induced lymphoma mimicking Hodgkin's disease. Diagnosis by polymerase chain reaction amplification of specific HTLV-I sequences in tumor DNA. Blood 1988; 71:1027.
  66. Macchi B, Balestrieri E, Mastino A. Effects of nucleoside-based antiretroviral chemotherapy on human T cell leukaemia/lymphotropic virus type 1 (HTLV-1) infection in vitro. J Antimicrob Chemother 2003; 51:1327.
  67. Bazarbachi A, Hermine O. Treatment with a combination of zidovudine and alpha-interferon in naive and pretreated adult T-cell leukemia/lymphoma patients. J Acquir Immune Defic Syndr Hum Retrovirol 1996; 13 Suppl 1:S186.
  68. Balestrieri E, Forte G, Matteucci C, et al. Effect of lamivudine on transmission of human T-cell lymphotropic virus type 1 to adult peripheral blood mononuclear cells in vitro. Antimicrob Agents Chemother 2002; 46:3080.
  69. García-Lerma JG, Nidtha S, Heneine W. Susceptibility of human T cell leukemia virus type 1 to reverse-transcriptase inhibitors: evidence for resistance to lamivudine. J Infect Dis 2001; 184:507.
  70. Machuca A, Rodés B, Soriano V. The effect of antiretroviral therapy on HTLV infection. Virus Res 2001; 78:93.
  71. Taylor GP, Goon P, Furukawa Y, et al. Zidovudine plus lamivudine in Human T-Lymphotropic Virus type-I-associated myelopathy: a randomised trial. Retrovirology 2006; 3:63.
  72. Taylor GP, Hall SE, Navarrete S, et al. Effect of lamivudine on human T-cell leukemia virus type 1 (HTLV-1) DNA copy number, T-cell phenotype, and anti-tax cytotoxic T-cell frequency in patients with HTLV-1-associated myelopathy. J Virol 1999; 73:10289.
  73. Guidelines for counseling persons infected with human T-lymphotropic virus type I (HTLV-I) and type II (HTLV-II). Centers for Disease Control and Prevention and the U.S.P.H.S. Working Group. Ann Intern Med 1993; 118:448.