Comparative study of ATL and HTLV-I related disorders

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Human T lymphotropic virus type I (HTLV-I) has been etiologically associated with a hematological malignancy termed adult T-cell leukemia (ATL) and a chronic neurological disease named HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP). HTLV-I infection is endemic in some areas of the world, for example, the southern part of Japan, the Caribbean basin. Many of the ATL patients studied in the USA, the UK, France, and the Netherlands originated from the Caribbean area.Antibodies against HTLV-I have been detected in 1.2 million people and more than 700 cases of ATL are diagnosed each year in Japan alone. However, in some areas of Central and South America many HAM/TSP patients are observed but not so many ATL patients. Clinical course, ATL subtype, frequencies of hypercalcemia and opportunistic infections, cell morphology, phenotypic profile, and response to treatment seem to be the same for ATL in Japanese, Caribbean, and African patients. One of the differences is in age at onset : the average age is lower for the Caribbean and African than for Japanese ATL patients. And there is a relative paucity of the chronic subtype in Caribbean countries as compared to Japanese cases, while the lymphoma type is more common in Jamaica than in Japan.The reasons for the differences recorded are not clear. Environmental and genetic influences may be significant in providing different cofactors affecting the manifestations of the disease.