Long term follow up study and prevention of ATL occurrence among HTLV-1 carriers : a nationwide cohort study

目前日本仍有100万HTLV-1运载火箭。携带者状态导致ATL发展的危险因素尚不清楚。研究HTLV-1携带者发生ATL的病毒和宿主特异性决定因素。一项针对HTLV-1携带者的全国性队列研究名为ATL发展诱发因素联合研究（JSPFAD），由41个机构组成。参与者是HTLV-1携带者，他们提供了书面知情同意书。每年检测HTLV-1前病毒载量（VL）和sIL-2R。每年还收集人口统计学特征和临床数据。我们评估了1218 HTLV-1携带者（426名男性和792名女性），他们在2002 - 2008年期间入组。入组时，男性的VL显著高于女性40 - 49岁和50 - 59岁组的平均拷贝数分别为2.10和1.39拷贝/100个PBMC。40岁（P值分别为0.02和0.007），且有ATL家族史者明显高于无ATL家族史者（中位数，2.32 vs 1.33拷贝/100 PBMC）（P = 0.005）。在截至2009年9月的随访期间，14名参与者进展为明显的ATL。他们的基线VL高（范围，4。17 - 28.58拷贝/100PBMC）。基线VL <4拷贝/100 PBMC者无一例发生ATL。多变量考克斯分析表明，不仅VL较高，而且高龄、ATL家族史和在治疗其他疾病期间首次进行HTLV-1检测的机会也是ATL从携带者状态进展的独立危险因素

There are still 1.0 million HTLV-1 carriers in Japan. Definitive risk factors for ATL development from carrier status remain unclear. To investigate viral- and host-specific determinants of the development of ATL among HTLV-1 carriers. A nationwide cohort study for HTLV-1 carriers named the Joint Study on Predisposing Factors of ATL Development (JSPFAD) comprising of 41 institutions. Participants were HTLV-1 carriers who provided written informed consent. HTLV-1 proviral load (VL) and sIL-2R were measured annually. Demographic characteristics and clinical data were also collected annually. We evaluated 1218 HTLV-1 carriers (426 males and 792 females) who were enrolled during 2002-2008. VL at enrollment was significantly higher in males than females (median, 2.10 vs 1.39 copies/100PBMC), in those aged 40-49 and 50-59 yrs than that of those aged &lt ; 40 yrs (P=0.02 and 0.007, respectively), and in those with a family history of ATL than those without the history (median, 2.32 vs 1.33 copies/100PBMC) (P=0.005). During follow-up as of September 2009, 14 participants progressed to overt ATL. Their baseline VL was high (range, 4. 17-28.58 copies/100PBMC). None developed ATL among those with a baseline VL lower than &lt ; 4 copies/100PBMC. Multivariate Cox analyses indicated that not only a higher VL but also advanced age, family history of ATL, and first opportunity for HTLV-1 testing during treatment for other diseases were independent risk factors for progression of ATL from carrier status