HTLV-I in patients with ocular disorders

Human T-lymphotropic virus type 1 (HTLV-I) has been shown to spread worldwide and to be responsible for distinct systemic diseases, namely adult T-celi leukaemia and HTLV-Iassociated myelopathy. Immune-mediated, inflammatory lesions in the lungs, joints, and lacrimal glands (Sjbgren's syndrome) are also suggested to be associated with the retrovirus. We studied seroprevalence of antibodies to HTLV-I in patients with various ocular disorders who are residents of south-west Japan, one of the endemic areas of HTLV-I. Of 310 patients with ocular disease 72 (23.2%) were seropositive. This seroprevalence did not differ significantly from that of the general population of the area. As regards individual ocular diseases, aetiologically undefined nonspecific uveitis showed a significantly high seropositivity for HTLV-I. Of 44 patients 18 (40.9%) were seropositive. Their clinical features were acute or subacute, transient and sometimes recurrent, and granulomatous changes in the anterior uvea. Patients with isolated cotton-wool spot of the retina, nonfamilial retinitis pigmentosa, or keratoconjunctivitis sicca did not show any significantly high prevalence ofHTLV-I infection. Kagoshima University Faculty of Medicine, Kagoshima-shi, Japan Department of Ophthalmology K Nakao N Ohba Institute of Cancer Research M Matsumoto Correspondence to: Kumiko Nakao, MD, Department of Ophthalmology, Kagoshima University Faculty of Medicine, Sakuragaoka 8-35-1, Kagoshima-shi 890, Japan Accepted for publication 23 August 1990 Human T-lymphotropic virus type 1 (HTLV-I) is a recently defined retrovirus that may cause malignant disease of the blood (adult T-cell leukaemia),'-3 and chronic neurological disease (HTLV-I-associated myelopathy or tropical spastic paraparesis).45 More recent studies also indicate that a diverse group of aetiologically unknown clinical disorders are probably associated with HTLV-I infection as well, including pulmonary alveolitis, Sjogren's syndrome, and arthropathy.58 HTLV-I has nothing to do with acquired immunodeficiency syndrome (AIDS), caused by a separate retrovirus HIV/HTLV-III,9 but has received much attention by many researchers. HTLV-I infection is worldwide, with endemic areas in south-west Japan, the Caribbean basin, central Africa, and Melanesia, and its main transmission routes include vertical transmission from infected mother to child, transfusion of infected blood, and sexual transmission.5 8 Ocular disorders in patients with HTLV-Iassociated systemic diseases include intraocular opportunistic infections such as cytomegalovirus retinitis in immunocompromised patients with adult T-cell leukaemia,'°" and non-infectious anterior uveitis, microvascular changes of the retina, and retinochoroidal atrophic lesions in patients with HTLV-I-associated myelopathy."-'5 Our hospital is located in south-west Japan, where HTLV-I infection is highly endemic, and we see many patients infected with the retrovirus. We have therefore performed a prospective study of HTLV-I seroprevalence in patients with various ocular diseases. The main purpose ofthis study was to search for any ocular disorder with an unusually high seroprevalence of HTLV-I infection. Materials and methods A series of 310 patients, 158 men and 152 women, whose age ranged from 10 to 83 years (mean, 54 7, SD 17-3), were the subjects of a prospective study for HTLV-I infection. They were residents of Kagoshima prefecture of south-west Japan, and presented with various ocular diagnoses during a three-year period 1987-9 (Table 1). Infection with HTLV-I was examined by assessment of serum antibodies against HTLV-I by the method of particle agglutination (PA method) as described elsewhere.'0 Agglutination reaction in serum of over 16 times dilution was regarded as seropositive, hence infected with the retrovirus. The patients also received a thorough ophthalmic and systemic examination. The prevalence of HTLV-I infection in the general population of south-west Japan was studied by the PA method in a control group of 2484 adults 868 men and 1616 women, whose age ranged from 20 to 80 years (mean 55-4, SD 10-7). The western blotting method (WB method) was also carried out on part of the material to confirm the accuracy ofdetection of the HTLV-I antibodies. Occasional materials showed inconsistency between the PA and the WB methods, though it was not so marked as to affect the conclusion in the present study. The Mantel-Haenszel X2 test'6 was used for statistical comparison between ocular diseases and general population in consideration of the age factor. Results Table 1 shows HTLV-I seroprevalence in patients with various ocular diseases, together with that in control adult residents of south-west Japan. Of 310 ophthalmic patients 72 (23-2%) were found to be infected with HTLV-I, the prevalence becoming higher with age. These results were compared with those for the general population of the same area, among whom 552 (22-2%) of 2484 control individuals were seropositive for HTLV-I, also with an increasingly high seropositivity with age. There was no significant difference in HTLV-I seroprevalence 76 group.bmj.com on October 30, 2017 Published by http://bjo.bmj.com/ Downloaded from