Prevention and Partner Notification

While there is currently no cure for HTLV-1 or HTLV-2 infection, treatment for HTLV-1 diseases and effective transmission prevention strategies are available. So far, 17 different prevention strategies are known to effectively reduce the risk of the transmission of blood-borne/sexually transmissible viruses, such as HBV, HCV and HIV-1 (91, 92). There is irrevocable evidence that the transmission of HTLV could also be averted. For example, the implementation of universal antenatal HTLV-1 screening and avoidance of breast-feeding by HTLV-1-infected women in Japan has reduced the prevalence of HTLV-1 infection from 20% to 2.5% since 1987 (93, 94). In 2017, Olindo et al. reported a significant reduction in HAM/TSP incidence due to antenatal and blood donor screening in the French island of Martinique in the West Indies (95). Blood and organ donor testing can reduce HTLV-1 prevalence (96) and HTLV-1 diseases (27), (Yuzawa K. et al. 18th International Retrovirology Conference, Tokyo, Japan, March 2017). In Australia, blood and organ donors are routinely tested for HTLV-1 and HTLV-2 infection and positive blood donors excluded. Local guidelines and advice vary on the donation of organs from HTLV positive donors. There are plans to stop HTLV-1 testing repeat blood donors (97). Unfortunately, there are no national or international guidelines on testing for HTLV infection or partner notification of people with HTLV infection, even for people with the highest risks of transmission or acquisition of infection, such as those attending antenatal or sexual health clinics or enrolled in needle exchange programs.

There is no routine pre- or post-exposure prophylaxis available for sexual or mother-to-child transmission of HTLV-1 or HTLV-2 infection. In some clinical settings, local guidelines for post-exposure prophylaxis suggest starting Truvada® (tenofovir/emtricitabine) alone or Truvada® with raltegravir within 72 hours following a needlestick injury and continuing this treatment for one month to prevent HTLV-1 transmission. However, this approach has not been verified since all anti-retroviral studies in HTLV infection have been conducted in people where the infection was already established (24).