Natural history of human T-lymphotropic virus 1-associated myelopathy: a 14-year follow-up study
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Stéphane Olindo1, Philippe Cabre, Agnes Lézin
1Department of Neurology, University Hospital of Fort de France, Fort de France, Martinique. stephane.olindo@chu-fortdefrance.fr
Background:
The progression of neurological disability in human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) remains undefined.
Objectives:
To determine the time course of disability scores and to identify predictors of outcome among patients with HAM/TSP.
Design:
Clinical 14-year follow-up study.
Setting:
University hospital. Patients One hundred twenty-three patients with HAM/TSP.
Main Outcome Measures:
We determined time from onset to the following 4 Kurtzke Disability Status Scale (DSS) end points: scores of 6 (unilateral aid required), 6.5 (bilateral aid required), 8 (wheelchair confinement), and 10 (death related to the disease). Times to reach selected DSS scores were estimated using the Kaplan-Meier method. Univariate and multivariate analyses identified variables related to the rate of progression to DSS 8. The HTLV-1 proviral loads were also assessed.
Results:
The disability of the cohort progressed throughout the follow-up period. The median times from onset to DSS 6, 6.5, and 8 were 6, 13, and 21 years, respectively. The median time from DSS 6 to DSS 8 was 8 years; DSS 10 was reached by one fourth of the patients within 20 years. Age at onset of 50 years or older and high HTLV-1 proviral load were associated with a shorter time to DSS 8 (P = .01 and P = .02, respectively). A shorter time to DSS 6 significantly adversely affected the time to progression from DSS 6 to DSS 8.
Conclusions:
Human T-lymphotropic virus 1-associated myelopathy/tropical spastic paraparesis is a rapidly disabling disease. Monitoring for HTLV-1 proviral load is recommended in future therapeutic trials.
