Targeted Interventions in HAM/TSP: Emerging Therapies and Future Directions - A Narrative Review

Human T-Lymphotropic virus type 1 (HTLV-1) infection can lead to HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), a debilitating chronic neurological disease characterized by progressive lower limb spasticity and autonomic dysfunction. Because the exact disease pathogenesis remains unclear and current management options have limited efficacy, there is a critical need for more effective therapies to reduce morbidity and mortality. This narrative review aims to review the available and diverse range of emerging treatment approaches for HAM/TSP.

A comprehensive narrative review of the existing literature was conducted to assess current treatment methods, historical treatment efforts, and modern therapeutic interventions. The scope includes pharmacological, immunological, targeted, and non-pharmacological strategies aimed at disease management.

Current disease-modifying therapies primarily rely on immunomodulatory agents, such as corticosteroids and interferon-alpha, to mitigate neuroinflammation and preserve motor function, whereas traditional antiretroviral therapies demonstrate limited clinical efficacy. Emerging targeted therapies, notably the monoclonal antibody mogamulizumab, show significant promise in reducing HTLV-1-infected cells and sustaining a decrease in spinal cord inflammation. Furthermore, comprehensive care must integrate treatments targeting specific cellular signaling pathways alongside vital non-pharmacological interventions, such as physical rehabilitation and psychological support.

The effective management of HAM/TSP necessitates a holistic, multidisciplinary approach encompassing targeted pharmacotherapy, symptomatic management, and psychosocial support. While novel interventions and disease-modifying therapies offer promising new directions, further high-quality, randomized clinical trials are essential to establish standard regimens, optimize dosages, and ensure long-term efficacy and safety.