title: Decreased survival of HTLV-I carriers in leprosy patients from the Democratic Republic of the Congo: a historical prospective study.
abstract: In this historical prospective study using sera stored for 22 years, we investigated the effect of HTLV-I infection on survival in a population of leprosy patients in the Democratic Republic of the Congo (formerly Zaire). We also determined the distribution of HTLV-I by subpopulation, age, and gender. Stored sera taken from a population of leprosy patients and controls in 1969 were tested for HTLV-I. Follow-up survival data on these patients were obtained in 1991. The sera collected in 1969 from 520 individuals was used to determine the prevalence of HTLV-I. Included in this number were 328 patients resident in the sanatorium. Survival and other data were available for 327 of these. A multivariate survival analysis using a logistic regression model was performed to evaluate the influence of HTLV-I status, age, type of leprosy, gender, duration of hospitalization, and ethnic group on survival. The overall prevalence of HTLV-I among the 520 individuals in the prevalence study was 34%, with 37.4% in the leprosy group and 25.2% in the control group (p < 0.01). Multivariate analysis using logistic regression showed that females of the Mongo and Ngombe ethnic group taken together were significantly more likely to be infected than the other groups (OR = 3.67, 95% CI: 2.14 to 6.30). A comparison of the death rates directly standardized for age and sex showed that the rate was significantly higher for HTLV-I positive (5.5/100 person-years of observation) compared with HTLV-I negative (3.6/100 person-years of observation). A survival analysis using the Cox model showed a risk ratio of 1.4 (CI: 1.04 to 1.89) for those infected with HTLV-I. An increase in the death rate was associated with HTLV-I infection in leprosy inpatients. The decreased survival associated with HTLV-I infection may result from an increased susceptibility to a variety of diseases.
authors.affiliation: Université Catholique de Louvain, Brussels, Belgium.
authors.forename: M F
authors.initials: MF
authors.lastname: Lechat
authors.forename: D I
authors.initials: DI
authors.lastname: Shrager
authors.forename: E
authors.initials: E
authors.lastname: Declercq
authors.forename: F
authors.initials: F
authors.lastname: Bertrand
authors.forename: W A
authors.initials: WA
authors.lastname: Blattner
authors.forename: B S
authors.initials: BS
authors.lastname: Blumberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002353:Carrier State / Q000453:epidemiology*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D015490:HTLV-I Infections / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007918:Leprosy / Q000150:complications* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors