title: Natural history of human T-lymphotropic virus 1-associated myelopathy: a 14-year follow-up study.
abstract: BACKGROUND
  The progression of neurological disability in human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) remains undefined.
  
  
  OBJECTIVE
  To determine the time course of disability scores and to identify predictors of outcome among patients with HAM/TSP.
  
  
  METHODS
  Clinical 14-year follow-up study.
  
  
  METHODS
  University hospital. Patients One hundred twenty-three patients with HAM/TSP.
  
  
  METHODS
  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.
authors.affiliation: Department of Neurology, University Hospital of Fort de France, Fort de France, Martinique. stephane.olindo@chu-fortdefrance.fr
authors.forename: Stéphane
authors.initials: S
authors.lastname: Olindo
authors.forename: Philippe
authors.initials: P
authors.lastname: Cabre
authors.forename: Agnes
authors.initials: A
authors.lastname: Lézin
authors.forename: Harold
authors.initials: H
authors.lastname: Merle
authors.forename: Martine
authors.initials: M
authors.lastname: Saint-Vil
authors.forename: Aissatou
authors.initials: A
authors.lastname: Signate
authors.forename: Mickael
authors.initials: M
authors.lastname: Bonnan
authors.forename: Aurelie
authors.initials: A
authors.lastname: Chalon
authors.forename: Lionel
authors.initials: L
authors.lastname: Magnani
authors.forename: Raymond
authors.initials: R
authors.lastname: Cesaire
authors.forename: Didier
authors.initials: D
authors.lastname: Smadja
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015368:Human T-lymphotropic virus 1; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D015493:Paraparesis, Tropical Spastic / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology*; D013997:Time Factors