title: Bronchiectasis is associated with human T-lymphotropic virus 1 infection in an Indigenous Australian population.
abstract: BACKGROUND
  Recent studies suggest that infection with human T-lymphotropic virus 1 (HTLV-1) might be associated with bronchiectasis among Indigenous Australians. The present study compared the clinical characteristics and outcomes of bronchiectasis in this population, according to HTLV-1 serologic status.
  
  
  METHODS
  We performed a retrospective cohort study of Indigenous adults with bronchiectasis and known HTLV-1 serologic status admitted to Alice Springs Hospital, central Australia, from January 2000 through December 2006.
  
  
  RESULTS
  Among 89 Indigenous adults whose HTLV-1 serologic status was confirmed, 52 (58.4%) were HTLV-1 seropositive. Differences between HTLV-1-seropositive and HTLV-1-seronegative groups were apparent in childhood presentations and adult outcomes. Among adults, an increasing number of bronchiectatic lobes (univariable odds ratio [OR], 1.51; 95% confidence interval [CI]; 1.03-2.20; P = .033) and the presence of ground-glass opacities at chest high-resolution computed tomography (univariable OR, 8.54; 95% CI, 1.04-70.03; P = .046) predicted HTLV-1 infection. Cor pumonale (HTLV-1-positive group, 10/52; HTLV-1-negative group, 1/37; P = .023) was more frequent among HTLV-1-seropositive adults, who also experienced a higher disease-specific mortality (univariable OR, 5.78; 95% CI, 1.17-26.75; P = .028). Only HTLV-1-seropositive patients were admitted specifically for the treatment of infected skin lesions, and this finding predicted death (multivariable OR, 6.77; 95% CI, 1.46-31.34; P = .014). Overall mortality was high; 34.2% of the cohort died at a median age of 42.5 years.
  
  
  CONCLUSIONS
  HTLV-1 infection contributes to the risk of developing bronchiectasis and worsens outcomes among Indigenous Australians.
authors.affiliation: Department of Medicine, Alice Springs Hospital, Alice Springs, Australia. lloyd.einsiedel@health.sa.gov.au
authors.forename: Lloyd
authors.initials: L
authors.lastname: Einsiedel
authors.forename: Liselle
authors.initials: L
authors.lastname: Fernandes
authors.forename: Tim
authors.initials: T
authors.lastname: Spelman
authors.forename: Daniel
authors.initials: D
authors.lastname: Steinfort
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gotuzzo
mesh_terms: D000328:Adult; D001315:Australia; D001987:Bronchiectasis / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015490:HTLV-I Infections / Q000150:complications*; D015368:Human T-lymphotropic virus 1 / Q000472:pathogenicity*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D044382:Population Groups; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome