title: High prevalence of bronchiectasis is linked to HTLV-1-associated inflammatory disease.
abstract: BACKGROUND
  Human T-lymphotropic virus type 1 (HTLV-1), a retrovirus, is the causative agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T-cell leukaemia/lymphoma (ATLL). The reported association with pulmonary disease such as bronchiectasis is less certain.
  
  
  METHODS
  A retrospective case review of a HTLV-1 seropositive cohort attending a national referral centre. The cohort was categorised into HTLV-1 symptomatic patients (SPs) (ATLL, HAM/TSP, Strongyloidiasis and HTLV associated inflammatory disease (HAID)) and HTLV-1 asymptomatic carriers (ACs). The cohort was reviewed for diagnosis of bronchiectasis.
  
  
  RESULTS
  34/246 ACs and 30/167 SPs had been investigated for respiratory symptoms by computer tomography (CT) with productive cough +/- recurrent chest infections the predominant indications. Bronchiectasis was diagnosed in one AC (1/246) and 13 SPs (2 HAID, 1 ATLL, 10 HAM/TSP) (13/167, RR 19.2 95 % CI 2.5-14.5, p = 0.004) with high resolution CT. In the multivariate analysis ethnicity (p = 0.02) and disease state (p < 0.001) were independent predictors for bronchiectasis. The relative risk of bronchiectasis in SPs was 19.2 (95 % CI 2.5-14.5, p = 0.004) and in HAM/TSP patients compared with all other categories 8.4 (95 % CI 2.7-26.1, p = 0.0002). Subjects not of African/Afro-Caribbean ethnicity had an increased prevalence of bronchiectasis (RR 3.45 95 % 1.2-9.7, p = 0.02).
  
  
  CONCLUSIONS
  Bronchiectasis was common in the cohort (3.4 %). Risk factors were a prior diagnosis of HAM/TSP and ethnicity but not HTLV-1 viral load, age and gender. The spectrum of HTLV-associated disease should now include bronchiectasis and HTLV serology should be considered in patients with unexplained bronchiectasis.
authors.affiliation: National Centre for Human Retrovirology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed St, W2 1NY, London, UK. sherry0508@doctors.org.uk.
authors.forename: Shohreh
authors.initials: S
authors.lastname: Honarbakhsh
authors.affiliation: National Centre for Human Retrovirology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed St, W2 1NY, London, UK. g.p.taylor@imperial.ac.uk.|Section of Infectious Diseases, Department of Medicine, Imperial College London, London, UK. g.p.taylor@imperial.ac.uk.
authors.forename: Graham P
authors.initials: GP
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data; D058345:Asymptomatic Infections; D044383:Black People / Q000706:statistics & numerical data; D001987:Bronchiectasis / Q000453:epidemiology* / Q000208:ethnology / Q000821:virology; D015331:Cohort Studies; D005260:Female; D015490:HTLV-I Infections / Q000453:epidemiology / Q000821:virology; D015368:Human T-lymphotropic virus 1; D006801:Humans; D016399:Lymphoma, T-Cell / Q000453:epidemiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015493:Paraparesis, Tropical Spastic / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013322:Strongyloidiasis; D006113:United Kingdom / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data