title: The Changing Epidemiology of Human T-Cell Lymphotropic Virus Type 1 Infection in Peruvian Female Sex Workers, 1993-2010.
abstract: Human T-cell lymphotropic virus type 1 (HTLV-1) was the first human retrovirus to be reported and is associated with neoplastic, neurological, autoimmune, and infectious complications. HTLV-1 is endemic in Peru, with the highest prevalence reported among commercial sex workers. Seroprevalence data collected from Peruvian female sex workers (FSWs) working in Callao over three study periods between 1993 and 2010 were used to examine the secular trend in HTLV-1 prevalence. Between 1993 and 2010, the prevalence of HTLV-1 decreased significantly from 14.5% to 3.1% (P< 0.01). The prevalence of HTLV-1 seropositivity differed significantly by birth cohort (1922-1959, 1960-1969, 1970-1979, and 1980-1992), and for each of the four birth cohorts, the prevalence did not significantly decrease by screening year (P> 0.07). There were no cases of HTLV-1 detected among FSW born after 1979 (N= 224). Participant characteristics associated with HTLV-1 seropositivity were birth in the Andes Mountains region, age, increased time in sex work, younger age of starting sex work, and human immunodeficiency virus (HIV) seropositivity. The secular trend in declining prevalence persisted after adjustment for age, time in sex work, place of birth, and HIV serostatus, with the odds of HTLV-1 infection decreasing approximately 16% per year (adjusted odds ratio = 0.84, 95% confidence interval = 0.78, 0.90). The increasing use of condoms by later birth cohorts noted in our analysis, as well as the increasing availability of free condoms provided by the Peruvian government-which started in the late 1980s before this study-may have been responsible for declining HTLV seroprevalence.
authors.affiliation: Department of Internal Medicine, University of Washington, Seattle, Washington. jenells@uw.edu.
authors.forename: Jenell
authors.initials: J
authors.lastname: Stewart
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington.
authors.forename: Kristen
authors.initials: K
authors.lastname: Heitzinger
authors.affiliation: Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Pollett
authors.affiliation: Clínica de Salud Pública "Alberto Barton" del Callao, Callao, Peru.
authors.forename: Martha
authors.initials: M
authors.lastname: Calderón
authors.affiliation: Instituto de Medicina Tropical, Universidad Nacional Mayor de San Marcos, Lima, Peru.
authors.forename: Jorge
authors.initials: J
authors.lastname: Alarcón
authors.affiliation: Department of Global Health and Neurology, University of Washington, Seattle, Washington.
authors.forename: Thanh G N
authors.initials: TG
authors.lastname: Ton
authors.affiliation: Department of Internal Medicine, University of Washington, Seattle, Washington.|Department of Epidemiology, University of Washington, Seattle, Washington.|Department of Global Health and Neurology, University of Washington, Seattle, Washington.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Zunt
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015490:HTLV-I Infections / Q000175:diagnosis / Q000453:epidemiology*; D015368:Human T-lymphotropic virus 1; D006801:Humans; D010568:Peru / Q000453:epidemiology; D016036:Seroepidemiologic Studies; D060386:Sex Workers / Q000706:statistics & numerical data*; D055815:Young Adult