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PEDIATRICS Vol. 112 No. 2 August 2003, pp. e136-e142

ELECTRONIC ARTICLE

A Cohort Study of Health Effects of Human T-Cell Lymphotropic Virus Type I Infection in Jamaican Children

Elizabeth M. Maloney, DrPH*, Stefan Z. Wiktor, MD, MPH*, Paulette Palmer, MPH§, Beverley Cranston, BSc§, Ernest J. Pate, MBBS, DCH, DM§, Sylvia Cohn, MPH||, Norma Kim, MS||, Wendell Miley, MS, Terry L. Thomas, PhD{ddagger},#, William A. Blattner, MD* and Barrie Hanchard, MBBS, FRCPC, FRCP Edin§

* Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, Bethesda, Maryland
{ddagger} Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, Bethesda, Maryland
§ Pathology Department, University of the West Indies, Kingston, Jamaica
|| Research Triangle Institute, Rockville, Maryland
Scientific Applications International Incorporated, Frederick, Maryland
# Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland

Objective. Human T-cell lymphotropic virus type I (HTLV-I) infection in childhood is believed to play an important role in risk for adult T-cell leukemia/lymphoma. Although HTLV-I is known to be associated with infective dermatitis in childhood, other HTLV-I-associated morbidity in children has not been well studied. We sought to determine the HTLV-I-associated health effects in Jamaican children.

Methods. We compared incidence rates of several health outcomes in 28 HTLV-I-infected and 280 uninfected children clinically followed from age 6 weeks to a maximum of 10 years. Cox proportional hazards regression analysis was used to analyze these prospectively collected data, adjusting for confounding effects of other variables as necessary.

Results. HTLV-I-infected children had significantly higher incidence rates of seborrheic dermatitis (rate ratio [RR] = 4.8, 95% confidence interval [CI] = 1.9–12.5), eczema (RR = 3.1, CI = 1.2–7.9) and persistent hyperreflexia (RR = 3.7, CI = 1.6–8.2). Additionally, HTLV-I infected children had increased rates of severe anemia (RR = 2.5, CI = 0.8–7.9) and abnormal lymphocytes (RR = 2.4, CI = 0.8–7.6) that were of borderline statistical significance.

Conclusions. Our study suggests that HTLV-I-associated skin diseases of childhood may include seborrheic dermatitis and eczema. Additionally, these data suggest that persistent hyperreflexia of the lower limbs may be an early sign of HTLV-I-associated neurologic involvement in children. Expansion and continued clinical observation of this cohort would be valuable.

Key Words: HTLV-I • pediatric • morbidity

Abbreviations: HTLV-I, human T-cell lymphotropic virus type I • ATL, adult T-cell leukemia/lymphoma • HAM/TSP, HTLV-I-associated myelopathy or tropical spastic paraparesis • ID, infective dermatitis • WBC, white blood cell • PCR, polymerase chain reaction • RR, rate ratio • CI, confidence interval • SD, seborrheic dermatitis

Received for publication Jan 28, 2003; Accepted Apr 8, 2003.




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