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12 Sep 2018

BY AMA PRESIDENT DR TONY BARTONE

The Federal Government recently announced the formation of a new taskforce consisting of relevant health care providers, researchers, clinicians, and all levels of government to combat HTLV-1 in remote Indigenous communities.

Human T-cell lymphotropic virus (HTLV) - an oncogenic virus first discovered in 1979, and the first retrovirus to be discovered - predominantly affects CD4+T cells, which play an important role in the body’s immune system.

HTLV-1 infects up to 20 million people globally, with the virus prevalent in south-western Japan and the developing countries of the Caribbean basin, South Americ, and sub-Saharan Africa.

HTLV-1 was first detected in 1988 in Central Australia in the Indigenous population, and recent studies indicate that 45 per cent of Indigenous adults who reside in remote communities in Central Australia have been infected with HTLV-1.

Commonly transmitted through contaminated blood, unprotected sex, and breast milk, the virus is associated with a fatal haematological malignancy - Adult T cell Leukemia/Lymphoma (ATLL) - and inflammatory diseases involving organs including the spinal cord, eyes, and lungs.

Studies suggest possible disease associations of note in the central Australian context (including bronchiectasis and infections in the blood) but more research is needed to further characterise this. The limited evidence available suggests that proviral load (a marker for the ‘amount’ of virus in the person) is a stronger predictor for these associated diseases than simply whether the virus is present or not (positive and negative serology). Current research initiatives are seeking to clarify some of these disease associations.

The extent and seriousness of the disease is dependent on the viral load in the blood stream.

Uveitis (inflammation of the middle layer of tissue in the eye) is another serious complication of HTLV-1, which was found through a case study done in Central Australia.

It can result in blindness, so it is important for treating professionals to be well informed about HTLV-1.

Unfortunately, there are no treatments currently available for HTLV-1 infection, but the following prevention strategies could result in the reduction of transmission and, ultimately, the eradication of the virus: 

  • Encourage the use of condoms among the sexually active population..
  • Organ donors and blood transfusion products should be tested, and transfusions and transplantations avoided where testing shows a positive result. Monitoring and follow-up are vital in these instances.
  • Injecting drug users should be educated and advised to use sterile needles, and regular testing for HTLV-1 should be available.
  • Evidence-based and up-to-date information regarding HTLV-1 should be available to health care providers so they can educate their clients on how to protect themselves.

The AMA supports an enhanced focus on Aboriginal and Torres Strait Islander people at risk of blood-borne viruses, including specific resourcing of management and research to address HTLV-1.

This is consistent with the AMA’s active participation in the Close the Gap strategy, and our series of Indigenous Health Report Cards, which have highlighted diseases such as rheumatic heart disease and otitis media, and which later this year will provide an audit of success or failure in Indigenous health policy over the past decade.

On top of this, the AMA supports other policies and initiatives that aim to reduce preventable diseases, many of which have an unacceptably high prevalence in remote Indigenous communities.

The AMA remains committed to working in partnership with Aboriginal and Torres Strait Islander groups to advocate for Government investment and cohesive and coordinated strategies to improve health outcomes for Indigenous people.

 


Published: 12 Sep 2018