Dr Lloyd Einsiedel is a physician who has provided a general medical and infectious diseases service to central Australia for more than a decade. He has active research interests in Indigenous health with particular reference to the interactions between the social determinants of health, health literacy and disease. He currently collaborates with the Poche Centre for Indigenous Health and Wellbeing and international groups at Imperial College, London, and the Institut Pasteur, Paris. ABSTRACT The Human T Lymphotropic Virus type 1 subtype c: an update of recent epidemiological and clinical studies in Australia.
Lloyd Einsiedel,
Associate Director Research, Aboriginal Health
BakerIDI, Alice Springs Hospital
Central Australia
The Human T Lymphotropic Virus type 1 has a global prevalence, however, most people living with HTLV-1 reside in clusters of high endemicity in resource poor countries. One such endemic focus is present in central Australia where infection with the Australo-Melanesian HTLV-1c subtype is highly prevalent among Indigenous Australians. This presentation will review recent epidemiological and clinical studies that are of relevance to an Australian context.
The HTLV-1 endemic area in Australia is vast, extending from the north-east of Western Australia to coastal South Australia. Prevalence rates among Indigenous adults exceed 40% in some remote communities. Infection with HTLV-1 is associated with i) a rapidly progressive Adult T-cell leukemia, ii) inflammatory disorders including HTLV-1 associated myelopathy and infective dermatitis and iii) complicated infections with parasites, such as crusted scabies and strongyloides hyperinfection. Although each of these conditions has been reported in central Australia, in this region HTLV-1 infection is most often associated with multi-lobar bronchiectasis and invasive bacterial infections. An inability to control viral replication is predictive of bronchiectasis, blood stream infections and death.
Research seeking to elucidate the immunological basis for the heightened risk of bacterial infection is ongoing. However, repeated exposure to virulent pathogens is an inevitable consequence of the poor social circumstances of many people living with HTLV-1 and this may play a major role in the outcome of HTLV-1 infection in resource poor areas.
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