DECREASED SURVIVAL OF HTLV-I CARRIERS IN LEPROSY PATIENTS FROM THE DEMOCRATIC-REPUBLIC OF THE CONGO - A HISTORICAL PROSPECTIVE-STUDY

In this historical prospective study using sera stored for 22 years, w e investigated the effect of HTLV-I infection on survival in a populat ion of leprosy patients in the Democratic Republic of the Congo (forme rly Zaire). We also determined the distribution of HTLV-I by subpopula tion, age, and gender. Stored sera taken from a population of leprosy patients and controls in 1969 were tested for HTLV-I. Follow-up surviv al data on these patients were obtained in 1991. The sera collected in 1969 from 520 individuals was used to determine the prevalence of HTL V-I. Included in this number were 328 patients resident in the sanator ium. Survival and other data were available for 327 of these. A multiv ariate survival analysis using a logistic regression model was perform ed to evaluate the influence of HTLV-I status, age, type of leprosy, g ender, duration of hospitalization, and ethnic group on survival. The overall prevalence of HTLV-I among the 520 individuals in the prevalen ce study was 34%, with 37.4% in the leprosy group and 25.2% in the con trol group (p < 0.01). Multivariate analysis using logistic regression showed that females of the Mongo and Ngombe ethnic group taken togeth er were significantly more likely to be infected than the other groups (OR = 3.67, 95% CI: 2.14 to 6.30). A comparison of the death rates di rectly standardized for age and sex showed that the rate was significa ntly higher for HTLV-I positive (5.5/100 person-years of observation) compared with HTLV-I negative (3.6/100 person-years of observation). A survival analysis using the Cox model showed a risk ratio of 1.4 (CI: 1.04 to 1.89) for those infected with HTLV-I. An increase in the deat h rate was associated with HTLV-I infection in leprosy inpatients. The decreased survival associated with HTLV-I infection may result from a n increased susceptibility to a variety of diseases.