CLINICAL SPECTRUM OF HTLV-I IN SOUTH FLORIDA

A total of 113 patients with infection due to human T-cell leukemia vi rus type 1 (HTLV-I) were evaluated at the University of Miami from Jan uary 1988 to March 1993. Forty patients were identified with adult T-c ell leukemia/lymphoma (ATLL) and 63 with HTLV-I-associated myelopathy (HAM). Three had concomitant ATLL and HAM. Two HAM patients co-infecte d with human immunodeficiency virus type 1 (HIV-I) developed clonal ly mphoproliferative disease during the study period. Patients with ATLL have a poor prognosis; multiple chemotherapy regimens including high-d ose cytotoxic agents have been utilized with a small impact on surviva l. Most of our patients are currently treated with experimental regime ns. Rheumatologic or autoimmune illnesses were identified, mostly in H AM patients, and a small number developed immunodeficiencies in the ab sence of other definable etiologic factors. Most of the patients were immigrants from areas of endemicity in the Caribbean basin, although m any Americans were also recognized. HTLV-I/II infection was diagnosed serologically and typed as HTLV-I by polymerase chain reaction (PCR) o r a modified Western blot when a DNA sample was not available. In 24 o f 40 patients with ATLL, Southern blot hybridization performed on DNA extracted from peripheral blood lymphocytes or tumor tissue demonstrat ed clonal HTLV-I integration. In South Florida, ATLL and HAM are now s een frequently. Since HTLV-I infection is associated with a 4% lifetim e risk of developing ATLL and an additional 0.25% lifetime risk for de veloping HAM, a large pool of asymptomatically infected individuals mu st exist here. Autoimmune conditions and immunodeficiency states are n ot uncommon in these patients. Unusual clinical presentations are now being recognized in those co-infected with HTLV-I and HIV-I.