Prevalência global e em Goiás das infecções pelos vírus linfotrópicos T humanos 1 e 2 em imigrantes e refugiados
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2024-04-10
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Universidade Federal de Goiás
Resumo
Introduction: The international migration of endemic populations for human Tlymphotropic virus 1 and 2 (HTLV-1 and 2) can play a significant role in introducing
these viruses in non-endemic territories. Objectives: To estimate the seroprevalence of
HTLV-1/2 infection among immigrants and refugees in Goiás State and the seropositivity
rates for HTLV-1 and HTLV-2, analyze factors related to HTLV-1/2 infection, and
describe the risk behaviors/practices reported by HTLV-1 and HTLV-2 seropositive
individuals. In addition, we estimate the global prevalence of HTLV-1 and HTLV-2
infections among immigrants and refugees, and also identify potential variables as
sources of heterogeneity between the studies analyzed. Methods: Article 1 - Crosssectional study with 537 international migrants in the State of Goiás. Participants were
interviewed about sociodemographic data and risk behaviors for HTLV-1/2 infection
between July 2019 and May 2021, and serum samples from 528 migrants were screened
using an enzyme-linked immunosorbent assay (ELISA). Anti-HTLV-1/2 reactive samples
were submitted for confirmation by a line immunoassay (LIA). Fisher's exact test was
used for statistical analysis. Article 2 – Systematic review and meta-analysis of
prevalence studies on HTLV-1 and/or HTLV-2 infections among immigrants and
refugees worldwide. The databases PubMed/MEDLINE, Scopus, EMBASE, Web of
Science and Virtual Health Library (VHL) were searched from the inception of studies
published until January 06, 2023. A meta-analysis using a generalized mixed linear
model with random effect was performed for HTLV-1 and HTLV-2. Subgroup analyses
were used to evaluate the effect of decade of study, sample size, confirmatory methods,
region of study, risk group, and region of origin on prevalence. Results: Article 1 - The
majority of participants were Venezuelan (47.9%) and Haitian (39.7%); 50.1% were
immigrants, 49% refugees and five were Brazilian children (0.9%) born to Haitian
immigrant parents. The overall prevalence of anti-HTLV-1/2 was 0.95% (95% CI: 0.31-
2.28), HTLV-1 (0.19%) and HTLV-2 (0.76%). All seropositive individuals (n = 5) were
refugees from Venezuela, resulting in a rate of 2.26% for anti-HTLV-1/2, HTLV-1
(0.45%) and HTLV-2 (1.81%) among Venezuelan refugees. Unprotected sexual
intercourse and having more than one sexual partner (≥2) in the previous 12 months were
factors related to HTLV-1/2 seropositivity among Venezuelans. Reporting of having been
breastfed for more than six months and unprotected sex with one or two partners were
risk characteristics observed in seropositive individuals. Article 2 – Of a total of 381
records initially identified, 21 studies were included. The global prevalence of HTLV-1
and HTLV-2 infections was 1.28% (95% CI: 0.58-2.81) and 0.11% (95% CI: 0.04-0.33),
respectively. HTLV-1 prevalence differed significantly by region of origin, with the
highest prevalence among those from the Western Pacific Region (7.27%; 95% CI: 2.94-
16.83). In the subgroup analysis, significant differences were also observed between the
estimates of HTLV-1 infection considering the decade of study, sample size, and regionof study. For HTLV-2, significant differences were noted in relation to sample size,
confirmatory methods, and risk group. Conclusions: The results show that the
seroprevalence of HTLV-1/2 among international migrants in Goias State is low;
however, the seropositivity for HTLV-1 and HTLV-2 indicates the circulation of these
viruses in Venezuelan refugees; also pointing out the importance of sexual transmission
of HTLV-1/2 in addition to the report of breastfeeding for more than six months by
seropositive individuals. The systematic review and meta-analysis reveal that, despite the
heterogeneity observed, the HTLV-1 prevalence among immigrants and refugees is
higher than HTLV-2. The high prevalence of HTLV-1 found, particularly among those
from the Western Pacific Region, suggests that targeted serological screening of
international migrants from HTLV-1 endemic regions could be a significant public health
intervention for this infection control in immigrant and refugee-receiving non-endemic
countries. Relevance and Impact: This study characterizes immigrants and refugees as
vulnerable to HTLV-1/2 infection, highlighting the importance of developing public
health policies focusing on prevention and control of this infection in international
migrants.
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Palavras-chave
HTLV-1/2 , Imigrante , Refugiado , Prevalência , Revisão sistemática , Metaanálise , HTLV-1/2 , Immigrant, , Refugee , Prevalence , Systematic review , Metaanalysis
Citação
MARINHO, T. A. Prevalência global e em Goiás das infecções pelos vírus linfotrópicos T humanos 1 e 2 em imigrantes e refugiados. 2024. 261 f. Tese (Doutorado em Medicina Tropical e Saúde Pública) - Instituto de Patologia
Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, 2024.