The Changing Epidemiology of Human T-Cell Lymphotropic Virus Type 1 Infection in Peruvian Female Sex Workers, 1993–2010

Jenell Stewart Department of Internal Medicine, University of Washington, Seattle, Washington.

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Kristen Heitzinger Department of Epidemiology, University of Washington, Seattle, Washington.

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Simon Pollett Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia.

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Martha Calderón Clínica de Salud Pública “Alberto Barton” del Callao, Callao, Peru.

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Jorge Alarcón Instituto de Medicina Tropical, Universidad Nacional Mayor de San Marcos, Lima, Peru.

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Thanh G. N. Ton Department of Global Health and Neurology, University of Washington, Seattle, Washington.

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Joseph R. Zunt Department of Internal Medicine, University of Washington, Seattle, Washington.
Department of Epidemiology, University of Washington, Seattle, Washington.
Department of Global Health and Neurology, University of Washington, Seattle, Washington.

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Human T-cell lymphotropic virus type 1 (HTLV-1) was the first human retrovirus to be reported and is associated with neoplastic, neurological, autoimmune, and infectious complications. HTLV-1 is endemic in Peru, with the highest prevalence reported among commercial sex workers. Seroprevalence data collected from Peruvian female sex workers (FSWs) working in Callao over three study periods between 1993 and 2010 were used to examine the secular trend in HTLV-1 prevalence. Between 1993 and 2010, the prevalence of HTLV-1 decreased significantly from 14.5% to 3.1% (P < 0.01). The prevalence of HTLV-1 seropositivity differed significantly by birth cohort (1922–1959, 1960–1969, 1970–1979, and 1980–1992), and for each of the four birth cohorts, the prevalence did not significantly decrease by screening year (P > 0.07). There were no cases of HTLV-1 detected among FSW born after 1979 (N = 224). Participant characteristics associated with HTLV-1 seropositivity were birth in the Andes Mountains region, age, increased time in sex work, younger age of starting sex work, and human immunodeficiency virus (HIV) seropositivity. The secular trend in declining prevalence persisted after adjustment for age, time in sex work, place of birth, and HIV serostatus, with the odds of HTLV-1 infection decreasing approximately 16% per year (adjusted odds ratio = 0.84, 95% confidence interval = 0.78, 0.90). The increasing use of condoms by later birth cohorts noted in our analysis, as well as the increasing availability of free condoms provided by the Peruvian government—which started in the late 1980s before this study—may have been responsible for declining HTLV seroprevalence.

Author Notes

* Address correspondence to Jenell Stewart, Department of Internal Medicine, Harborview Medical Center, 325 Ninth Ave, Box 359775, Seattle, WA 98104. E-mail: jenells@uw.edu

Financial support: This work was partially funded by the National Institutes of Health Office of the Director, Fogarty International Center, Office of AIDS Research, National Cancer Center, National Eye Institute, National Heart, Blood, and Lung Institute, National Institute of Dental and Craniofacial Research, National Institute On Drug Abuse, National Institute of Mental Health, National Institute of Allergy and Infectious Diseases, and National Institutes of Health Office of Women's Health and Research through the Fogarty International Clinical Research Scholars and Fellows Program at Vanderbilt University (R24 TW007988) and the American Relief and Recovery Act.

Authors' addresses: Jenell Stewart, Department of Internal Medicine, University of Washington, Seattle, WA, E-mail: jenells@uw.edu. Kristen Heitzinger, Department of Epidemiology, University of Washington, Seattle, WA, E-mail: heitzk@uw.edu. Simon Pollett, Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia, E-mail: spollett@med.usyd.edu.au. Martha Calderón, Clínica de Salud Pública, “Alberto Barton” del Callao, Callao, Peru, E-mail: marthacalderonsilva@yahoo.com. Jorge Alarcón, Instituto de Medicina Tropical, Universidad Nacional Mayor de San Marcos, Lima, Peru, E-mail: joav06@gmail.com. Thanh G. N. Ton and Joseph R. Zunt, Department of Global Health and Neurology, University of Washington, Seattle, WA, E-mails: thanhton@gmail.com and jzunt@u.washington.edu.

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