Management of HAM/TSP: Systematic Review and Consensus-based Recommendations 2019

Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Diseases. Laboratory for Clinical Research in Neuroinfections. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Immunology of Infection. United Kingdom / University of São Paulo. Faculty of Medicine. Institute of Tropical Medicine of São Paulo. São Paulo, SP, Brazil / Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical "Alexander von Humboldt". Lima, Peru / National Institutes of Health. Viral Immunology Section. Bethesda, MD / Stonewall Medical Centre. Windsor, Australia / São Paulo University. Emilio Ribas Hospital Infectology Institute. São Paulo, SP, Brazil / Federal University of the State of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Virology. United Kingdom / St Marianna University School of Medicine. Institute of Medical Science. Department of Rare Diseases Research. Kanagawa, Japan.
Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Diseases. Laboratory for Clinical Research in Neuroinfections. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Immunology of Infection. United Kingdom / University of São Paulo. Faculty of Medicine. Institute of Tropical Medicine of São Paulo. São Paulo, SP, Brazil / Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical "Alexander von Humboldt". Lima, Peru / National Institutes of Health. Viral Immunology Section. Bethesda, MD / Stonewall Medical Centre. Windsor, Australia / São Paulo University. Emilio Ribas Hospital Infectology Institute. São Paulo, SP, Brazil / Federal University of the State of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Virology. United Kingdom / St Marianna University School of Medicine. Institute of Medical Science. Department of Rare Diseases Research. Kanagawa, Japan.
Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Diseases. Laboratory for Clinical Research in Neuroinfections. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Immunology of Infection. United Kingdom / University of São Paulo. Faculty of Medicine. Institute of Tropical Medicine of São Paulo. São Paulo, SP, Brazil / Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical "Alexander von Humboldt". Lima, Peru / National Institutes of Health. Viral Immunology Section. Bethesda, MD / Stonewall Medical Centre. Windsor, Australia / São Paulo University. Emilio Ribas Hospital Infectology Institute. São Paulo, SP, Brazil / Federal University of the State of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Virology. United Kingdom / St Marianna University School of Medicine. Institute of Medical Science. Department of Rare Diseases Research. Kanagawa, Japan.
Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Diseases. Laboratory for Clinical Research in Neuroinfections. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Immunology of Infection. United Kingdom / University of São Paulo. Faculty of Medicine. Institute of Tropical Medicine of São Paulo. São Paulo, SP, Brazil / Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical "Alexander von Humboldt". Lima, Peru / National Institutes of Health. Viral Immunology Section. Bethesda, MD / Stonewall Medical Centre. Windsor, Australia / São Paulo University. Emilio Ribas Hospital Infectology Institute. São Paulo, SP, Brazil / Federal University of the State of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Virology. United Kingdom / St Marianna University School of Medicine. Institute of Medical Science. Department of Rare Diseases Research. Kanagawa, Japan.
Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Diseases. Laboratory for Clinical Research in Neuroinfections. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Immunology of Infection. United Kingdom / University of São Paulo. Faculty of Medicine. Institute of Tropical Medicine of São Paulo. São Paulo, SP, Brazil / Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical "Alexander von Humboldt". Lima, Peru / National Institutes of Health. Viral Immunology Section. Bethesda, MD / Stonewall Medical Centre. Windsor, Australia / São Paulo University. Emilio Ribas Hospital Infectology Institute. São Paulo, SP, Brazil / Federal University of the State of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Virology. United Kingdom / St Marianna University School of Medicine. Institute of Medical Science. Department of Rare Diseases Research. Kanagawa, Japan.
Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Diseases. Laboratory for Clinical Research in Neuroinfections. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Immunology of Infection. United Kingdom / University of São Paulo. Faculty of Medicine. Institute of Tropical Medicine of São Paulo. São Paulo, SP, Brazil / Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical "Alexander von Humboldt". Lima, Peru / National Institutes of Health. Viral Immunology Section. Bethesda, MD / Stonewall Medical Centre. Windsor, Australia / São Paulo University. Emilio Ribas Hospital Infectology Institute. São Paulo, SP, Brazil / Federal University of the State of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Virology. United Kingdom / St Marianna University School of Medicine. Institute of Medical Science. Department of Rare Diseases Research. Kanagawa, Japan.
Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Diseases. Laboratory for Clinical Research in Neuroinfections. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Immunology of Infection. United Kingdom / University of São Paulo. Faculty of Medicine. Institute of Tropical Medicine of São Paulo. São Paulo, SP, Brazil / Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical "Alexander von Humboldt". Lima, Peru / National Institutes of Health. Viral Immunology Section. Bethesda, MD / Stonewall Medical Centre. Windsor, Australia / São Paulo University. Emilio Ribas Hospital Infectology Institute. São Paulo, SP, Brazil / Federal University of the State of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Virology. United Kingdom / St Marianna University School of Medicine. Institute of Medical Science. Department of Rare Diseases Research. Kanagawa, Japan.
Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Diseases. Laboratory for Clinical Research in Neuroinfections. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Immunology of Infection. United Kingdom / University of São Paulo. Faculty of Medicine. Institute of Tropical Medicine of São Paulo. São Paulo, SP, Brazil / Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical "Alexander von Humboldt". Lima, Peru / National Institutes of Health. Viral Immunology Section. Bethesda, MD / Stonewall Medical Centre. Windsor, Australia / São Paulo University. Emilio Ribas Hospital Infectology Institute. São Paulo, SP, Brazil / Federal University of the State of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Virology. United Kingdom / St Marianna University School of Medicine. Institute of Medical Science. Department of Rare Diseases Research. Kanagawa, Japan.
Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Diseases. Laboratory for Clinical Research in Neuroinfections. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Immunology of Infection. United Kingdom / University of São Paulo. Faculty of Medicine. Institute of Tropical Medicine of São Paulo. São Paulo, SP, Brazil / Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical "Alexander von Humboldt". Lima, Peru / National Institutes of Health. Viral Immunology Section. Bethesda, MD / Stonewall Medical Centre. Windsor, Australia / São Paulo University. Emilio Ribas Hospital Infectology Institute. São Paulo, SP, Brazil / Federal University of the State of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Virology. United Kingdom / St Marianna University School of Medicine. Institute of Medical Science. Department of Rare Diseases Research. Kanagawa, Japan.
Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Diseases. Laboratory for Clinical Research in Neuroinfections. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Immunology of Infection. United Kingdom / University of São Paulo. Faculty of Medicine. Institute of Tropical Medicine of São Paulo. São Paulo, SP, Brazil / Universidad Peruana Cayetano Heredia. Instituto de Medicina Tropical "Alexander von Humboldt". Lima, Peru / National Institutes of Health. Viral Immunology Section. Bethesda, MD / Stonewall Medical Centre. Windsor, Australia / São Paulo University. Emilio Ribas Hospital Infectology Institute. São Paulo, SP, Brazil / Federal University of the State of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Rio de Janeiro, RJ, Brazil / Imperial College London. Department of Infectious Disease. Section of Virology. United Kingdom / St Marianna University School of Medicine. Institute of Medical Science. Department of Rare Diseases Research. Kanagawa, Japan.

Abstract

Purpose of Review: To provide an evidence-based approach to the use of therapies that are prescribed to improve the natural history of HTLV-1–associated myelopathy/tropical spastic paraparesis (HAM/TSP)—a rare disease. Recent Findings: All 41 articles on the clinical outcome of disease-modifying therapy for HAM/TSP were included in a systematic review by members of the International Retrovirology Association; we report here the consensus assessment and recommendations. The quality of available evidence is low, based for the most part on observational studies, with only 1 double-masked placebo-controlled randomized trial. Summary: There is evidence to support the use of both high-dose pulsed methyl prednisolone for induction and low-dose (5 mg) oral prednisolone as maintenance therapy for progressive disease. There is no evidence to support the use of antiretroviral therapy. There is insufficient evidence to support the use of interferon-α as a first-line therapy.

Keywords

HAM/TSP
International Retrovirology Association
HTLV-1
Rare Disease

Publisher

Lippincott Williams & Wilkins

Citation

ARAUJO, Abelardo et al. Management of HAM/TSP: Systematic Review and Consensus-based Recommendations 2019. Neurology: Clinical Practice, v. 11, n. 1, p. 49-56, Feb. 2021.

DOI

10.1212/CPJ.0000000000000832

ISSN

2163-0402

Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/62091

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