Strengthening awareness and response to HTLV-1 infection in Africa: a neglected threat to blood safety and public health
Author(s)
Type
Journal Article
Abstract
Human T-cell lymphotropic virus type 1 (HTLV-1) is a deltaretrovirus endemic in several regions worldwide, with Africa considered the largest reservoir of infection.1, 2 Despite its discovery over 45 years ago,3, 4 HTLV-1 remains one of the most neglected infectious agents in global public health. It is estimated that at least 5 to 10 million individuals are infected worldwide, with a disproportionately high prevalence concentrated in sub-Saharan Africa, particularly in western, central, and austral regions.1, 5
HTLV-1 is a life-long infection, transmitted primarily via mother-to-child (especially through prolonged breastfeeding), sexual contact (especially from men to women), and blood transfusion or organ transplantation. The virus is etiologically linked to a spectrum of diseases including adult T-cell leukemia/lymphoma (ATLL), a highly aggressive hematological malignancy with poor prognosis,6 and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), a chronic, disabling neurological disorder.7 There is also strong evidence that HTLV-1 infection is associated with increased age-adjusted all-cause mortality.8 Despite these severe outcomes, most infected individuals remain asymptomatic throughout life, or die of fulminant hematological malignancies before the diagnosis is made, complicating public health surveillance and awareness efforts.
Unfortunately, routine testing for HTLV-1 remains absent or extremely limited in most African countries, including testing prior to blood transfusions, a key route of transmission.9 This perspective article synthesizes the first symposium on HTLV-1 and blood transfusion in Africa, including current knowledge on HTLV-1 epidemiology, clinical impact, and research advances on the continent. It further highlights critical gaps in diagnostic and preventive policies, culminating in a summary of key policy recommendations to strengthen regional responses.
HTLV-1 is a life-long infection, transmitted primarily via mother-to-child (especially through prolonged breastfeeding), sexual contact (especially from men to women), and blood transfusion or organ transplantation. The virus is etiologically linked to a spectrum of diseases including adult T-cell leukemia/lymphoma (ATLL), a highly aggressive hematological malignancy with poor prognosis,6 and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), a chronic, disabling neurological disorder.7 There is also strong evidence that HTLV-1 infection is associated with increased age-adjusted all-cause mortality.8 Despite these severe outcomes, most infected individuals remain asymptomatic throughout life, or die of fulminant hematological malignancies before the diagnosis is made, complicating public health surveillance and awareness efforts.
Unfortunately, routine testing for HTLV-1 remains absent or extremely limited in most African countries, including testing prior to blood transfusions, a key route of transmission.9 This perspective article synthesizes the first symposium on HTLV-1 and blood transfusion in Africa, including current knowledge on HTLV-1 epidemiology, clinical impact, and research advances on the continent. It further highlights critical gaps in diagnostic and preventive policies, culminating in a summary of key policy recommendations to strengthen regional responses.
Date Issued
2025-10-07
Date Acceptance
2025-09-12
Citation
HemaSphere, 2025, 9 (10)
ISSN
2572-9241
Publisher
Wiley
Journal / Book Title
HemaSphere
Volume
9
Issue
10
Copyright Statement
© 2025 The Author(s). HemaSphere published by John Wiley & Sons Ltd on behalf of European Hematology Association. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/41064106
PII: HEM370234
Subjects
Hematology
Life Sciences & Biomedicine
Science & Technology
TRANSFUSION
Publication Status
Published
Coverage Spatial
United States
Article Number
e70234
Date Publish Online
2025-10-07