DTIC ADA280525: Human T Cell Lymphotropic Virus Type I Infection Among Female Sex Workers in Peru

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AD-A280 525
NAIN PAGE
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toel.c, Of V.&"Cemf^ A Aeevn4oq Ftetn 010d.0Si ts), *M '1., 20-3.
t. AUtM-T ubt. INLT (Leave blank) 2. REPORT DATE 3. REPORT TYPE AND DATES COVERED
4. TITLE AND SUBTITLE Human T cell lymphotropic vi ru5' type I infection 5. FUNDING NUMBERS
PR
- V?44631051-29
6. AUTHOR(S) Gotuzzo E, Sanchez J, Escamilla J, Carillo C, Phillips IA, TA -AA
Morcyra L, Stamm W, Ashley R, Rorjqcn EL, Krciss J, Plot. P, WIJr -12 60
11olmen KK
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Naval Medical Research Institute REPORT NUMBER
Commanding Officer
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Bethesda, Maryland 20889-5607
9. SPNSORN / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSORING /MONITORING
Naval MeNdical Research and Development Command AGENCY REPORT NUMBER
National Naval Medical Center
Building 1, Tower 12 DN243566
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Bethesda, Maryland 20889-5606
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11. SUPPLEMENTARY NOTES
Reprinted from: Journal of Infectious Diseases 1994 Vol.169 pp.754-7S9
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Approved for public release; distribution is unlimited.
13. ABSTRACT Vlaxi.nurn2C-0w ords)
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14. SUBJECT TERM-S 15. NUMBER OF PAGES
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HTLV-1, Female sex workers, Peru, South America
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17. SECURITY CLASSIFICATION 18. SECURITY CLASSIFICATION 19. SECURITY CLASSIFICATION 20. LIMITATION OF AfS TRACT
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Human T Cell Lymphotropic Virus Type I Infection amnong Female Sex Workers
in Peru
FUnardo Commzz. Joig Slnchez., Joui! Eseamlfla. (Imnlura ds Mirdidna 2-~rrau"icA frzmnder -01i IlHmoifd," Unsmidad
Walter Ctarri CRIrWahironoa dglsta Arr AAvaS.rns hr e llhlzehobn, Uy mipARE, hLridLunaiit i . .NRb~~aorrm.e,PCnOw.X v/e:. no and C#:ilro AIhnCrieMcndv1uladt n. obLa',S dAo.efIN DLaSmf tIaAon,I edMd SiiRTc1nD1i 1 Ra94nr u ooS Drdra hpS naInnlwrsimddi omvUu e 'DoPOf" nMA. AMPaJ1ijec''r,n.t8e
Joa Krehss Petcr Plot, and Kin; IL HolSm" Labonvor*,' M~d~riss. and Spidaoriaelv. UeiumMery of Wohisqidit
Seairfh: Intlttefgg of 7roplf~I MWACliw Aniwetp. Balg14Ii
Four bundred female sex workers attending a sexuially transmitted dimsus chisic In Ulrns,
Peru. ware interviewed for desnographle Wnormation and medical. contractotive. and sexual-
practice historian. Cerrical cultures were defte for Neirseria gonorrhoatf1 and chaIR,,IY& twIho---
mailt. uand minimn wu4 leeed f'or suribodies to human i~nmwsuodskleuy ~virs, humsin T cell-
lymphottopic viuzs type I (HTLV.X), Tmponeneo poflidim, C frackomoiis. berpee slitplex vsirus-
typo 2 (HSV-2). eMd flurmop hi!.: ducrevl. The prevalenoe of HTLV-I increased with datration of ~-
prostitution lfrom 3.6% (,0. year) to 9.3% (3-4 yeam) to IS.9% (>'6 y~uan. P e. .03). After
adjus~tmentt for dUn~dOD ofprostitution, reduced risk of HTLV-I was ulunjflcantly Correlated with
condom usa for mome than half of &Hsel xual exPowies for >3S years (odds ratio [ORI, 0..K- 95.%
confideace Interval [0!). 0.13-0,89). Forthitz adJustins for cor~dom use. NTLV-Ileinoposltivity
Wes associated with C. trachomxds (OR. 3.71,95% Ml 1.4-13.2) And with antibody to HSV.20
(Olt, 3.1; 9S% C1. 0.5-29.6)- Thu%d uration of prostitution. lacit of Coasistent condom use, and
Pitt Infection with C iroe/iomatis were significantly associated with HThV.I stropositivity.
Hu man T call lyrnphotropi;c viruI type I (BTLV-I) is auso-_ ser3Iogically discordant couples include older aie. high ax...
ciated with a.v ariety of :l1inicul syndromes. Includin; adult T body titers, and pmrsenCt otanti-tax nnibody in the scroposr.
cell leukernia/lymphiomfl [1. 2) and HTL-associated 1w- tive Male spouses(1.4.inSthAei. cntno-
mmaynei op thyUopical spastic parapare~is (33. The virus is inAiOn suggests thatHL. a ecm o t rusa
cnderic in southwestern Japan t ll, the southeastern United risk for sexually tranmntrutwd diseaSeS (STD). Including huv-
Sutes f4l. the Caribbean basin (5]. South Americe [6, 7], and man iunmunodeficleflcy virus (HIV) Infection 16. 7). Data
Pans of Africa IS). Patterns of age- and sex-spccific preva- regarding the risk factors for ioxuai Innhsmnission are limited
lence of HTL V-I difrer ftom country to country. suggesting an otaitr lhuhrlmnrcaa uls n&I
different dynamics of transmiission [9). The major routes of ogy to &ikf actors for sexual tranimnisslon of HIV[N 1]
transzrnsszonare frot ntocher to child via brustt-teding [iC. The present study aastisesn the relationship of HTLV-1 infec'
I 11. through blood transfusion (121. and vta sexual transmis- tion to sexual behavior and demographic variables and to
sion 113). Among Japanese m&Mcd couples. concordant me- STD (including HIlV infection) among female sex workers
ropouitivity is much more common than extpecttd by chance. (P5W) attending in STD clinic in Urna. Peru.
tratimtliSSi~f ftem man to Woman is more Comm'on thant
from woman to man. and risk factors for :ransmissou within
Methods
Stkdyp opulatiO'ot and de-ign. A crosesectional survey of the J
Rtaftwve1 27 JLy 1" 3: urvted 8 Docembff 199). cpdemialo~y of HTLV-l was done among VSW in Lb=a be-
t#UP(jCIoTAsMeSoteow1PlO Rruwure4u r*mosAne,of2baIo.lAaatp~7 t rvOnmreUlA7aiyiiUWsOn Am3np ns Ctt7Ti7dp'oai; dsa.v aVn dp s Leyro.0hr tAMnmJoqroiowtnSSn'Ih1ncc-9.gTrmNwy3a dtn*:tC ho oeoe if1otbodnn vi rW4ooiyta Hfesi 4pdfW lIhwawto 5eM tI nhMore)rDaMou:AdleoMd~ evdu d k h6ttUttsabeMich.Ai 68 lnaiufc1tlwhItwot 1aDeti,nihntSRys l eS'a m aoR~eiRn fr.n ese D odaFeMSlsh rnomsrye ufu.tie r1buS aleonn0wIj roewadifc0c~nadmfe b)rCn gi f).PW lel oengI IotntRmae jv4Ytr'sOsw6oto'l0iliLi e a_vkfis1rHId iC;unp itNe*wthEet*wFioeMeaeouqWo o i iy6Cel.tUoMrn pI.&sio A r.s e Maf~miSUnaeoClfy.uncui*rl dCo aunidIhmtI ensefnnf nau tctf ntt rrhamei m lotw2e4tee1to nhe 1W f9i rd5eta ~ofc91o. e.lS I3it tot'iiLs.taDhifs n ileAAt~mAesocSiovf I IfehtDDtie Utem.Ct toSoStnpeYo &d a az nW"vRaauatOenGoidAgrh t- 1 ttoo t tpatiAOav1nnneo 5prtnts dnve.won,edcw o irddcpainvCut oya uoiedshersnlOl sl .wkawat tteb rhcowrteaelxuoeto dcroatrgnCoyete ibmudd inffnpeooli ireenaatnrrfidwhw vr a Ptrtaea ht1reoisti5 ,eo9t'h cWam9noeli~As1wg belie tirowhntxs naa tah atgchcainle vnlsoiauuida pel rednB ppledtrpehra As.th ert rdaioAfespdirnoc oeecfFcrefr tnguiu tIbSeliosti cnls rrWtaoeu t1ftoo.pori fr .9 aol rLerm9oTet ansih2tonMo~sh eite.fitns idosncsatLs t r Sl ctm tptcCmhttaMraeuol odsi eduNnns. t dxyns tPerPai msStetuamIueppqbnTieetlarDiuadiiciin ion ar mmiasrtgn.paicyibic.caalmcd tsilprispl3o -aihiofhnlan0loyiIi. isns ulpo ric~sm s ttf eswartt Lhvivt avc.eeeera anesortmnedtyrs..f. - ;.4
Ps 122. were later assayed for antibodies to KIV. HTLV-I. C. twcAomo.a-
rjp- Jeurul adoofd@lOe6" e 94:-11~54 tis. herpes simplex viVuI type 2 (HSV.2). and Naomophiha
. F- 714 ~'1 :l4 02Z404
2 ..-:~ 2. .~
LPJ KkG MIEDICAL .. PERL' E GOTrZZO Q003,'007
93-12:6 14 (Apr'.3I MTV- In Pema Sex workers,75
LUborarorv #,w/tcdr HiTLV'l antiboditi wait determinend Table 1. Univariute MO"ysI of the relationship of woodemnogva-
by ELISA (ýGenatic Systems. Seattlei). and peweistantly rea.-dve Ptlic and meodical history chancteris~tcs to MTLY-1l tnfecfloa
sera wfte tested by Western blot (Cambndge Slotectu Worces- ansort; ftmale stax worken; (FS W) inLirna.
tor. Nf A). Sera were considered positive if*a ntibodies to 924., ml
pl1O. and Sp46 proteins were dcmonsuueted and intensity ofr cac HL-/tl() (5 t
Abby o th p. 19) band wonrse byWeterthn blatofthep bCanbd;e EU5L
Sarae were clasiefieedn aes mpcldveIf antoonye thed iagOz'cue AC(hYKOMO)C** ) 06 O..13
badh apard ain~mnyothomerbnd piassay weWr1e5 LISdto tnest 41M OJ.12237~ .
termiantide (1o1 9. Cutreawnu~ainlfor Nijeoro rthI:1a nd C 21o-h21_ ms~e 16/107 (2.1) t.(0.733
rc~ondaeil wiart donnpaspeti ulyt tbdon. Scsi (2e.reT esedfHorS V.0 9/120 j7.) .11,-06h
2antibodye tb yVw ere blone bsy [23J (Abdbotta tbody tone. 24ast 1761(3.027) i.u 29-46
Ab~wdbot.Pyk EL)aSn dj by4W31a1tt 1- blt Cabrdg HIonIrmed .5)"0
Sloteca accordin to vorldNiltenly wOrganzatone coriteria 18) Jumntsle 7/45 (119) !0 ( A5
Satorenn Stdente:~dtp oeOsddt.s ratios ( ~ bytse e bt used HNig h hoo 1/24 (11.0) 0.60.313
mate trelanemrani s od. abslesptwicisrae st~ (SPSS/PC 4eot(2.03M (2'"). 0.7 (0.:.0,)
ThrogctrimmunSPSS.creseo) assesse1d w heu sedatibotens sis m Sl 1221346(S6.) 1.0
cons-idfer evtioa n~todfspl ed inslkc tion. Factowwrte#s PeH cVr pion15b it 3.7
inth umyni ivaa riate nalyses were nontden ae 'orel saialoud PrpyItV"#* tiun rjr
(Pibls us.int)h e X3tesaotw.v rtohe m odtel.Mte~sto ~ati na ation otee fta 16l2l03 .31.
twe.and Studento' r pest Odidsnc ofs (OS) wort usedV- wao iyY e's 1.6)
majuter jd v rpft r Sibl ie log istriac usingalogiti regrS4iS.o0n 0 Wood4 (6.4) '.0
pr~m, P&Cic~)aua h rltonhpbtwe 4 33/46(62 6) 1.0 C959
NTV- Infeytis. andn&a ecfc Oitrr avr wt P< Y onuoka 14los .7(.649
in Ph uartiipanests w4e0rFe W28renitered fnorordttlh: v aibes. P,*t ylili qe~Q~Sj. i civ
were (ieudadinato wtAh ntelo dtrl Anifv nthrece y6: 1ifarI sogaai~ Kesr tatOM trend: .0(.3)
(P ry .05H lthe asdiv pnowoef r ithermoel). The manaotwsb e-39~ YeW (26/5 old.(1(100.-
pitivecb y LISA. sordeui ndeemnSwTDbVWA netarnblttia-swys lHad"s iifocffrn pyiwithirauzgpeence
adjred for p4 oshf~be nctnfondetiresusiglt~shdeth iess1 m, Nodis Wom34w46 ho evrrciv.pohyatcpeii
bbae ncadonn iddc eurledd postive accorinHittotyi nf bnuthirt infectionS(eqntyasdi Pstopee o
to becopnaevtlv al4le0 S (284smna weouor erdou died feri- TVt-aIn tib: .05. e tia ote P ~.0) H
odexyaodeeminato wth sptee ntyoA idenitivntye oftihes Min- Manhitel o syphulita.c or pnare wonth 22(.4)of 44w i
Ith o Hrealthand by6 nulturegisered).5 The mtN. Moorhwe as s.ocpto ohrta reiilo.hsoyo lo
(3038t604 yard (3r8angCe. :m4c. vomallS5328 S.% ,*r oerl n- nthio itr foooca n~to.adhsoyo
firme (76/400):Cv .t Hraero'n1S5e. ra 44Tw0Vo)J m HeeS wV.e2h r0ewmnakowegdevrhvn
82.2%iv (3y3/39):Band H. determ initeb yW84e0tr)u bosssy aed intravenous dr h ruig rV4gs.fKTVan
Tabanld couldare cosiHerTeV lspositive accodi-negato ein bnvarhiate anajt yisotfequenly usehavioPru to pretvinoth r
to be toattrai All 4eId emograpicands wreoxclude fitor HTest, afnprcoet ibuties tin ohrelati en (t<oH0nT) eLcVin Vr
abe Inreosing age acnudt uewreasn 7.5%ucationlel orrhe-e srh.ow cpaiot abotlhee ropis.tTitumtiowTnS .W r ofdb onomod
::'tT YD 99i-(Hr
1746 -11,nz
Tabia2. tVnivirimb Analysis of the relationship of eexuAl tvchav. 30, cW is9 hlof a*ttIavs$
for and practice e(prostitution chmclristikuto HTLV-l Iinfscijon a
amfong5 fermalc tcx w~orkers (P3W) Int Lima. 25 to h o ws No f~ a fr
No. positive Ibor Odds fatio 0
HTV/oI(S) (931 C0 o 20.-
~15.
Age at Ant.te seual lnteftowm
*18 2/71 (2.3) 1.0 - 10.
14-1 B 22,1291 (7.6) 2.3 (0.7-25S.31 f
4CAI 3/31 (9.7) 3.7 (0. e-S3, 3)5
Yan uiorkin ta sf~lW
3 3-6 .
1011(-)2.9(0.0-1.0)
10/63 (1S3.9) 5.10.11-151) Durationo0f Prostitution In Years
r~ ,Seomprevslgence of 14TtV-I accordint to duration of
19/203s (0.0) .0prostitution and condom usN.
No16(& 1.0 more than half or the time fbr >3 years or for the full durA.
Yes 2=&28 (7. ) 1.0 (0.4-2.7) tion of prostittion if <3 yum were signiflicetntly associated
Aith atntibodies to HTLV.[. There was also a trend itowaud an,
Soicsf:comior btawm of the client
N~ish 2/162(5.6) 3.0 association ofUTLV-l with history of oral conutacptive use
Medium 9/1101(7.3) 1.3(0-1-3.9) (OR. 2.7: 95!o confidence interval [01J. 0.9-7.9. P - .06).
Ever "I/t2 (9.2 3.7(0.64. The mean number of clients per day and type of exuAl acdv-
No 21/312 (6.11) LD ity (e.&.. sex during menses, receptive anlal sex. and perfor- 4
Ye% 7/33 (t.4) 1.3 0.3.) mance of oral sex) wert not significantly associated with
AleChOl o.fri son lam year TLV-l soroposivity.
No S/Il (,9) 1.0The reladoonships between HTLV.I1 and all flctor signif-
.;.WcK% oo ff tthhee ot'.rmme o¶ 94//4i 294( 3(7,.22)) 11.2, .((100 ..43--24,.70)) cwaisnet ilno gtihseti c mrengivrtetrsiasitoen a naanlaylysseissi .w Ienr ea fdudritthioenr .a asm suuldtip! bliyc astteivpe- i
Dmp efaf wxin teraction between age and duration of work asaon PW was
No 2/2.31(.0 used as a voldable. The use ofcondoms more than h~alf ofthe 4
SetI (9.ns 1.5 0.54. time for >3 years or for the full duration ofp rouitution land
No 101113 (81) 1.0 duration of Prostitution entered the model. After these vari*
at o*Nd e time i3/227 (3.7) 0.6 (C,3-I 6) ables entered the model, the other potential demographic
3D of the Or., S55~(9: 1.0 (iA.-3.S) and behavioral variables were noc 1008or iassociated with
14TLV-1I nfection. The above. variable roe condom use was
Anal su
No )1/:72 (6.4) 1.0 Idpendenitly associcated with HTLV-I. even saler adjusting
FAldom :0/152 (64.) 1.0 (0.4-2.1 fbi mtiwmo rking ats an FSW (OR. 0.34,, 95% C1. 0. 13-0.89; P
Mare~o Oral 1/6(1.6 0651 <. .05). The relationship of HTLV-l stoptvaleri2c to con-
NO a 318.3 (.6) 1.0 dorn use for each 5tratumn of duration of prostitution iss hown
y" 1/30 (A.1) .4 0.7-l~o infigure 1. Figure I sunsaut an interfaction between the
amounit of condomn usea and duration of proutitution as pme
Ever VII Oal winlracorpuvw
No Yes ~ 244//1217IS2 ((M11.). 1112)..07 (0 9-.7-. 9) daiccitoor s ioorfm th teo p tehreem mntoadgSe l wHiTthL bVo-1th p o"saitiiv ee.f ~Atcdud ainlsgo asnu glingteetrs.
Co.ncdKo mof Uth"ee wtimit~he . eollre~fpfl e~ cro~ w. time bu¶. ~signihcant this possibiilnIt yt h(eP u-niv.3a11ri)a. tI, n aan astyespiwsi u(min tcrulund inwgit hb ovtahr imabaliane
21/11.0 (12.4) 1.0 eficu) and the interaction .terrn. the interaction term was
3bploroo trftimtut iffitr orW dc ) y3e n ea0,Rrolthe fint tcamn to wotr the model (P - .004). followed by
duration atprostituOtio ir <3ysi&n 7/200 (.5%) 0.24(0 1-0.4) condom ume (P - .02); no other variables entered.
aswoiation ofHTh V- to currnt and pant STDs were
NOT. f. on~mrInervlThe
:C!. 0n1eneIte5 next examined by uniwarlate analyses HTLV-1 uarpotitivsty
NOTE.
t ifettil'*Ifw al t foir iWa:tred4l:P -.os waus ftbund in 6 (11. A) of 54 with and In 21 (6.2%) of340
X1' test; Pw . 06. without current chiansydial infogtijoe (OR. 1.9: 95% Cl. 0.6-
CC5~~~:D1. P40 .r- UPM1 4S1 14 823404
?411i9nF .e1m0ae( SAejxr Wl)k'eLksVgs -1 757
Tablo 3. Serologic evideace of texually iransmitted disease as risk Wacon for HThV-1.
No. Polihive fbr Creds OR. Mjusted Olt
M -ICTOY(a.i t) OCss 0) (955 0I) P
No211320 (6.5) 1.0
7/75 (9.;) 1..( 0.6-3.6) 0.6 (0.3-2.) .74
-t
AC
NO4/167(2.4) 1.0
22/220 (10.0) 4.50.5-014) Ui3. U. .02
No 19/3 10t6. 1) 1.0
Y 9/11(11.1) 1.9 (0.8-.4,) 1.2 (0.s-2.8) .67
NOTE. OR. odds facto: C1. Co Ideace hntcrVaj.
AdIjusted for duratlea or protitUStif1 and CQnd0M Mht.
j .2FP AS) and in 0 or 29 with and 27 (7-41) of 364 aminaiion may actually shcnten the* duration of infection.
fl
wcthou'. gonorrhea (P -. 2). thereby decreasing or eliminating the told of this.e xposure as
The relationships between sPrologic evidenceOfS TD# and ar ilk factor. Of coumse it rtAmain possible that exposures to
HTL V-1 are shown in table 3. Past infection with C.t racho- C. machoma:Is and HSV-2 wene only markers (br sexual ex-
mari and HSV-Z were strongly associated with HTLV1 -scm.- posure to HflVl., rather than tue risk fhctors, despite of-
positivity. Nly .3* (400 womenS were HIV-I -positive. none fobrt to adjst ibr du ration of proswtitton as a possible con.
of whom' had HThV-1 infection. fbunder and despite evidence that number of sexual
Finally, the relationship or serologic evidence of STD to exposures was not a risk Akctor.
HTLV-1 seropositivity was asseased by logistic repeasion These d~ata suggest that genital chlamnydial Infecfon and
analysis. adJ usting tor time wotking us an FSW and condom genital herpes may be risk rlectors tbr swtual transmission of
use. Thfis analysis showed that C. trac/zoinails antibody re- HTLV-I. as has beeu repored for sexual transmission or
maincd signiftcancl associated with HThV-I (tAble 3). The HIV. Previous studies involvial sox workers in the United
OR ror antibody to 11fLV' with antibody to HSV-2 was also States (26] anid Peru 127]jalso bay* oaand that theduration of
increased (OR 3.7). but this astociatlon was not statistically prostitution wus related to HTLV-1 seroositlvity. Lack of
significant. condom use and strologic evidence of prior HS V-2 or chia-
mvdlial infection were not examined as rik factors for
DiscuaioaHThV-I infection in those two studies. However. other stud-
DiscussionIts have suggested associatlmn of HTLV4 Infection witht
This study showed that HTLV-1 was prevalent among syphilis (IS, 27. 28] and IfSV-2 116. 291.4a4 of a satisfec-
FSW in Lima durin& 1992 and was ninle times more preva- tory sesologle test for past getiococcal inftvdon precluded an
lent thin HIV. The wiociation of HTLV-1 infection with anlalysis of prior gonorrhsaas ar isk Ibtor for HTLV.t infec.
duration o priostitution and lack of consdom use suggests that lion.
l4ThV-1 Isa cquirod sexually in this population anid that con- The privaileace of HTLV-I amcmg P8W In Lima wasn Iowe
dom use is protective. The interaction efibcx, between con- than that amoong FSW du&$n 1988 in Callao (25%), the hiar-
domn use anid duration of prostitution Isa lso consistent with bor of Limna (271. However, the women in our study were
the oersistent efrect of condomn use. younger (23.8 ±t 6.4 %*.3&3. 8 3. 2 years). had worked as
Even aflr adjustment ror durationi of prostitution and prostitutds for rewtr yewr (3.5 t; 4.0 vs. 8.19 t 6.7). and Wa
condom use. HTLV-1 infoctlon was significantly associated had fewer clients pcr month (59 *79 vs,214 ;t 138) thin the
with serologic evidence of pust infection with C. :ra~Vomads women in Callao. Therefore, dikrences Ilk tota number of
anid not signifcantly with scrologic evidence of XSV-2 Infec- exposures. may account for the diftremc in the prevalence
tion. It is not clear why antibodies to C. trachomaUJ and bettwieen the two popuilations.
FISV.2 were associstad with increased OM* fib HTLY-I in As reported 1br other F{TV-I-eademic populationt, the
the ttdjusted analyses While anitibodies to T.p alllduni and H. prevalence of arttibodies Increased with age. Uxplanations
duici'cv were ntot associated. The uerology tst for M.d uc'wyl previously postulated included a possible cohort effect (i.e.,
antibody Ise xperimental and may have been relatively naA' the probabWlit of expostire in past yeas may have been
SPOCIfRC in thi3 population. For syphilis, the freq~uency of ex- greater than 1n recnt years). However, In the rnultwarlate
o~-~:9~4~44 ~ J~H :4 *23404
75. oWltO @13a1l CJD 1994:169 (Apni)
anaysis, neither a~l Aor the ifnlerAC91011 betweeri see and who probably had b5cliferehM~-41Vemge Access t0 health Care
duration or pros.titution had a significant Infitience on the and STD a~iment than did the FSW population au awhole.
modet. indicating that the durationi ot exposure as an Sw Furthermore. our cross-sectional study design dlid not defiril-
arid lack of condom use. indetpendent oftge. were the impor- tively exclude cohort eflbcts and could rot directly inteelncl-
tant cont'lates rot the acquisition of HTL V-I1, dance rites for I4TLV-l infection. Purther. thc crosa-sec-
Sextuul behavior risk ractors have been implicated In other tional design did not permit assessmeriL of the hezniporal
becaulte of the large and hithly variable number of clienti live for HTLV-I by EULSA and negative or indetermirtate by
and bccauseourestimate of thenurbev orrecent clients mav Western blot, a small misciaasoffcation bias could have oc.
not have reflected the total number of lifetime exposures. curred. Nonetheless. the results of this study can serve as a
C.i rachaniatit produces on intense subepithelial nionottu- guide for future p.-ospeive studies to further define risk fkc-
clear cell infiammAtorv reponse in the cervix and cpithtlal torn for HT'V-I transmission arnd to Aacies the eflectivenett
microulcerstions. Tbii riucosal disruption and inflarnma.- of condom use for prevention of HTLV-I infection.
tion could facilitate HTLVl1 transmission in a manner analo- In summary. this study demonstrated that I4TLV-1 infec-
gous to that piropomed fbr the effect of cervical chlamydialition is common among FSW in Lima, that other STD3 may
infection on H1V- I traniml~sson In Affica. (30. 311A. lterna- increuc risk of sexual acquisition of HTL V-1. and that con-
tively. chiamnydial urethritill might render am an with HTLy. dorn use may be protective. The high~ provalenec of HTLV-1
I inlcio more infectious and more likely to Eransmit in older FSW is quite disconcerting. and Rurveys of other
HTLV-1 to aw omaun (along with chlamnydia). high-risk populations in Latin American are warranted.. The
Although oral contraceptive use was associated with significance of high rates orR-TLY-1 among FSW remains to
HTLV-1 infection by univariate analysis. the association was be defined. The zisk or trananulssion to clients and lie risk of
not supported by the multivariat~e m~odel. Nonetheless. oral verticl trannmission has not ye! been studied In this popula-
contraceptive use Increase the age-specific prevalence of tiozu. What Is ee fifciunua aiu snsC%eh
cervical actopy. arid cervical ectopy may incre~ve a woman's acquisition of HTLV-I? Does the high risk of other STM
risk of acquiring HIV 1321. Two prospective studies in Nai- make FSW particularly likely to transmit HTLV-I7 What is
rob! (bund an association of oral cont~raceptive pill use with the risk of siquelta fotlowiri; adult acquisition of IITL V-I?
risk oflHlV infection (30, 331 while other studies have found Finally. what is the influence otfllV-1 on c~oexisting HIV
no such association 134. 35). heavirig the question unre. infetcion in high-risk populations? Although these questions
solved. The relationship of cervical ectepy to risk ofacquisi. remain to be answered, there isf eason to be concerned that
tion of HTLV-! should be examintcd flrnher. IITLNV.J infection may be an STV of major importance. at
Parersterail transm'isuiont dotes not appear to be a major least in this region
route of acquisition of HTLV-1 among ?SW In Lima. Blood
transftion has not bean associAted with HTLV-I in Nhs pop.
talation. and parenteral drug use Isu ncommon in Peru. Mowa- Ackrzowledsments
ever, need]*& and syringes are commnonly rertsed in Peri. And WetakCiia.'gnto trvwn F .AaMaa
propyla ic njecinso pnclinw are commonly Fiven to W tkCitn Snfri avlwa S.AaMr
Pb5 Wa. nTtch oiW udo torforHWV!treanssio Novaan(wd doino the gyriccolooc extaminations. DOU0la W~ai
FSe Wari.sT choAi ldm r fo HTV-1trasmisio if andLawrn ioutaky fbr reviekiog the manuscript. and Lloyd
the needles and syringes are improperly sterilized befcet frsatsaa spot
reuse. H~owever, in the multivaeriatc analysis model. history
of penicillin prophylaxis did not rermain associ~ated with
HTLV-1 infection. 11teruien
WherM5 PC~ierI3nat transmission of 1HTLV.1 or trarismis,- t.wunY.xmd .co rea)Atba oaul vi kr
sian through breast-feeding; from mother to child appear to
*ilmY.OmoaiaCo-vreiLwnl-beutadua1flhtifkmed tatipti (ATLA) In sm from patients wnith
be common in HTLV-I-endemic ateas; of Japan. these P l McnrIii eaq£-a~cwd t.p~i~~~ td
peai to be ur toomor amsong FSWi n~uP eru, since the prea- inJ aa, o Caflw 1912;296tS
lance or infection was very low for those just beginning to 2. Rb MO CU moinh~~ce~ou~
wor asFSWbetween the humnr ?-aeII Zaukerntailyinphoma Ytru (5(TLV) aed
works FSWadultuI Tcle ukenia. Slur igS ui2.M
Our study is subject to several hatitatiUofl, On was th 3. Celahmn A. Saris 7. Verma~t JC. ct &LT he 0 antibodies to human
inability to extrapolate to the entire population of FSW of T-yYmpllropicYvlnuitypo I in paevtsitscal "tucprakere
Lima: our simple was biased toward FSW who at terided the 19i1.L15a2e~ 407-10.
STO clinic reaularly to renew their registfation status arid 4. Slayney DW. listuier WA. Rkobern4vrolf X t MlT.h e humen T-aell
~114 823434 P. 0"
~-~-94 14:43 II JC
ItoID" 1694(A~p ril) IITL.V- iA FemAlc &A Workers
I.qk*M~a virus in tho soeoucMa United $tutes. JAMA 11. Simns WIL M~iril PA. Ckkm)vwyfrailirsvartit lailldos ofii aotheA1113.
l9&3~20::O4-~2.in: Holmes K&~ Mkdh F&. lpauing FF. ~wittoi Pl. edo. Iaauaily
s. C~A~rbet " midehiocp Center. Pubic health implittatio's ofHTLV-1 teuietnoitd dietaes. 2nd t4. Nw. Yftiii 1.4a~w-HA1 199017-
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f. Phhilip 1.N jvAms KC. Wlgnail P3. at al. M.TV-J CO-44nketon in 24 22. Lame $A.H unter EF. Creowsn Br. Syplaillh. 7.u Holmes KXCM 5.rdh
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S. deowicte aniibadtas to heipos simplex virvie rips I and 2t o human
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