Labcorp and its Specialty Testing Group, a fully integrated portfolio of specialty and esoteric testing laboratories.
To detect a human T-lymphotropic virus (HTLV) infection; to help diagnose the cause of adult T-cell leukemia or lymphoma or HTLV-associated myelopathy
When you have signs or symptoms that suggest that you may have an HTLV-associated neoplastic condition or demyelinating disorder, especially when you have identified risk factors; rarely when you have donated blood and been told that you are positive for HTLV antibodies
A blood sample drawn from a vein in your arm; rarely a sample of cerebrospinal fluid (CSF) collected from the lower back using a procedure called a lumbar puncture (spinal tap)
Human T-lymphotropic virus (HTLV) infection is associated with certain rare diseases of T lymphocytes (T-cells), a type of white blood cell that is an important part of the body's immune system. This test detects an HTLV infection in order to help identify the virus as the underlying cause of an individual's leukemia, lymphoma, rare nervous system disorder, chronic pulmonary infection, uveitis, infectious dermatitis, or other inflammatory disorder.
Two types of HTLV are most commonly identified through testing: HTLV-I and HTLV-II. It is estimated that 15-20 million people worldwide are infected with HTLV. The prevalence of HTLV-1 infection is greatest in Japan, sub-Saharan Africa, the Caribbean islands, and Central and South America. HTLV-II appears to be endemic among Native American populations and is prevalent among intravenous (IV) drug users in North America and Europe.
In the United States, about 22 out of every 100,000 people are infected with HTLV, with HTLV-II infection being more common than HTLV-I infection. HTLV-II infection is associated with female sex, older age, non-white race/ethnicity, lower educational level, and residence in the Western and Southwestern U.S. Some Native American Indian populations have infection rates as high as 13%. Those most likely to be infected with HTLV-I have immigrated to the U.S. from a country where HTLV-1 infection is prevalent, are children of such immigrants, are IV drug users, or are sex workers.
An HTLV-I infection can be passed from mother to child during pregnancy or breastfeeding. Both HTLV-I and HTLV-II infections can be sexually transmitted or spread through exposure to contaminated blood as occurs with sharing of needles during IV drug use, although the majority of drug use-related infections are linked to HTLV-II. Both types may be passed through a blood transfusion or an organ transplant, but infection due to these procedures is now rare in the United States because all donors are tested for HTLV-I/II.
Other risk factors for HTLV infection include: living in parts of the world where HTLV is more common (such as those listed above); having a sexual partner who came from one of these areas; having multiple sex partners; being an IV drug user; being Native American Indian; or having a history of blood transfusions.
Both HTLV-I and HTLV-II preferentially infect T-lymphocytes. Most people infected with HTLV-I or HTLV–II will have few to no symptoms but can pass the infection on to others. After the initial infection, the virus never completely goes away but remains in the body in an inactive (latent) form. A small percentage of those infected go on to develop one of several associated diseases, typically months to many years or even decades after their initial exposure, and may then become acutely or chronically ill.
HTLV-I is associated with:
HTLV-II is less clearly linked with specific diseases but may be associated with certain lung conditions, neurological disorders, arthritis, asthma, and dermatitis.
The body responds to an HTLV-I or HTLV-II infection by producing antibodies. These antibodies can be detected in the blood during testing. The viruses may also be directly tested using molecular tests (polymerase chain reaction, PCR) that detect the genetic material of the viruses.
Human T-lymphotropic virus (HTLV) testing is used to detect an infection by HTLV-I or HTLV-II. When the virus enters the body, it preferentially infects T-cell lymphocytes. The body's immune system responds by producing antibodies that target the virus. Most individuals who are infected do not develop an active illness, but a rare few will develop a condition related to a disorder of the T-cells.
HTLV testing may be used in a few different ways:
Two types of HTLV testing are available, antibody and molecular testing:
In the U.S., all donated blood is screened for HTLV. If a person who has donated blood tests positive for HTLV-I/II, then confirmatory testing may be performed to determine if the initial screening result is a false positive or if the person who donated the blood has an HTLV-I/II infection.
HTLV testing may be performed when a person has symptoms or findings that suggest that the person has a condition associated with an HTLV-I or HTLV-II infection, especially when that person also has identified risk factors.
Signs and symptoms of adult T-cell lymphocytic leukemia or lymphoma may include:
Symptoms of HTLV-I–associated myelopathy/tropical spastic paraparesis (HAM/TSP) may include:
Testing may be performed on:
HTLV testing is usually done in a stepwise fashion and usually includes an initial test followed by confirmatory testing, depending on the results.
If initial HTLV testing is negative, then it is unlikely that the individual has an HTLV infection and the person's symptoms are likely due to another cause. Typically, no further testing is necessary.
If someone has HTLV-I or HTLV-II antibodies on both initial and confirmatory testing, then it is likely that the person has an HTLV infection. If the person also have symptoms linked to an HTLV-associated condition, then it is likely that this infection is the underlying cause.
A person with positive initial and confirmatory results but no symptoms, such as someone who has been tested because she is the mother of an affected child or the sexual partner of an affected person, or someone whose donated blood was positive and confirmatory testing is also positive, is likely to have the infection. However, in the vast majority of cases, the person will never develop an illness. These people can, however, pass the infection on to other people and should take necessary precautions (see Common Questions #3).
Those who have a positive initial HTLV-I/II test and a negative confirmatory test likely have a false positive and not an HTLV infection. Those with an indeterminate confirmatory test result should be retested in several weeks to determine if they have developed antibodies. If the confirmatory testing is negative or still indeterminate, then it is unlikely that the person has an HTLV infection.
A positive HTLV-I/II molecular test indicates that the person tested has an HTLV-I or HTLV-II infection. If the molecular result is negative, then the person is less likely to be infected, but it cannot be ruled out as the amount of virus in the blood may have been too low to detect at the time of the test.
The following table summarizes some typical results that may be seen with HTLV testing:
|Initial Antibody Testing (HTLV I/II)||Confirmatory Testing (Western blot)||Additional Testing||Likely Interpretation|
|Positive||Negative||Repeat Western blot negative||False positive on initial test|
|Positive||Positive HTLV-I||N/A||HTLV-I infection|
|Positive||Positive HTLV-II||N/A||HTLV-II infection|
|Positive||Indeterminate||Molecular test (PCR) positive or repeat Western blot positive for HTLV-I or HTLV-II||HTLV-I or HTLV-II infection|
|Positive||Indeterminate||Molecular test (PCR) negative or indeterminate and repeat Western blot negative or still indeterminate||Likely false positive on initial antibody testing|
The HTLV-I/II viruses become inactive (latent) in the body after an infection, but they are never totally eradicated. For this reason, a person who has tested positive will not be able to donate blood.
HTLV-II antibodies may show a positive result on a test for HTLV-I antibodies (cross-reaction). This means that even though a person has really had an HTLV-II infection, initial testing may show an HTLV-I positive test result.
No. The incidence of HTLV-I/ll is low in the United States and most people who are infected do not ever become ill, so it is not considered necessary. However, since the viruses can be passed from one person to another through blood transfusions and organ transplants, all donated blood (since 1988) and all relevant donated organs are tested for HTLV-I/II.
This would be something to discuss with your healthcare practitioner. If you have risk factors, such as you have lived in one of the countries where these infections are more common, have had multiple sex partners, have been an IV drug user, or are a Native American Indian, then you and your healthcare practitioner may want to consider it.
You can take several steps to avoid spreading the infection, according to the Centers for Disease Control and Prevention:
No, blood collection is performed using a sterile needle. You cannot get an HTLV infection from donating.
They both belong to the same group of viruses known as retroviruses and can be passed through blood and sexual contact, but they are only very remotely related, and HTLV does NOT cause AIDS and does not have the same devastating effects on a person's immune system that HIV does.
HTLV and HIV do, however, share a historical naming convention. HTLV-III was the name given to HIV (human immunodeficiency virus) when it was first identified. The virus was later reclassified and the name was changed to HIV. Since that time, the term HTLV-III has been re-used to designate a different HTLV virus. The newly designated HTLV-III virus, as well as an HTLV-IV virus, have been identified and are being studied, but testing of them is only being done on a research basis.
Sources Used in Current Review
Szczypinska EW, Wallace MR, Wainscoat B, Salas CM, Rich JD. (5 October 2015 updated.) Human T-Cell Lymphotropic Viruses. Available online at http://emedicine.medscape.com/article/219285-overview. Accessed February 5, 2017.
Goncalves, DU, Proietti FA, Ramos Ribas JC, et al. Epidemiology, Treatment, and Prevention of Human T-Cell Leukemia Virus Type 1-Associated Diseases. Clinical Microbiology Reviews. 2010;23(3):577-589.
Mayo Medical Laboratories. Human T-Cell Lymphotropic Virus Types I and II (HTLV-I/-II) Antibody Screen with Confirmation, Serum. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/9539. Accessed February 15, 2017.
National Organization for Rare Disorders. (2012 updated.) HTLV Type I and Type II. Available online at https://rarediseases.org/rare-diseases/htlv-type-i-and-type-ii/. Accessed February 5, 2017.
Sources Used in Previous Reviews
Szczypinska, E. et. al. (Updated 2012 January 11). Human T-Cell Lymphotrophic Viruses. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/219285-overview. Accessed June 2012.
(© 1995–2012). Test ID: HTLVI9539 Human T-Cell Lymphotropic Virus Types I and II (HTLV-I/-II) Antibody Screen with Confirmation, Serum. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/9539. Accessed June 2012.
Slev, P. (Updated 2011 September). Human T-Lymphotropic Virus Types I, II - HTLV I, II. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/HTLV.html. Accessed June 2012.
Crane, M. (2012 March 28). FDA Approves Test for Viruses in Blood Donations. Medscape Medical News [On-line information]. Available online at http://www.medscape.com/viewarticle/761099. Accessed June 2012.
Yasunaga, J. and Matsuoka, M. (2007 May 14). Human T-Cell Leukemia Virus Type 1 Induces Adult T-Cell Leukemia: From Clinical Aspects to Molecular Mechanisms Medscape Today News from Cancer Control. v14(2):133-140. [On-line information]. Available online at http://www.medscape.com/viewarticle/556137. Accessed June 2012.
Bite, C. et. al. (2009 July 3). HIV/Human T-cell Lymphotropic Virus Coinfection Revisited: Impact on AIDS Progression. Medscape Today News from AIDS Rev. v11(1):8-16. [On-line information]. Available online at http://www.medscape.com/viewarticle/703708. Accessed June 2012.
(© 2012). General Information – HTLV. Health Protection Agency [On-line information]. Available online at http://www.hpa.org.uk/web/HPAweb&Page&HPAwebAutoListName/Page/1191942172148. Accessed June 2012.
Proietti, F. et. al. (2005). Global epidemiology of HTLV-I infection and associated diseases. Oncogene v 24, 6058–6068. [On-line information]. Available online at http://www.nature.com/onc/journal/v24/n39/full/1208968a.html. Accessed June 2012.
Rubin, M. (Revised 2007 January). Tropical Spastic Paraparesis/HTLV-1–Associated Myelopathy. Merck Manual for Healthcare Professionals [On-line information]. Available online through http://www.merckmanuals.com. Accessed June 2012.
Outhred, A. et. al. (2011 July 5). Viral Arthritides. Medscape Today News from Expert Rev Anti Infect Ther. v9(5):545-554. [On-line information]. Available online at http://www.medscape.com/viewarticle/743675. Accessed June 2012.
(Revised 2012 January 26). What are the risk factors for non-Hodgkin lymphoma? American Cancer Society [On-line information]. Available online at http://www.cancer.org/Cancer/Non-HodgkinLymphoma/DetailedGuide/non-hodgkin-lymphoma-risk-factors. Accessed June 2012.
(2010 May 27). NINDS Tropical Spastic Paraparesis Information Page. National Institute of Neurological Disorders and Stroke [On-line information]. Available online at http://www.ninds.nih.gov/disorders/tropical_spastic_paraparesis/tropical_spastic_paraparesis.htm. Accessed June 2012.
Ratliff, C. (Reviewed 2009 July). Diseases That Mimic MS. Multiple Sclerosis Foundation [On-line information]. Available online at http://www.msfocus.org/article-details.aspx?articleID=18. Accessed June 2012.
Gan, L. and Miller, F. (2012 January 1). State of the Art: What We Know About Infectious Agents and Myositis. Medscape Today News from Curr Opin Rheumatol. V 23(6):585-594. [On-line information]. Available online at http://www.medscape.com/viewarticle/751211. Accessed June 2012.
Pagana, K. D. & Pagana, T. J. (© 2011). Mosby's Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 652-653.
(June 25, 1993) Centers for Disease Control and Prevention. Recommendations for Counseling Persons Infected with Human T-Lymphotrophic Virus, Types I and II. MMWR, 42(RR-9);1-13. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/00021234.htm. Accessed July 2012.