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International Journal of Medical Laboratory
Shahid Sadoughi University of Medical Sciences
Tue, May 20, 2025
[Archive]
Volume 11, Issue 2 (May 2024)
IJML 2024, 11(2): 130-135 |
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Rostamzadeh Khameneh Z, Oshnouei S. Seroprevalence of Human T-lymphotropic Virus Infections among Pregnant Women in Urmia, Northwest Iran. IJML 2024; 11 (2) :130-135
URL: http://ijml.ssu.ac.ir/article-1-525-en.html
URL: http://ijml.ssu.ac.ir/article-1-525-en.html
Solid Tumor Research Center, Urmia University of Medical Sciences, Urmia, Iran
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Introduction
Human T-lymphotropic virus (HTLV) infection in pregnant women poses a significant public health concern, especially in endemic areas. The prevalence of this infection varies depending on the region. In endemic areas of Iran, such as Mashhad and Neyshabur, the incidence rate among pregnant women ranges from 1.5% to 3.3% [1]. Brazil has an estimated infection rate of 1.05% [2]. A recent study conducted in the Peruvian Amazon revealed a prevalence of 1.7% among pregnant women [3]. The prevalence of HTLV-1/2 infection among pregnant women from the Caribbean, South America, and Central America regions CSA & C regions is reported to be 1.3%, with HTLV-1 being the predominant type. This rate exceeds that of other routinely screened microbial agents during antenatal care, such as human immunodeficiency virus (HIV), hepatitis B, and syphilis. Consequently, mandatory antenatal testing for HTLV-1/2 is recommended for pregnant women from the CSA & C globally [4]. The research on HTLV prevalence in pregnant women has significant implications for public health policy, clinical practice, and further research in the field of HTLV infection. This study aimed to ascertain the prevalence of HTLV infection among pregnant women receiving care in Urmia, located in northwest Iran.
Materials and Methods
This cross-sectional study was conducted in Urmia, the capital city of West Azerbaijan Province in the northwest of Iran. Eighty-six pregnant women were randomly selected from those referred to health centers in Urmia for routine pregnancy follow-up. These women resided in various areas of the city. The study took place from September 2014 to May 2015.
The participants completed a questionnaire through interviews. The questionnaire asked about previous pregnancy outcomes, including the medical history of abortion (number of times abortion occurred during pregnancy) and the number of previous pregnancies. Serum samples were separated and stored at -20 °C. Zero point five cubic centimeters 0.5 cc of serum sample was required for each test. HTLV-1/HTLV-2 IgG was determined using enzyme-linked Immunosorbent assay (ELISA; DIA.PRO Diagnostic Bioprobes Srl, Italy; sensitivity of 100% and a specificity greater than 99.5%). Frequency tables were utilized, and a bar chart was employed to display the characteristics of the study population. Data were analyzed using SPSS version 20 and Excel Software 2007.
Results
The average age of the patients was 25.56 years (SD = 5.3). The majority of the patients were born in rural areas, but currently, most of them reside in urban areas. Approximately 60% of the patients had completed undergraduate education. A significant proportion of the pregnant women studied (72.23%) reported a history of one abortion (Table 1). In the ELISA examination of the samples, all serum samples tested negative for IgG HTLV-I/II.
Materials and Methods
This cross-sectional study was conducted in Urmia, the capital city of West Azerbaijan Province in the northwest of Iran. Eighty-six pregnant women were randomly selected from those referred to health centers in Urmia for routine pregnancy follow-up. These women resided in various areas of the city. The study took place from September 2014 to May 2015.
The participants completed a questionnaire through interviews. The questionnaire asked about previous pregnancy outcomes, including the medical history of abortion (number of times abortion occurred during pregnancy) and the number of previous pregnancies. Serum samples were separated and stored at -20 °C. Zero point five cubic centimeters 0.5 cc of serum sample was required for each test. HTLV-1/HTLV-2 IgG was determined using enzyme-linked Immunosorbent assay (ELISA; DIA.PRO Diagnostic Bioprobes Srl, Italy; sensitivity of 100% and a specificity greater than 99.5%). Frequency tables were utilized, and a bar chart was employed to display the characteristics of the study population. Data were analyzed using SPSS version 20 and Excel Software 2007.
Results
The average age of the patients was 25.56 years (SD = 5.3). The majority of the patients were born in rural areas, but currently, most of them reside in urban areas. Approximately 60% of the patients had completed undergraduate education. A significant proportion of the pregnant women studied (72.23%) reported a history of one abortion (Table 1). In the ELISA examination of the samples, all serum samples tested negative for IgG HTLV-I/II.
Table 1. Characteristics of the study population
| Variables | ||
| Mean of Age (years) | 25.56 ± 5.3 * | |
| Place of birth | Urban | 42 (48.83) ** |
| Rural | 44 (51.17) | |
| Residency | Urban | 77 (89.53) |
| Rural | 9 (10.47) | |
| Educational level | Illiterate | 30 (34.88) |
| Undergraduate | 52 (60.46) | |
| Graduate | 4 (4.66) | |
| History of blood transfusion | 3 (3.49) | |
| History of tattoo | 4 (4.65) | |
| History of abortion | 18 (20.93) | |
| No. of abortion | 1 | 13 (72.23) |
| 2 | 2 (11.11) | |
| 3 | 2 (11.11) | |
| 4 | 1 (5.55) |
* Standard Deviation; ** Data are presented as N (%)
Discussion
This study examined the serological status of HTLV I/II in pregnant women receiving healthcare at government health centers in Urmia, an area of Iran that is not endemic to the virus. However, the study population showed a 0% prevalence of HTLV I/II.
The occurrence rates within different demographic groups demonstrate a higher prevalence in nations with lower Human Development Index (HDI) scores compared to those with higher HDI scores, highlighting the existing disparity and underscoring significant implications for public health and policy, particularly in the realms of disease prevention and healthcare resource allocation. The global prevalence of HTLV-1 infection varies significantly, with an estimated prevalence of 0.91%. Notably, in countries with high HDI, the prevalence is approximately three times lower than in countries with low HDI. Moreover, the prevalence in the general population surpasses that in pregnant women by about fivefold and is 41 times more prevalent than in blood donors [5].
Previous studies in Urmia have assessed the serological status of HTLV among kidney graft recipients, hemodialysis patients, and patients with hereditary bleeding diseases [6-8]. One out of 91 (1.09%) renal transplant recipients were HTLV positive [6]. Among hemodialysis and blood donor patients in Urmia between 2005 and 2006, 2.6% of cases tested positive for HTLV by ELISA. The total seroprevalence of HTLV in healthy blood donors was 0.34% [7]. Seropositivity of HTLV-1 among kidney graft recipients was 1.09% in Urmia in 2010 [6]. Infection was not found in any of the patients with Hereditary Bleeding in Urmia [8].
Research on HTLV infection in pregnant women in Iran has been conducted. Studies have shown a higher prevalence of HTLV-1 infection in pregnant women compared to non-pregnant women in cities such as Mashhad and Neyshabur, located in Razavi Khorasan Province, which are endemic areas for HTLV-1 infection in Iran. The incidence rate of HTLV-1 infection in pregnant women in these areas ranges from 1.5% to 3.3% [1]. Additionally, a study in Mashhad, Iran, investigated the role of genetic polymorphisms in the MASP2 gene and its association with susceptibility to HTLV-1 infection. The study found that specific genetic variations in the MASP2 gene were associated with a higher risk of HTLV-1 acquisition in blood donors from Mashhad, Iran [9].
On the contrary, the southeastern regions of Iran have been identified as endemic areas for HTLV. Around the same period as our study, a separate investigation conducted in Sari, Iran, involving 1092 pregnant women, reported an HTLV prevalence of 0.2%. Consequently, due to the low prevalence of this infection, screening was not advised [10]. In different regions of Golestan province, HTLV-1 seroprevalence rates among healthy individuals were noted as follows: 0%, 0%, 0.1%, 1.9%, 0.3%, 0%, and 2.6%. The eastern part, which borders Khorasan province, exhibited the highest rate of 2.6% [11].
It is important to note that although the prevalence of HTLV infection varies by location [12], in non-endemic regions like Urmia, there is no available research indicating a complete absence of HTLV infection among pregnant women. To draw meaningful conclusions about the absence of HTLV prevalence, researchers need studies that specifically test pregnant women for HTLV and consistently find zero cases across numerous large and representative samples. Presently, existing literature tends to focus on determining the prevalence rather than reporting instances of no infections. While reporting null results is crucial to mitigate publication bias, the emphasis in current research lies more on quantifying prevalence rather than studies that do not detect any infections. A more thorough reporting of research outcomes, including studies with no observed HTLV cases, would offer a more comprehensive understanding of the epidemiological landscape within this population.
Considering the current knowledge and valuable evidence available, it is important to highlight that HTLV-1 infection poses a significant health concern among Iranian patients who receive multiple transfusions. The prevalence of HTLV-1 infection among individuals who undergo frequent transfusions in Iran varies significantly across different regions of the country; however, it is endemic in nearly all provinces [13].
Conclusion
While HTLV infection may not be as prevalent in Urmia compared to some other regions, it remains crucial to screen pregnant women for this condition. Factors that are linked to a higher prevalence of HTLV include lower educational attainment, lack of condom use before pregnancy, and a family history of infectious diseases. This study suggests conducting further research to assess the clinical evidence regarding the absence of HTLV I/II infection in pregnant women in this province. The 2014 study was carried out in the West Azerbaijan region. It is noteworthy that publishing articles on seronegative HTLV in pregnant women is significant as it highlights the potential limitations of current screening procedures and their implications for the vertical transmission of the virus. Understanding the factors contributing to false-negative results in HTLV testing among pregnant women is vital for improving diagnostic precision and implementing effective preventive measures. Research on seronegative HTLV in pregnant women can also guide healthcare practices and policies aimed at reducing the risk of mother-to-child transmission and enhancing outcomes for both mothers and infants.
Ethical Considerations
The Ethics Committee of Urmia University of Medical Sciences approved the study with the code No. IR.UMSU.REC.1394.30
Funding
The responsible author covered the experiment and other associated costs.
Conflict of Interest
The authors declared no conflict of interest.
Acknowledgment
The Urmia Research Deputy of Urmia University of Medical Sciences supported this study. The authors would like to thank the Clinical Research Development Unit of Imam Khomeini Hospital for their methodological assistance.
Authors' Contributions
Z.R. was responsible for designing the review protocol, conducting the literature review, providing feedback on the manuscripts, writing the manuscript and improving the interpretation of the results. S.O. was responsible for writing the manuscript, assembling data, analyzing data, and interpreting analyses.
The occurrence rates within different demographic groups demonstrate a higher prevalence in nations with lower Human Development Index (HDI) scores compared to those with higher HDI scores, highlighting the existing disparity and underscoring significant implications for public health and policy, particularly in the realms of disease prevention and healthcare resource allocation. The global prevalence of HTLV-1 infection varies significantly, with an estimated prevalence of 0.91%. Notably, in countries with high HDI, the prevalence is approximately three times lower than in countries with low HDI. Moreover, the prevalence in the general population surpasses that in pregnant women by about fivefold and is 41 times more prevalent than in blood donors [5].
Previous studies in Urmia have assessed the serological status of HTLV among kidney graft recipients, hemodialysis patients, and patients with hereditary bleeding diseases [6-8]. One out of 91 (1.09%) renal transplant recipients were HTLV positive [6]. Among hemodialysis and blood donor patients in Urmia between 2005 and 2006, 2.6% of cases tested positive for HTLV by ELISA. The total seroprevalence of HTLV in healthy blood donors was 0.34% [7]. Seropositivity of HTLV-1 among kidney graft recipients was 1.09% in Urmia in 2010 [6]. Infection was not found in any of the patients with Hereditary Bleeding in Urmia [8].
Research on HTLV infection in pregnant women in Iran has been conducted. Studies have shown a higher prevalence of HTLV-1 infection in pregnant women compared to non-pregnant women in cities such as Mashhad and Neyshabur, located in Razavi Khorasan Province, which are endemic areas for HTLV-1 infection in Iran. The incidence rate of HTLV-1 infection in pregnant women in these areas ranges from 1.5% to 3.3% [1]. Additionally, a study in Mashhad, Iran, investigated the role of genetic polymorphisms in the MASP2 gene and its association with susceptibility to HTLV-1 infection. The study found that specific genetic variations in the MASP2 gene were associated with a higher risk of HTLV-1 acquisition in blood donors from Mashhad, Iran [9].
On the contrary, the southeastern regions of Iran have been identified as endemic areas for HTLV. Around the same period as our study, a separate investigation conducted in Sari, Iran, involving 1092 pregnant women, reported an HTLV prevalence of 0.2%. Consequently, due to the low prevalence of this infection, screening was not advised [10]. In different regions of Golestan province, HTLV-1 seroprevalence rates among healthy individuals were noted as follows: 0%, 0%, 0.1%, 1.9%, 0.3%, 0%, and 2.6%. The eastern part, which borders Khorasan province, exhibited the highest rate of 2.6% [11].
It is important to note that although the prevalence of HTLV infection varies by location [12], in non-endemic regions like Urmia, there is no available research indicating a complete absence of HTLV infection among pregnant women. To draw meaningful conclusions about the absence of HTLV prevalence, researchers need studies that specifically test pregnant women for HTLV and consistently find zero cases across numerous large and representative samples. Presently, existing literature tends to focus on determining the prevalence rather than reporting instances of no infections. While reporting null results is crucial to mitigate publication bias, the emphasis in current research lies more on quantifying prevalence rather than studies that do not detect any infections. A more thorough reporting of research outcomes, including studies with no observed HTLV cases, would offer a more comprehensive understanding of the epidemiological landscape within this population.
Considering the current knowledge and valuable evidence available, it is important to highlight that HTLV-1 infection poses a significant health concern among Iranian patients who receive multiple transfusions. The prevalence of HTLV-1 infection among individuals who undergo frequent transfusions in Iran varies significantly across different regions of the country; however, it is endemic in nearly all provinces [13].
Conclusion
While HTLV infection may not be as prevalent in Urmia compared to some other regions, it remains crucial to screen pregnant women for this condition. Factors that are linked to a higher prevalence of HTLV include lower educational attainment, lack of condom use before pregnancy, and a family history of infectious diseases. This study suggests conducting further research to assess the clinical evidence regarding the absence of HTLV I/II infection in pregnant women in this province. The 2014 study was carried out in the West Azerbaijan region. It is noteworthy that publishing articles on seronegative HTLV in pregnant women is significant as it highlights the potential limitations of current screening procedures and their implications for the vertical transmission of the virus. Understanding the factors contributing to false-negative results in HTLV testing among pregnant women is vital for improving diagnostic precision and implementing effective preventive measures. Research on seronegative HTLV in pregnant women can also guide healthcare practices and policies aimed at reducing the risk of mother-to-child transmission and enhancing outcomes for both mothers and infants.
Ethical Considerations
The Ethics Committee of Urmia University of Medical Sciences approved the study with the code No. IR.UMSU.REC.1394.30
Funding
The responsible author covered the experiment and other associated costs.
Conflict of Interest
The authors declared no conflict of interest.
Acknowledgment
The Urmia Research Deputy of Urmia University of Medical Sciences supported this study. The authors would like to thank the Clinical Research Development Unit of Imam Khomeini Hospital for their methodological assistance.
Authors' Contributions
Z.R. was responsible for designing the review protocol, conducting the literature review, providing feedback on the manuscripts, writing the manuscript and improving the interpretation of the results. S.O. was responsible for writing the manuscript, assembling data, analyzing data, and interpreting analyses.
References
- Nazari Z, Ghaffari J, Ghaffari N. Prevalence of human T lymphotropic virus type 1 in pregnant women: A narrative review. Medical Laboratory Journal 2020; 14(3): 46-8.
- Barmpas D, Monteiro DL, Taquette SR, Trajano AJ, Raupp RM, Miranda FR, Rodrigues NC. Infecção pelo HTLV-1/2 em gestantes brasileiras. Revista Hospital Universitário Pedro Ernesto (HUPE). 2014; 13(3): 81-8.
- Ramos-Rincón JM, Ortiz-Martínez S, Vásquez-Chasnamote ME, de-Miguel-Balsa E, Gamboa-Paredes ON, Talledo-Albujar MJ, et al. Screening for human T-Cell lymphotropic virus (HTLV) in pregnant women in the peruvian amazon and systematic review with meta-analysis of HTLV infection in Peru. Pathogens 2021; 10(3): 260.
- Sánchez-Núñez JP, de-Miguel-Balsa E, Soriano V, Lorenzo-Garrido E, Giménez-Richarte A, Otero-Rodriguez S, et al. Prevalence of HTLV-1/2 infection in pregnant women in Central and South America and the Caribbean: A systematic review and meta‑analysis. Int J Infect Dis. 2024; 143(6): 107018.
- Sampaio GCL, Ribeiro JR, de Almeida CN, Boa-Sorte N, Galvão-Castro B, Grassi MFR, et al. Human T cell lymphotropic virus type 1 global prevalence associated with the human development index: Systematic review with meta-analysis. AIDS Res Hum Retroviruses 2023; 39(4): 145-65.
- Khameneh ZR, Sepehrvand N, Masudi S, Taghizade-Afshari A. Seroprevalence of HTLV-1 among kidney graft recipients: a single-center study. Exp Clin Transplant 2010; 8(2): 146-49.
- Khameneh ZR, Baradaran M, Sepehrvand N. Survey of the seroprovalence of HTLV I/II in hemodialysis patients and blood donors in Urmia. Saudi Journal of Kidney Diseases and Transplantation 2008; 19(5): 838-41.
- Rostamzadeh Z, Valizadeh N, Mohammadian M. Prevalence of seropositivity for human T lymphocytes virus in patients with hereditary bleeding diseases in population of West Azerbaijan. International Journal of Medical Laboratory 2016; 3(3): 159-62.
- Aghamohammadi A, Rafatpanah H, Maghsoodlu M, Tohidi N, Mollahosseini F, Shahabi M. Mannose binding lectin‐associated serine protease 2 (MASP2) gene polymorphism and susceptibility to human T‐lymphotropic virus type 1 (HTLV‐1) infection in blood donors from Mashhad, Iran. Microbiol Immunol. 2022; 66(10): 460-64.
- Ghaffari J, Naghshvar F, Nazari Z, Farid R, Torabizadeh J, Madani F. Seroprevalence of human T-cell lymphotropic virus type 1 infection (HTLV1) in different patients in the north of Iran. Af J Biotechnol. 2011; 10(52): 10752-10755.
- Kalavi Kh, Moradi A, Tabarraei A. Population-based Seroprevalence of HTLV-I Infection in Golestan Province, South East of Caspian Sea, Iran J Basic Med Sci. 2013; 16(3): 225-28.
- Djuicy DD, Mouinga-Ondémé A, Cassar O, Ramassamy JL, Idam Mamimandjiami A, Bikangui R, et al. Risk factors for HTLV-1 infection in Central Africa: A rural population-based survey in Gabon. PLOS Neglect Tropic Dis. 2018; 12(10): 6832.
- Hedayati-Moghaddam, MR, Amini AR. HTLV-1 infection as a serious health issue among Iranian multi-transfused patients: evidence from a systematic review and meta-analysis. Iranian Journal of Blood and Cancer 2015; 7(2): 85-94.
Type of Study: Research |
Subject:
Virology
Received: 2024/06/4 | Accepted: 2024/11/25 | Published: 2025/01/8
Received: 2024/06/4 | Accepted: 2024/11/25 | Published: 2025/01/8
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