THE INVISIBILITY OF HTLV-1 AMONGST HOMELESS PERSONS: A CASE REPORT OF A PREGNANT WOMAN WITH HAM

Abstract
Background
HTLV is a human retrovirus that can cause silent infection. The estimate is that 800,000-2.5 million individuals are infected with HTLV-1 in Brazil, with a higher prevalence in African descendent women, with less education and of advanced age. Considering risk groups, the homeless population stands out for its social invisibility. Currently, in Brazil, there are 221,000 people living on the streets and this number has been growing sharply due to the pandemic. This increase brings with it the warning of the possibility of increased dissemination of HTLV in this vulnerable group.
Methods
We report a case of HTLV-1 infection in a vulnerable individual, complicated with HTLV-1 associated myelopathy (HAM/TSP)
Results
A 23-year-old woman, African descendent, single, low level of education, homeless. She never worked and lived on the streets until discovered she was pregnant, with a gestational age of 20 weeks. Abortion at 18-year-old. Cocaine and loló user, suspended upon pregnancy, when she opted to return to her family. HIV diagnosis in 2017, without treatment adherence. Syphilis episodes in 2015 and 2020. Attended eight prenatal consultations. Initial VDRL was 1/256 with a drop to 1/16 after 2 months. The started ARV regimen was effective. During the entire prenatal period, she reported difficulty in walking, complaining of progressive weakness in the lower limbs, starting 7 years ago. Serological screening for HTLV-1/2 was positive, which corroborated her referral and follow-up to the Hospital Universitário Gaffrée e Guinle Neuroinfection clinic (UNIRIO). The outcome of the pregnancy was a cesarean delivery, without complications. Neurological evaluation identified spastic paraparesis, lower limbs hyperreflexia, Babinsky's sign and Hoffman's sign bilaterally. Cerebrospinal fluid examination revealed anti-HTLV-1/2 antibodies, with non-reactive VDRL. HAM/TSP was diagnosed. The initial approach was the prescription of baclofen, methylprednisolone pulse-therapy, without adherence to treatment and follow-up.
Conclusions
This case report highlights that the absence of strategies to control the HTLV transmissibility in the homeless population allows not only the increase of contagion within this population, but also the worsening of the presented symptoms. Access to adequate screening, prevention and treatment are essential to avoid worsening the individual's health with the possibility of irreversibility of the condition.
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