Could Cesarean Delivery Help Prevent Mother-to-Child Transmission of Human T-Lymphotropic Virus Type 1?

• Published in: The Journal of infectious diseases Vol. 228; no. 12; pp. 1766 - 1775
• Main Authors: Prates, Gabriela, Paiva, Arthur, Haziot, Michel E, Fonseca, Luiz Augusto M, Smid, Jerusa, Marcusso, Rosa Maria do N, Assone, Tatiane, de Oliveira, Augusto C P, Casseb, Jorge
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 20.12.2023
• Subjects: risk factors; HTLV-1; breastfeeding; cesarean delivery; mother-to-child transmission
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jiad219

Abstract Background Mother-to-child transmission (MTCT) of human T-lymphotropic virus type 1 (HTLV-1) is an important route of transmission that can cause lifelong infection. There is high morbidity and mortality due to adult T-cell leukemia/lymphoma, HTLV-1–associated myelopathy (HAM), and other inflammatory disorders. These conditions develop in nearly 10% of people with HTLV-1 infection, with a higher risk if infection occurs early in life. Identification of risk factors can inform targeted measures to reduce HTLV-1 MTCT. This study aimed to investigate the potential of cesarean delivery to prevent HTLV-1 MTCT. Methods We performed a review of the cases of women and their offspring under regular follow-up at the HTLV-1 outpatient clinic at the Institute of Infectious Diseases Emilio Ribas. Results A total of 177 HTLV-1–infected women and 369 adult offspring were investigated. Overall, 15% of the children were positive for HTLV-1 and 85% were negative. Regarding vertical transmission, we found that a breastfeeding duration of >6 months was associated with MTCT. Moreover, maternal proviral load was not associated with transmission, but high educational level and cesarean delivery were identified as protective factors. Conclusions HTLV-1 MTCT was associated with mother's age at delivery of >25 years, low educational level, prolonged breastfeeding, and vaginal delivery. Cesarean delivery has high potential in preventing mother-to-child transmission of human T- lymphotropic virus. Cesarean delivery implementation policies should be established to reduce the rate of neonatal infection during delivery. Formula feeding should be encouraged.