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This review addresses the limited surveillance and frequent oversight of Human T-cell lymphotropic virus type 1 (HTLV-1), an oncogenic retrovirus. The authors conducted a literature review to examine evidence supporting targeted screening strategies in both endemic and non-endemic settings, focusing on epidemiological data, transmission dynamics, and policy initiatives. They suggest that expanding targeted screening offers a practical approach to reduce transmission and enable earlier clinical intervention.
Targeted screening for HTLV-1 in high-risk groups, such as migrants and family members of carriers, is a feasible strategy to reduce transmission and enable earlier clinical intervention.
INTRODUCTION Human T-cell lymphotropic virus type 1 (HTLV-1) is an oncogenic retrovirus responsible for adult T-cell leukemia/lymphoma and severe inflammatory diseases. Although at least several million individuals are infected worldwide, surveillance remains limited and the infection is frequently overlooked. Global migration has altered the epidemiology of HTLV-1, increasing the number of carriers in previously low-prevalence regions and creating hidden high-risk clusters. As universal population screening is not cost-effective, targeted testing of groups with elevated risk has become a critical public health priority. AREAS COVERED This review summarizes the changing global distribution of HTLV-1 and examines evidence supporting targeted screening strategies. A literature review was conducted focusing on epidemiological data, transmission dynamics, and policy initiatives in both endemic and non-endemic settings. Populations evaluated include migrants from endemic regions, family members of carriers, individuals with sexually transmitted infections, pregnant women, blood and organ donors, and patients with clinical conditions strongly associated with HTLV-1. EXPERT OPINION Expanding targeted screening offers a practical approach to reduce transmission and enable earlier clinical intervention. Integration of HTLV-1 testing into antenatal care, sexual health services, and specialty clinics is feasible. Broader recognition of HTLV-1 will be essential to reducing the global burden of this neglected infection.
