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Adult T‐cell leukaemia/lymphoma‐like human T‐cell leukaemia virus‐1 replication in infective dermatitis

Summary. Adult T‐cell leukaemia/lymphoma (ATLL) is a malignant T‐cell proliferation that occurs in 3–5% of individuals infected with human T‐cell leukaemia virus‐1 (HTLV‐1). HTLV‐1 infection is also linked to the development of infective dermatitis (ID), an exudative dermatitis of children that has been proposed as a cofactor of ATLL. Here, HTLV‐1 replication was investigated over time in a girl with ID and multiparasitic infestation including strongyloidiasis, a disease also known to predispose HTLV‐1 carriers to ATLL. Quantitative polymerase chain reaction (PCR) revealed extremely high proviral loads. During the 2‐year period of the present study, the proportion of circulating infected cells ranged between 12% and 36%. Quadruplicate linker‐mediated PCR amplification of HTLV‐1 flanking sequences identified a pattern of extensive and persistent oligoclonal expansion of infected lymphocytes. As viral loads, both the number and the degree of infected T‐cell expansion were independent of treatment or clinical signs. However, the temporal fluctuation of proviral loads correlated significantly with the degree of infected T‐cell expansion, but not with the overall number of detected clones. This pattern of HTLV‐1 replication over time is very different from that observed in asymptomatic carriers and reminiscent of that observed in ATLL, a result consistent with the proposal of ID as an ATLL cofactor.