![]() Although intra-uterine transmission of HTLV-1 has been described and perinatal transmission cannot be fully excluded ( 10, 11), the majority of HTLV-1 MTCT occurs via breastfeeding since the level of infection among babies that are exclusively formula fed is low ( 6, 7). 0.8–2.5 million PHTLV) or Central Australia is still a matter of discussion ( 3, 8, 9). In endemic areas of HTLV-1-infection, such as southwestern Japan, MTCT has been demonstrated to be the primary mode of transmission ( 7), while the main route of transmission for other countries like Brazil (ca. Infection upon MTCT poses an exceptional high risk for the infants to develop ATLL during their lives ( 6). Approximately 10% of PHTLV develop incurable diseases including HTLV-1-associated inflammatory conditions like HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), or the fatal neoplasia Adult T-cell leukemia/lymphoma (ATLL). Carriers face the risk of developing diseases with high morbidity and mortality, especially if infection has been acquired during infancy and due to the high incidence of co-infections ( 5). Upon infection, HTLV-1 integrates into the host cell genome and PHTLV are life-long suffering from the burden of HTLV-1-infection and an increasingly recognized impairment of quality of life ( 4). ![]() Therefore, PHTLV might pass the virus to other vulnerable groups via blood products, sexual transmission and mother-to-child transmission (MTCT). Problematically, many of the PHTLV are unaware of their infection since HTLV-1 is not screened routinely in every endemic country ( 1). A high frequency of people infected with HTLV-1 (PHTLV) worldwide lives in resource-limited settings or belongs to social or ethnic minorities ( 2, 3). Endemic regions are located in Japan, Melanesia, Central Australia, Sub-Saharan Africa, parts of South America (e.g., Brazil), the Caribbean, and the Middle East ( 2). Human T-cell leukemia virus type 1 (HTLV-1) is a neglected highly oncogenic retrovirus infecting at least 5–10 million people worldwide, which is probably an underestimation ( 1). Here, we review these questions and provide an outlook how future research could help to uncover prevention strategies that might ultimately allow infants to benefit from breastfeeding while reducing the risk of HTLV-1 transmission. Despite significant progress in understanding details of HTLV-1 cell-to-cell transmission, it is still not fully understood, which cells in which organs get infected via the oral route, how these cells get infected, how breast milk affects this route of infection and how to inhibit oral transmission despite breastfeeding, which is an urgent need especially in underrepresented areas of the world. Risk of transmission increases with the duration of breastfeeding, however, abstinence from breastfeeding as it is recommended in some endemic countries is not an option in resource-limited settings or underrepresented areas and populations. HTLV-1 is transmitted via cell-containing body fluids such as blood products, semen, and breast milk, which constitutes the major route of mother-to-child transmission (MTCT). ![]() Worldwide, at least 5–10 million people are HTLV-1-infected and most of them are unaware of their infection posing the risk of silent transmissions. HTLV-1 is a highly oncogenic yet neglected retrovirus, which primarily infects CD4 + T-cells in vivo and causes incurable diseases like HTLV-1-associated inflammatory conditions or Adult T-cell leukemia/lymphoma (ATLL) after lifelong viral persistence. Intriguingly, few viruses are transmitted via breastfeeding including Human T-cell leukemia virus Type 1 (HTLV-1). ![]() FAU Junior Research Group “Retroviral Pathogenesis” and BMBF Junior Research Group in Infection Research “Milk Transmission of Viruses”, Institute of Clinical and Molecular Virology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germanyīreastfeeding is recommended by the World Health Organization for at least 6 months up to 2 years of age, and breast milk protects against several diseases and infections. ![]()
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