Isaac Alva, MD MPH
Nominated From: University of Washington
Research Site: Peru
Research Area: Infectious Disease
Primary Mentor: Joe Zunt
Vertical Transmission of HTLV-1/-2 in the Peruvian Amazon Region: Frequency and Potential Culturally Grounded Prevention Strategies
HTLV (Human T-lymphotropic virus) is a silent and neglected public health problem that has been identified as a research priority in Latin America and the Caribbean (LAC). HTLV-1 is associated with adult T-cell leukemia/lymphoma and with myelopathy/tropical spastic paraparesis. HTLV-1 is also associated with tuberculosis, uveitis, infective dermatitis, strongyloidiasis and human papillomavirus. HTLV-2 infection is associated with neurologic degenerative disease, recurrent pneumonia and neuropathy.
In two studies we found a high prevalence (6.2% in 2007 and 9.7% in 2010) of HTLV-1/-2 among women from the Shipibo-Konibo ethnic group, the third largest Amazonian indigenous group in Peru.
In endemic areas for HTLV, breastfeeding is considered the most important form of transmission. Women from this indigenous group have poor access to education, health, and basic sanitation and have a high reproductive rate.
In Peru, all the research about vertical transmission has been focused on the epidemiology of the virus and not on assessing cultural practices that may be perpetuating the infection. Also, there has not been any approach to study the feasibility of low-cost sustainable forms to decrease mother-to-child transmission. Additionally, even in highly endemic areas for HTLV, there are no policies that promote antenatal screening of the virus. The specific aims of this study are:
1. To determine HTLV-1/-2 prevalences among children aged 2-10 born to HTLV-1/-2 positive mothers.
2. To identify cultural practices (e.g shared breastfeeding) that may influence vertical transmission of HTLV-1/-2.
3. To explore infant feeding options (e.g. cross-nursing, flash- heating of breastmilk to eliminate the virus, shortened breastfeeding duration, and formula feeding) to prevent vertical transmission of HTLV-1/-2.
We hope that our study will help to address the problem of HTLV vertical transmission, as well as to advocate for policy changes with regards to prevention of this virus in the Peruvian endemic areas.
Advice for Potential Applicants
Do research with underserved populations and help the local decision makers to understand and to use the results of your research.