HTLV infection and cessation of breastfeeding: context and challenges in implementing universal prevention policies in Brazil.

The benefits of breastfeeding are extensive and well known. However, in certain medical conditions it is contraindicated, such as in women living with a human T-cell lymphotropic virus type 1 (HTLV-1) infection.1 HTLV-1 was discovered in the 1980s, although its impact was underestimated and neglected for many years.2 It is commonly reported in the scientific literature that only 5% to 10% of infected individuals experience symptoms of the virus infection; nevertheless, there is a consensus that its deleterious effects are broader and more frequent than previously recognized.2 HTLV-1 is the etiological agent of adult T-cell leukemia/lymphoma (ATLL), an unfavorable prognosis neoplasm, and HTLV-1-associated myelopathy (HAM), a progressive neurological disease. The virus can also cause inflammatory diseases, such as uveitis, infective dermatitis, encephalitis, as well as pulmonary, intestinal and urinary alterations, in addition to erectile dysfunction, psychological disorders and negative impact on co-infections.3 A study commissioned by the World Health Organization (WHO) revealed that the risk of death among people living with HTLV-1 increases by 57%.4 Notwithstanding, the virus, which affects between 800,000 and 2.5 million Brazilians, remains neglected in the country. HTLV-1 is transmitted through unprotected sexual intercourse, contact with infected blood (blood transfusion, organ transplantation or contact with sharp objects) and mother-to-child transmission, mainly through breastfeeding. There is no vaccine or curative treatment for HTLV-1.3,5 In Brazil, the risk of parenteral transmission is reduced due to universal screening of blood and organ donors.6,7 In order to prevent mother-to-child transmission, the Brazilian Ministry of Health recommends the cessation of breastfeeding for mothers living with the virus.8,9 Antiretroviral therapy is not effective in reducing HTLV-1 proviral load and therefore it is not recommended for people living with HTLV-1.10 Avoidance of breastfeeding, on the other hand, prevents about 85% of childhood infections, consequently it is considered the most effective intervention currently available.11 The public policy proposed by the Ministry of Health (lactation inhibition) is also a strategy recommended in several countries, such as Japan, Chile, Colombia, Uruguay, Santa Lucia and Infecção pelo HTLV e suspensão do aleitamento materno: contexto e desafios na implementação das políticas de prevenção de forma universal no Brasil