doi:10.1016/j.jcv.2023.105619engde-Mendoza, CarmenPérez, LeireRando, AriadnaReina, GabrielAguilera, AntonioBenito, RafaelEirós, José MaríaRodríguez-Avial, ItziarOrtega, DiegoPozuelo, María JoséPena, María JoséSoriano, VicenteHTLV-1-associated myelopathy in SpainART-2023-137163Background HTLV-1 infection is a neglected disease. Over 10 million people are infected worldwide, with hot spots of high endemicity across all continents. Roughly 5% of HTLV-1 carriers develop HTLV-1-associated myelopathy (HAM), a progressive subacute neurological disabling disease. Methods We report the main features of patients diagnosed with HAM up to date in Spain, a non-endemic country with a relatively high migrant flow from Latin America and Equatorial Africa, where HTLV-1 is endemic. Results A total of 451 cases of HTLV-1 had been recorded in Spain until the end of year 2022. HAM had been diagnosed in 58 (12.9%). The current incidence is of 2–3 new cases per year. Women represent 76%. Mean age at diagnosis is 49 years-old. Nearly 60% are Latin Americans. Although sexual transmission is the most likely route of HTLV-1 acquisition, up to 6 individuals had been infected following solid organ transplantation. Rapid onset myelopathy developed in all but one of these transplant recipients from three HTLV-1-positive donors. HTLV-1 subtype 1a transcontinental was the only variant recognized in HAM patients. HTLV-1 proviral load was significantly greater in HAM patients than in asymptomatic HTLV-1 carriers (677 vs 104 HTLV-1 DNA copies/104 PBMC; p = 0.012). Symptom relief medications and physiotherapy have been the only treatment providing some benefit to HAM patients. Neither significant clinical nor virological efficacy was noticed using antiretrovirals in at least 9 HAM patients. Two thirds of HAM patients ended up in a wheelchair and with urinary/fecal sphincter incontinence. Conclusion HAM is the most frequent clinical manifestation of HTLV-1 infection in Spain, a non-endemic country. Middle aged women migrants from Latin America are the most frequently affected. Two thirds end up in a wheelchair despite using antiretroviral therapy.2023http://zaguan.unizar.es/record/13169810.1016/j.jcv.2023.105619http://zaguan.unizar.es/record/131698oai:zaguan.unizar.es:131698info:eu-repo/grantAgreement/ES/ISCIII/FIS/PI21-1717JOURNAL OF CLINICAL VIROLOGY 169 (2023), 105619 [5 pp.]All rights reservedhttp://www.europeana.eu/rights/rr-f/info:eu-repo/semantics/closedAccess