Saeed Z, et al. - Researchers here sought for the circulating cellular inflammatory changes that distinguish human T-lymphotropic virus type 1 (HTLV-1)–associated myelopathy (HAM), an inflammatory condition characterized by severe disability and high levels of infected white blood cells, from asymptomatic infection. They studied 38 women living with HTLV-1 infection, at a median age of 59 (52–68) years, for determining the immune characteristics of individuals with low or high HTLV-1 proviral load (pVL), symptomatic disease, and the impact of immunosuppressive therapy. Nineteen were asymptomatic carriers with low or high pVL; 19 were diagnosed with HAM, with 10 receiving anti-inflammatory therapy. All groups had inflation of the CD4:CD8 ratio (> 2) irrespective of pVL. This indicates CD4:CD8 ratio inflation as a feature of HTLV-1 infection. However, HAM is characterized by enhanced CD4+ T cell maturation and monocyte aggregation, indicating widespread inflammatory change, which may be identifiable presymptomatically and be amenable to anti-inflammatory therapy.