CD4 and tropical spastic paraparesis: A role for CD4+ T cells in initiating and causing HAM/TSP is also consistent with the immunogenetic observations that the possession of HLA-DRB1*0101, which restricts the immunodominant epitope of HTLV-1 Env gp21, was associated with susceptibility to HAM/TSP in independent HTLV-1-infected populations in Southern Japan [37, 41] and Northeastern Iran [40].