Human T-cell lymphotropic virus type 1 (HTLV1) exists with high prevalence in various geographical regions, most notably Japan, the Caribbean islands, sub-Saharan Africa, South America, and regions of Oceania. The virus is predominantly spread mother-to-child through breastfeeding and infects CD4+ T cells. In less than 5% of infected individuals, a multihit pathogenic process occurs over decades as multiple somatic mutations occur, eventually resulting in an HTLV-1 associated peripheral T-cell lymphoma known as adult T-cell leukemia/lymphoma (ATL). ATL has varied manifestations and subtypes (see text). Created in BioRender.com.