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Objective: High prevalence of human T-cell lymphotropic virus type 1 (HTLV-I) infection in the northeastern of Iran has been proven. However, there is no overall estimation of the infection in the country. This systematic review was conducted to make an accurate estimation of HTLV-I infection prevalence in the Iranian blood donors. Method: All cross-sectional studies which had reported the prevalence of HTLV-I infection in the Iranian blood donors in both English and Persian languages until August 2011 were adopted. The inclusion criteria were proper sampling methods, adequate sample size, and valid measurement methods. The overall prevalence rate was estimated using meta-analysis method as well as survey data analysis methods. Results: From 843 electronic searched citations, and 245 surveys found in gray literatures, 13 studies met the inclusion criteria. They were from seven provinces including Razavi Khorasan (0.38-1.16%), West Azarbaijan (0.34%), Ilam (0.21%), Hormozgan (0.18%), Alborz (0.11%), South Khorasan (0.04%), and Bushehr (0.01%). The overall estimation of the HTLV-I prevalence rate in Iranian blood donors was 0.119% (95% confidence interval (CI): 0.050-0.287 percent). Conclusion: It is concluded that HTLV-I infection in Iranian blood donors is considerably prevalent. It is highly recommended to continue prevention programs such as strict blood screening. [ABSTRACT FROM AUTHOR]