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Abstract: Background: Mashhad, in the northeast of Iran has been suggested as an endemic area for human T cell lymphotropic virus type I (HTLV-I) infection since 1996. Objectives: We performed a community-based seroepidemiology study to examine the prevalence and risk factors for HTLV-I infection in the city of Mashhad. Study design: Between May and September 2009, overall 1678 subjects from all the 12 geographical area of Mashhad were selected randomly by multistage cluster sampling for HTLV antibody. The study population included 763 males and 915 females, with the mean age of 29.1±18.5 years. 1654 serum samples were assessed for HTLV antibody using ELISA and reactive samples were confirmed by Western blot and PCR. Results: The overall prevalence of HTLV-I infection in whole population was 2.12% (95% CI, 1.48–2.93) with no significant difference between males and females (p =0.093) and the prevalence of HTLV-II seropositivity was 0.12% (95% CI, 0.02–0.44). The HTLV-I Infection was associated with age (p <0.001), marital status (p <0.001), education (p =0.047), and history of blood transfusion (p =0.009), surgery (p <0.001), traditional cupping (p =0.002), and hospitalization (p =0.004). In logistic regression analysis, age was the only variable that had a significant relation with the infection (p =0.006, OR=4.33). Conclusions: Our results demonstrated that Mashhad still remains an endemic area for HTLV-I infection despite routine blood screening. Thus, further strategies are needed for prevention of the virus transmission in whole population. [Copyright &y& Elsevier]