Abstract
Human herpes virus type 8 (HHV-8) is the causative agent of Kaposi’s sarcoma (KS). We systematically reviewed literature published between 1998 and 2017, according to the PRISMA guidelines, to understand the distribution of HHV-8 infection in Africa. More than two-thirds (64%) of studies reported on seroprevalence and 29.3% on genotypes; 9.5% were on both seroprevalence and genotypes. About 45% of African countries had data on HHV-8 seroprevalence exclusively, and more than half (53%) had data on either seroprevalence or genotypes. Almost half (47%) of the countries had no data on HHV-8 infection. There was high heterogeneity in the types of tests and interpretation algorithms used in determining HHV-8 seropositivity across the different studies. Generally, seroprevalence ranged from 2.0% in a group of young children in Eritrea to 100% in a small group of individuals with KS in Central African Republic, and in a larger group of individuals with KS in Morocco. Approximately 16% of studies reported on children. Difference in seroprevalence across the African regions was not significant (95% CI, χ2 = 0.86; p = 0.35), although specifically a relatively significant level of infection was observed in HIV-infected children. About 38% of the countries had data on K1 genotypes. K1 genotypes A, A5, B, C, F and Z occurred at frequencies of 5.3%, 26.3%, 42.1%, 18.4%, 5.3% and 2.6%, respectively. Twenty-three percent of the countries had data for K15 genotypes, and genotypes P, M and N occurred at frequencies of 52.2%, 39.1%, and 8.7%, respectively. Data on HHV-8 inter-genotype recombinants in Africa are scanty. HHV-8 may be endemic in the entire Africa continent but there is need for a harmonized testing protocol for a better understanding of HHV-8 seropositivity. K1 genotypes A5 and B, and K15 genotypes P and M, from Africa, should be considered in vaccine design efforts.
Highlights
Human herpes virus type 8 (HHV-8) is the causative agent of four classes of Kaposi’s sarcoma (KS) [1]: endemic, classic, iatrogenic and AIDS-associated KS; of these, endemic-KS and AIDS-KS are the most aggressive
We firstly present a descriptive analysis of the systematic literature search on studies on HHV-8 sero-epidemiology in Africa
To extract salient sero-epidemiological features, amid the challenges posed by different methodologies, we performed, where plausible, comparable analysis for studies involving children, pregnant women, and for rural and urban populations, against the backdrop of the risk factors for HHV-8 acquisition, for the different regions of Africa (Southern, Central, West, East, and North Africa)
Summary
Human herpes virus type 8 (HHV-8) is the causative agent of four classes of Kaposi’s sarcoma (KS) [1]: endemic, classic, iatrogenic and AIDS-associated KS; of these, endemic-KS and AIDS-KS are the most aggressive. AIDS-KS has been highlighted in young homosexual men [2], while classic-KS is common in elderly Mediterranean people and individuals of Eastern Europe [3]. [4], reported on endemic-KS, called African endemic-KS, as common in children and young adults in sub-Saharan Africa. The epidemiologic pattern of HHV-8 is uneven, but follows that of KS, and countries at high risk of KS report high prevalence of HHV-8. There is great variability in the seroprevalence of HHV-8, as opposed to groups at increased risk of developing KS. HHV-8 undergoes both latent and lytic phases in its life cycle, whereby the virus remains within the host at a dormant stage until other cofactors trigger it to start replicating, leading to the lytic phase [7–9]
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