Abstract
BackgroundThe occurrence of, and risk factors for, HHV-8 infection have yet to be definitively determined, particularly among heterosexual individuals with at-risk behavior for sexually transmitted infections (STI). The objective of this study was to estimate the incidence and determinants of HHV-8 infection among HIV-uninfected individuals repeatedly attending an urban STI clinic.MethodsSera from consecutive HIV-uninfected individuals repeatedly tested for HIV-1 antibodies were additionally tested for HHV-8 antibodies using an immunofluorescence assay. To identify determinants of HHV-8 infection, a nested case-control study and multivariate logistic regression analysis were performed.ResultsSera from 456 HIV-uninfected individuals (224 multiple-partner heterosexuals and 232 men who have sex with men (MSM]) were identified for inclusion in the study. The HHV-8 seroprevalence at enrollment was 9.4% (21/224; 95% C.I.: 6.0–14.2%) among heterosexuals with multiple partners and 22.0% (51/232; 95% C.I.: 16.9–28.0%) among MSM. Among the 203 multiple-partner heterosexuals and 181 MSM who were initially HHV-8-negative, 17 (IR = 3.0/100 p-y, 95% C.I.: 1.9 – 4.8) and 21 (IR = 3.3/100 p-y, 95% C.I:.2.1 – 5.1) seroconversions occurred, respectively. HHV-8 seroconversion tended to be associated with a high number of sexual partners during the follow-up among MSM (> 10 partners: AOR = 3.32 95% CI:0.89–12.46) and among the multiple-partner heterosexuals (> 10 partner; AOR = 3.46, 95% CI:0.42–28.2). Moreover, among MSM, HHV-8 seroconversion tended to be associated with STI (AOR = 1.80 95%CI: 0.52–7.96).During the study period the HIV-1 incidence was lower than that of HHV-8 among both groups (0.89/100 p-y among MSM and 0.95/100 p-y among multiple-partner heterosexuals).ConclusionThe large difference between the incidence of HHV-8 and the incidence of HIV-1 and other STIs may suggest that the circulation of HHV-8 is sustained by practices other than classical at-risk sexual behavior.
Highlights
The occurrence of, and risk factors for, human herpesvirus 8 (HHV-8) infection have yet to be definitively determined, among heterosexual individuals with at-risk behavior for sexually transmitted infections (STI)
The large difference between the incidence of HHV-8 and the incidence of HIV-1 and other STIs may suggest that the circulation of HHV-8 is sustained by practices other than classical at-risk sexual behavior
In areas of low endemicity, such as North America and Northern Europe, HHV-8 infection appears to be concentrated among men who have sex with men (MSM) at high risk of HIV-1 infection and other sexually transmitted infections (STI), whereas it is uncommon among persons who have not reached the age of sexual activity [1,2]
Summary
The occurrence of, and risk factors for, HHV-8 infection have yet to be definitively determined, among heterosexual individuals with at-risk behavior for sexually transmitted infections (STI). The objective of this study was to estimate the incidence and determinants of HHV-8 infection among HIV-uninfected individuals repeatedly attending an urban STI clinic. Several prevalence studies among MSM have reported an association between HHV-8 infection and receptive anal sex, the number of sexual partners, HSV-2 infection, hepatitis B virus infection, a history of syphilis, and HIV-1 infection, suggesting that the modes of transmission of HHV-8, among MSM, are similar to those for common STIs [3,4,5,6,7]. The results of recent incidence studies among MSM suggest that oro-genital sex, rather than receptive anal sex, is an important mode of HHV-8 transmission [810]. The hypothesis of transmission through saliva is supported by the results of studies showing that HHV-8 DNA sequences are more likely to be detected in saliva or in mouth swabs than in semen or cervical-vaginal swabs [13,14,15,16]
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