Abstract
BackgroundFactors previously associated with Kaposi's sarcoma-associated herpesvirus (KSHV) transmission in Africa include sexual, familial, and proximity to river water. We measured the seroprevalence of KSHV in relation to HIV, syphilis, and demographic factors among pregnant women attending public antenatal clinics in the Gauteng province of South Africa.MethodsWe tested for antibodies to KSHV lytic K8.1 and latent Orf73 antigens in 1740 pregnant women attending antenatal clinics who contributed blood to the "National HIV and Syphilis Sero-Prevalence Survey - South Africa, 2001". Information on HIV and syphilis serology, age, education, residential area, gravidity, and parity was anonymously linked to evaluate risk factors for KSHV seropositivity. Clinics were grouped by municipality regions and their proximity to the two main river catchments defined.ResultsKSHV seropositivity (reactive to either lytic K8.1 and latent Orf73) was nearly twice that of HIV (44.6% vs. 23.1%). HIV and syphilis seropositivity was 12.7% and 14.9% in women without KSHV, and 36.1% and 19.9% respectively in those with KSHV. Women who are KSHV seropositive were 4 times more likely to be HIV positive than those who were KSHV seronegative (AOR 4.1 95%CI: 3.4 - 5.7). Although, women with HIV infection were more likely to be syphilis seropositive (AOR 1.8 95%CI: 1.3 - 2.4), no association between KSHV and syphilis seropositivity was observed. Those with higher levels of education had lower levels of KSHV seropositivity compared to those with lower education levels. KSHV seropositivity showed a heterogeneous pattern of prevalence in some localities.ConclusionsThe association between KSHV and HIV seropositivity and a lack of common association with syphilis, suggests that KSHV transmission may involve geographical and cultural factors other than sexual transmission.
Highlights
Factors previously associated with Kaposi’s sarcoma-associated herpesvirus (KSHV) transmission in Africa include sexual, familial, and proximity to river water
Several studies that show a strong association between HIV and KSHV infection fail to show a similar strong association with other sexually transmitted infections that are clearly associated with HIV infection [9,13]
This study aims to examine the seroprevalence of KSHV in pregnant women attending antenatal clinics and to identify the risk for KSHV infection in relation to already collected information on socio-demographic and geographical factors, HIV and syphilis serology
Summary
Factors previously associated with Kaposi’s sarcoma-associated herpesvirus (KSHV) transmission in Africa include sexual, familial, and proximity to river water. The biological, social and environmental factors involved in non-sexual horizontal transmission of KSHV are still largely unknown. In South Africa, HIV co-infection is associated with up to 50 fold increases in risk for developing KS [11]. The role of HIV as a risk factor for KSHV infection in South Africa is unclear; some reports show a strong association whereas others show none [9,12]. KSHV infection has been associated with sources of drinking water and with living in close proximity to rivers or streams [17,18]. The role of vectors and environmental factors in KSHV endemic countries is a topic of ongoing study [19,20]
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