Primary infection with human herpesvirus 8 in an HIV-1-infected patient.

Abstract

Human herpesvirus 8 (HHV-8) has been clearly associated with three neoplastic disorders, Kaposi's sarcoma (KS), primary effusion lymphoma (PEL) and multicentric Castleman's disease [1,2]. So far, the clinical manifestations of HHV-8 primary infection have not been extensively described. Seroconversions for HHV-8 antibodies have been retrospectively documented in cohorts of homosexual men, and epidemiological studies have demonstrated that HHV-8 infection could be sexually transmitted, particularly in homosexual men [3,4]. We describe here the clinical manifestations related to an HHV-8 primary infection in an HIV-1-infected homosexual man. A 40-year-old man was followed for more than 8 months after a symptomatic HIV-1 primary infection. Clinical examination and sera sampling were repeated monthly. This patient was infected with HIV-1 by unprotected anal intercourse. Thirty days after, he presented with symptoms typically associated with an acute HIV-1 infection, which all regressed spontaneously within 2 months (Table 1). These symptoms were associated with a specific pattern of HIV-1 seroconversion, with the succeeding appearance of p24 antigenaemia and HIV-1 seroconversion, as demonstrated both by enzyme-linked immunosorbent assay and Western blot assays. One month after the recovery of primary HIV-1 infection symptoms, this patient consulted with a 3 day history of fever between 38 and 39°C, sweats, lombalgia and myalgia. Physical examination revealed lymph node enlargement with inguinal painful lymphadenopathies. One week later, these symptoms persisted and he was admitted to hospital. At this time, the patient harboured the same symptoms associated with severe asthenia and diarrhoea. Haematology tests did not reveal any anaemia, thrombocytopenia or mononuclear leukocytosis with atypical lymphocytes. Hepatic manifestations consisted of self-limited elevation of hepatocellular enzyme levels (serum aspartate aminotransferase concentration was 60 U/l), without any hepatomegaly or splenomegaly. Acute viral infections, such as human cytomegalovirus, Epstein–Barr virus, hepatitis B virus and hepatitis C virus, were ruled out using serodiagnosis tests, and acute bacterial infections were ruled out by the use of urine and blood cultures. The assay for antibodies to a latent HHV-8 antigen was performed using a standard immunofluorescence procedure on a PEL cell line latently infected with HHV-8 (BCP-1, kindly provided by Professor P.S. Moore and Y. Chang, New York City, USA) [5,6]. Serial dilutions on sample sera were performed to obtain HHV-8 antibody titres. A specific HHV-8 seroconversion was observed and was followed by a dramatic increase in HHV-8 antibodies during the convalescence period (Table 1). This profile unambiguously demonstrated a primary HHV-8 infection. We report here an acute primary infection with HHV-8. Compared with the clinical and biological manifestations of an acute infection with Epstein–Barr virus, which is the closest human herpesvirus, the main differences were the lack of pharingitis and mononuclear leukocytosis with atypical lymphocytes. In the past, one report [7] described HHV-8 primary infection symptoms associating transient fever, arthralgia, cervical mass, cervical lymphadenopathy, splenomegaly and cytopenia. In both cases, the presentation of HHV-8 acute infection was very similar with respect to the clinical manifestations and their duration, with spontaneous remission within 8 weeks. However, HHV-8 serology obtained with the same assay was different because the HHV-8 antibodies were detected 5 weeks before the onset of symptoms in the other case report, whereas they were negative 4 weeks before the onset of symptoms in our observation. This case report demonstrates and confirms that primary infection with HHV-8 can be symptomatic, but without any specific clinical signs. Recently, it has been demonstrated that some HHV-8 infections are observed in renal grafts from donors to recipients and also during the follow-up of HIV-1-infected subjects included in cohorts [8–10]. This clinical observation should lead physicians to perform serological HHV-8 testing in the context of HIV-1-infected patients harbouring either similar or, conversely, atypical clinical findings.Table 1: Clinical events and biological findings. Anne-Geneviève Marcelina Nicolas Dupinb François Simonc Diane Descampsc Henri Aguta Vincent Calveza