Prospective study of human herpesvirus 8 oral shedding, viremia, and serological status among human immunodeficiency virus seropositive and seronegative individuals in Sao Paulo, Brazil

Paulo H Braz-Silva,Tania R Tozetto-Mendoza,Laura M Sumita,Wilton Freire,Michelle Palmieri,Alan M Do Canto,Vivian I Avelino-Silva,Marina Gallottini,Philippe Mayaud,Claudio S Pannuti

doi:10.1080/20002297.2017.1384287

Abstract

ABSTRACTHuman herpesvirus 8 (HHV-8) is a gamma-herpesvirus and etiological agent of all forms of Kaposi sarcoma (KS). Saliva may play an important role in HHV-8 transmission in specific populations. Little is known about HHV-8 oral shedding pattern and the possible correlation with the HHV-8 serological profile and viremia. A prospective study was conducted of HHV-8 salivary excretion among human immunodeficiency virus HIV-seronegative (n = 47) and -seropositive (n = 44) homosexual men and HIV-seropositive women (n = 32) over a 6-month period with monthly HHV-8 serologies (immunofluorescence assays to identify antibodies to latent and lytic HHV-8 viral proteins, and a whole-virus HHV-8 enzyme-linked immunosorbent assay [ELISA]), monthly HHV-8 DNA serum/plasma detection, and daily self-collected oral rinses for HHV-8-DNA detection using real-time polymerase chain reaction. HHV-8 seropositivity was 51.1%, 63.6%, and 37.5%, in the three studied groups. There was no case of HHV-8 DNA detection in serum/plasma. Intermittent detection of oral HHV-8 DNA was observed during 5.1% (110/2,160) of visits among 28% (18/64) of HHV-8-seropositive individuals, all of whom were males and HHV-8 ELISA seropositive. In immunologically controlled populations of Brazil, HHV-8 oral shedding was limited to HHV-8-seropositive men, occurred infrequently and intermittently, and was not linked to HHV-8 viremia, suggesting a limited potential for oral or blood transmission.

Highlights

Transmission of human herpesvirus 8 (HHV-8), the agent of Kaposi sarcoma (KS) and other human immunodeficiency virus (HIV)-associated rare conditions, has been the subject of conflicting evidence [1]
The patients had no history of KS or other lesions associated with HHV-8
24/47 (51.1%) HIV-seronegative men who have sex with men (MSM), 28/44 (63.6%) HIV-seropositive MSM, and 12/32 (37.5%) HIV-seropositive women were positive by at least one HHV-8 serological assay over six time points (Table 1)

Summary

Introduction

Transmission of human herpesvirus 8 (HHV-8), the agent of Kaposi sarcoma (KS) and other human immunodeficiency virus (HIV)-associated rare conditions, has been the subject of conflicting evidence [1]. Oral samples have been consistently shown to have the highest rates of HHV-8 viral detection compared to semen, urine, urethral, vaginal, and anal samples, suggesting that saliva may play an important role in HHV-8 transmission [2,3,4,5,6,7,8,9]. Studies among blood donors outside KS endemic areas have shown very rare detection of HHV-8 DNA in blood samples, even among HHV-8-seropositive individuals [10,11]. Associations between HHV-8 serological status and HHV-8 DNA oral shedding are not clear, with some studies even showing HHV-8 oral shedding in HHV-8-seronegative individuals [13]. The lack of a gold standard for HHV-8 serological status further compounds the limited ability to determine ‘true infection’ status [14]

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