Abstract
BackgroundInfection with human herpesvirus 8 (HHV-8), also known as Kaposi's sarcoma-associated herpesvirus (KSHV), is the necessary causal agent in the development of Kaposi's sarcoma (KS). Infection with HIV-1, male gender and older age all increase risk for KS. However, the geographic distribution of HHV-8 and KS both prior to the HIV/AIDS epidemic and with HIV/AIDS suggest the presence of an additional co-factor in the development of KS.MethodsBetween January 1994 and October 1997, we interviewed 2576 black in-patients with cancer in Johannesburg and Soweto, South Africa. Blood was tested for antibodies against HIV-1 and HHV-8 and the study was restricted to 2191 HIV-1 negative patients. Antibodies against the latent nuclear antigen of HHV-8 encoded by orf73 were detected with an indirect immunofluorescence assay. We examined the relationship between high anti-HHV-8 antibody titers (≥1:51,200) and sociodemographic and behavioral factors using unconditional logistic regression models. Variables that were significant at p = 0.10 were included in multivariate analysis.ResultsOf the 2191 HIV-1 negative patients who did not have Kaposi's sarcoma, 854 (39.0%) were positive for antibodies against HHV-8 according to the immunofluorescent assay. Among those seropositive for HHV-8, 530 (62.1%) had low titers (1:200), 227 (26.6%) had medium titers (1:51,200) and 97 (11.4%) had highest titers (1:204,800). Among the 2191 HIV-1 negative patients, the prevalence of high anti-HHV-8 antibody titers (≥1:51,200) was independently associated with increasing age (ptrend = 0.04), having a marital status of separated or divorced (p = 0.003), using wood, coal or charcoal as fuel for cooking 20 years ago instead of electricity (p = 0.02) and consuming traditional maize beer more than one time a week (p = 0.02; p-trend for increasing consumption = 0.05) although this may be due to chance given the large number of predictors considered in this analysis.ConclusionsAmong HIV-negative subjects, patients with high anti-HHV-8 antibody titers are characterized by older age. Other associations that may be factors in the development of high anti-HHV-8 titers include exposure to poverty or a low socioeconomic status environment and consumption of traditional maize beer. The relationship between these variables and high anti-HHV-8 titers requires further, prospective study.
Highlights
Infection with human herpesvirus 8 (HHV-8) is the necessary causal agent in the development of Kaposi's sarcoma (KS)
HHV-8 has been detected in the lesions of most patients with Kaposi's sarcoma [4,5] and it predicts the development of Kaposi's sarcoma when found in the blood [3,6]
A total number of 2191 HIV-1 negative patients without KS who were tested for HHV-8 form the basis for the analysis presented in this paper
Summary
Infection with human herpesvirus 8 (HHV-8) is the necessary causal agent in the development of Kaposi's sarcoma (KS). Infection with HIV-1, male gender and older age all increase risk for KS. Human herpesvirus 8 (HHV-8, known as Kaposi's sarcoma-associated herpesvirus) is understood to be the necessary, causal agent in the development of Kaposi's Sarcoma (KS) [1,2,3]. HIV infection, other immunosuppression, male gender and older age all increase risk [9,10]. Researchers have suggested that infection with HHV-8 later in life, high socioeconomic status and/or exposure to substances in the water or soil may be potential co-factors increasing risk for KS in adulthood [11,12,13]. Using a database of information on over 2000 HIV1 negative black, South African hospitalized cancer patients, we conducted a case control study of risk factors for high titers to HHV-8 (≥1:51,200) using patients with high titers as cases and HHV-8 infected patients with low titers as controls (median titer 1:200)
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