Abstract
Seroepidemiological surveys show that the prevalence of human herpesvirus 8 (HHV-8) infection mostly varies in various geographical areas and reflects the local incidence of classic and endemic KS, being widespread in sub-Saharan Africa and Mediterranean countries and uncommon in the USA and Northern Europe. In the Middle East only few populations, such as Ashkenazi and Sephardic groups in Israel, have been adequately evaluated for HHV-8 seroprevalence. Among Iranian population a striking higher seroprevalence of HHV8 has been reported among haemodialysis (16.9%), renal transplant recipients (25%) and HIV (45.7%) patients compared to blood donors (2%). Kaposi's sarcoma (KS) is the rarest cancer in Iran, with an annual age-standardized incidence varying from 0.10 to 0.17 per 100,000 in males and from 0.06 to 0.08 per 100,000 in females. KS, however, is one of the most important malignancies in Iranian renal transplanted patients affecting up to 2.4% of organ recipients. The epidemiology of HHV8 and KS in Iran needs further evaluation. While the high prevalence of HHV-8 antibodies in HIV positive and haemodialysis individuals may be attributed to high-risk sexual behavior and polytransfusions, respectively, unknown determinants may be responsible for high seroprevalence of HHV8 and high incidence of KS in solid organ recipients. A global survey on HHV8 seroprevalence in Iran is mandatory to define co-factors associated with HHV8 infection and KS risk in the general Iranian population and in specific patient groups.
Highlights
Kaposi’s sarcoma (KS) is a mesenchymal tumor involving blood and lymphatic vessels that was first described in Eastern Europe in the late 19th century [1] and classically considered an indolent disease of elderly men
The mean-age of Iranian renal transplants developing KS is below 50 years, which is lower than that of patients with classic Kaposi’s sarcoma (50-79 years)
Most cases of post-transplantation KS develop as a result of viral reactivation, since more than 80 percent of transplant recipients with KS are seropositive for human herpesvirus 8 (HHV-8) before transplantation [34,64]
Summary
Kaposi’s sarcoma (KS) is a mesenchymal tumor involving blood and lymphatic vessels that was first described in Eastern Europe in the late 19th century [1] and classically considered an indolent disease of elderly men. About 1.14-6% (mean = 2.8%) of Iranian renal transplant recipients develop cancer lesions, mostly skin cancers (Table 1) [37,38,39,40,41,42,43] These findings are consistent with other report in Middle Eastern countries. The mean-age of Iranian renal transplants developing KS is below 50 years, which is lower than that of patients with classic Kaposi’s sarcoma (50-79 years) This finding is consistent with data reported by other studies on renal transplant patients from different regions of the world [30,32,45,60,61]. Visceral lesions affected 10% of patients and predominantly involved the lymph nodes, gastrointestinal tract, and lungs [63] In agreement with these worldwide studies, 80% of Iranian transplant recipients with KS developed cutaneous lesions.
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