M. Capuano

Kaposi's Sarcoma Associated with Previous Human Herpesvirus 8 Infection in Kidney Transplant Recipients

ABSTRACT This study investigates the prevalence of human herpesvirus 8 (HHV-8) infection in kidney transplant patients, evaluating the risk of HHV-8 transmission via transplantation and the association between pre- and posttransplantation HHV-8 infection and the subsequent development of Kaposis sarcoma (KS). Immunofluorescence and an enzyme immunoassay were used to determine HHV-8 seroprevalence in 175 patients awaiting kidney transplantation and 215 controls who were attending our clinic for other reasons. All patients in the study came from central or southern Italy. Seroprevalence was similar in both groups (14.8 versus 14.9%), with no significant difference between the rates for male and female patients. Of the 175 patients, 100 were tested for anti-HHV-8 antibodies at various times during follow-up. During follow-up, seroprevalence increased from 12% on the date of transplantation to 26%. This increase was paralleled by an age-related increase in seroprevalence in the control group. During follow-up from 3 months to 10 years after transplantation, KS was diagnosed in seven patients (4.0%). Six of these patients were positive for HHV-8 prior to transplantation. Overall, 23.0% of patients who were HHV-8 positive before transplantation developed KS, whereas only 0.7% of seronegative patients developed the disease (relative risk, 34.4; 95% confidence interval, 4.31 to 274.0). This finding suggests that the key risk factor for KS is infection prior to transplantation and that antibody detection in patients awaiting transplantation could be useful in identifying patients at high risk for KS. In patients from geographic areas with a high prevalence of HHV-8, serological tests on donors may be less important.

HHV8 in renal transplant recipients

Abstract Human herpevirus 8 (HHV8) DNA sequences have been found in lesions from patients with Kaposis sarcoma (KS) in several forms including immunosuppressed transplant patients. We wanted to study the transmission of HHV8 in kidney transplant recipients and to assess the risk of development of KS related to the viral infection in this group of patients. We tested sera of 120 renal transplant recipients with serological assay for antibodies to HHV8 antigens before transplantation and then we tested sera of 66 patients of the same group after transplantation. Antibodies were detectable in 27.5 % of the patients before transplantation. In the seropositive population 15.1 % developed KS and in the negative group 1.1 %. Analysing 66 posttransplant sera we noticed that 24 % of the seronegative patients became positive after transplantation. Our data suggest that being positive for HHV8 before transplantation could be an important risk factor for the development of KS.

Antibodies against human herpesvirus 8 in subjects with non-venereal dermatological conditions

BACKGROUND Human herpesvirus 8 (HHV8) is considered as the infectious cofactor involved in the pathogenesis of Kaposis sarcoma (KS). Its seroprevalence and modes of transmission in the general population are still undetermined. OBJECTIVES We aimed to estimate the prevalence of HHV8 infection in a population at low risk for sexually transmitted diseases. METHODS We conducted a seroepidemiological survey on randomly selected individuals attending the dermatology department of a teaching hospital in Rome. Of 257 patients, 248 had their blood analysed for anti-HHV8 antibodies and 201 completed a standardized interview. Serological analysis was performed by an immunofluorescence assay able to detect antilytic antibodies. RESULTS We found an overall seroprevalence of 15.7% (95% confidence interval, CI 11.4-20.9%), similar in men and women (15.1% vs. 16.3%) and higher at older ages. Seropositivity was not related to sexual habits, while it was significantly associated with a history of hepatitis (seroprevalence 34.6%, adjusted odds ratio, OR 4.08, 95% CI 1.52-11.00) and with a diagnosis of non-melanoma skin cancer (42.9%, OR 4.20, 95% CI 1.26-14.02) or atypical naevi (35.3%, OR 6.21, 95% CI 1.85-20.86). CONCLUSIONS Our data suggest that a non-sexual mode of transmission of HHV8 infection is plausible in an Italian population at low risk for sexually transmitted diseases and that other factors, besides differences in prevalence of HHV8 infection, may be involved in the epidemiology of classical KS. The unexpectedly high seropositivity rates in subjects with non-melanoma skin cancer and atypical naevi should be viewed with caution and require confirmation.

Antibodies against human herpesvirus 8 in subjects with non-venereal dermatological conditions: HHV8 IN NON-VENEREAL DERMATOSES

Background  Human herpesvirus 8 (HHV8) is considered as the infectious cofactor involved in the pathogenesis of Kaposis sarcoma (KS). Its seroprevalence and modes of transmission in the general population are still undetermined. Objectives We aimed to estimate the prevalence of HHV8 infection in a population at low risk for sexually transmitted diseases. Methods We conducted a seroepidemiological survey on randomly selected individuals attending the dermatology department of a teaching hospital in Rome. Of 257 patients, 248 had their blood analysed for anti‐HHV8 antibodies and 201 completed a standardized interview. Serological analysis was performed by an immunofluorescence assay able to detect antilytic antibodies. Results We found an overall seroprevalence of 15·7% (95% confidence interval, CI 11·4–20·9%), similar in men and women (15·1% vs. 16·3%) and higher at older ages. Seropositivity was not related to sexual habits, while it was significantly associated with a history of hepatitis (seroprevalence 34·6%, adjusted odds ratio, OR 4·08, 95% CI 1·52–11·00) and with a diagnosis of non‐melanoma skin cancer (42·9%, OR 4·20, 95% CI 1·26–14·02) or atypical naevi (35·3%, OR 6·21, 95% CI 1·85–20·86). Conclusions Our data suggest that a non‐sexual mode of transmission of HHV8 infection is plausible in an Italian population at low risk for sexually transmitted diseases and that other factors, besides differences in prevalence of HHV8 infection, may be involved in the epidemiology of classical KS. The unexpectedly high seropositivity rates in subjects with non‐melanoma skin cancer and atypical naevi should be viewed with caution and require confirmation.