Confirming Shedding of Human Herpesvirus 8 in Urine from Infected Patients in Brazil

Abstract

Since the discovery of Kaposi's sarcoma-associated herpesvirus, also known as human herpesvirus 8 (HHV-8), several studies have been conducted to identify the body fluids into which the virus is shed, with consequent potential virus transmission (7,10). Although saliva has been pointed out as the main route of virus transmission, mostly in populations in areas where the virus is endemic, semen, blood, urine, and stool have also been suggested as vehicles of virus transmission-acquisition in populations at risk of infection, such as homosexual males and human immunodeficiency virus (HIV)-AIDS patients (4,5,11). Unfortunately, all specimens analyzed up to now have yielded controversial results except saliva, which tested positive for HHV-8 DNA for several asymptomatic carriers and for Kaposi's sarcoma (KS) patients (3,4,9,11,12).In the last years, a group of researchers published interesting studies conducted on Malawian people. First, they investigated the molecular epidemiology of HHV-8 and the routes of virus transmission (1,8). Then, using PCR, sequencing, and other molecular approaches, they evaluated blood and several oral samples from KS patients and their relatives and identified the HHV-8 subtypes named B1, A2, and A5 that circulate in Malawi. To add some information concerning this matter, we present the results obtained with a group of KS patients and HIVinfected patients in São Paulo, Brazil, whose urine was analyzed for the presence of HHV-8 DNA by PCR of ORF 26 and K1/V1, as previously described (1). The results obtained revealed HHV-8 DNA positivity in 6 out of 55 (11%) KS patients and in 5 out of 18 (28%) HIV-1-infected patients without clinical evidence of KS. Interestingly, the group without KS presented the higher prevalence rate of HHV-8 infection. On the basis of clinical and epidemiological data, we may speculate that these patients were recently infected with HHV-8 or had KS at sites not yet identified. In agreement with this hypothesis, two out of five HHV-8-infected patients were found to be HHV-8 seropositive in immunofluorescence assays (6). In contrast, the relatively low rate of HHV-8 infection detected in the urine of KS patients may be the result of highly active antiretroviral therapy and/or ABV treatment to which these patients were submitted, which can contribute to virus clearance in blood and urine.We do not know the exact significance of HHV-8 DNA in urine, but we can hypothesize that when virions are present in urine, this specimen could be of importance for virus transmission-acquisition, mainly in populations of countries with poor socioeconomic and sanitary conditions where the virus is endemic and also in individuals with promiscuous behaviors. Additional investigations, including the determination of viral load using real-time PCR and primers for different regions of the HHV-8 genome, are needed to solve this question. If urine is confirmed to be another vehicle of virus transmission, it will be necessary to formulate recommendations to block the spread of the virus.

First survey for detecting the presence of human herpesvirus 8 infection (HHV-8) in Maputo, Mozambique

“…No association between HHV-8 and exposure to STDs, use of illicit drugs, hepatitis, or other variables was detected, but we could not exclude participant omission or lack of knowledge regarding this information. Concerning the significant association between KS and HIV, the results are in accordance with the literature as well as our previous studies confirming HHV-8 infection in KS patients, most of whom were HIV/AIDS patients [6,8,12,13]. Although the number of individuals analyzed was small, this preliminary study emphasizes the need for extending and confirming these data in order to properly prevent and treat individuals from this geographic area.…”

“…In support of this finding, some studies conducted in Africa demonstrated poor sanitary and hygienic practices as well as lack of tap water and low socioeconomic status as risk factors for HHV-8 transmission/ acquisition [10,11]. In addition, segments of DNA/HHV-8 were detected in saliva and urine, which implicate these specimens as potential routes of virus transmission [5,12]. Of note, although not statistically significant, several individuals enrolled in the present study mentioned lack of electricity and tap water at home.…”

Porcine lymphotropic herpesvirus DNA detection in multiple organs of pigs in Brazil

“…As PLHVs are detectable in blood, mainly B cells [2], the detection of PLHVs in different organs supplied with blood, including urinary bladder and CNS, is not surprising. Although not always at significant titers, studies have shown that the herpesviruses may also be present in the urine of humans [19,20] and other animal species, including swine [21,22]. Although there is a presence of PLHV DNA in paired kidney and urinary bladder samples of pigs in this study and the consistent results from these tissues, the urinary shedding of PLHV was not evidenced herein.…”

Diffuse Large B-cell Lymphoma Arising Primarily at the Stoma After Bladder Reconstruction Using Ileal Conduit

“…Actually, we have not yet identified biological mechanisms of lymphomagenesis, which may be the subject of future investigations. Further, human herpes virus 8 (HHV-8) is suggested to be associated with lymphoma and the virus itself could also be detected in urine (15). Hence, if we undertook virological analysis, the consequences might be scientifically intriguing.…”