Oral HHV-8 replication among women in Mombasa, Kenya

Abstract

Human herpesvirus-8 (HHV-8) replication in the oropharynx may play an important role in HHV-8 transmission and contribute to the development of Kaposi sarcoma (KS) in some individuals. Studies in the United States and Europe report high rates of HHV-8 DNA detection in saliva of HHV-8 infected men, but little is known about the natural history of HHV-8 among persons in sub-Saharan Africa, where prevalence of HHV-8 infection and KS is greatest. To address this gap, this study evaluated oral HHV-8 replication in a cohort of 40 HHV-8 seropositive Kenyan women. Study clinicians collected daily oral swabs from participants for up to 30 consecutive days, and swab samples were tested for HHV-8 DNA using quantitative, real-time polymerase chain reaction. HHV-8 was detected at least once in 27 (68%) participants, and the overall shedding rate was 23%. On days with HHV-8 detection, mean HHV-8 quantity was 4.5 log10 copies/ml. Among HIV-infected women, CD4 count ≥500 cells/mm3 versus <500 cells/mm3 was associated with higher HHV-8 copy number (4.8 log10 copies/ml vs. 3.4 log10 copies/ml; coef 1.2 [95% CI, 0.5–1.9]; P=0.001) and a higher HHV-8 shedding rate (49% vs.12%; RR, 4.2 [95% CI, 0.8–21.4]; P=0.08). No other factors were associated with HHV-8 shedding rate or copy number. The study demonstrates high rates and quantity of HHV-8 in the oropharynx of HHV-8 seropositive African women. These findings support the observation that oral replication is an essential feature of HHV-8 infection, with likely implications for HHV-8 transmission and KS pathogenesis.

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

“…The present findings differ from other studies that have reported a high frequency (32–68%) of HHV-8 shedding and high viral loads among HIV-seropositive women in Africa [3,4]. These studies were carried out in KS endemic areas (Kenya) among very specific populations (sex workers who did not use HAART) [3,4].…”

“…These studies were carried out in KS endemic areas (Kenya) among very specific populations (sex workers who did not use HAART) [3,4]. The small number of HHV-8-seropositive women in the present study, the different participant characteristics, and the fact that Brazilian patients were immunologically well controlled on HAART may explain these different results.…”

Oral shedding of herpesviruses in HIV-infected patients with varying degrees of immune status

“…The etiological agent for KS is KSHV and the etiological agent for OHL is EBV. CMV, EBV, KSHV, HSV-1 are present in oral secretions and transmitted via the oral route [12, 35–37] . CMV plasma VL is closely linked to immune suppression, whether by HIV or iatrogenic drug regimen [35, 38] .…”

Prevalence of human herpesvirus 8 infection in people living with HIV/AIDS in Pernambuco, Brazil

“…Although, it seems pertinent to observe that in sexual encounters it is difficult to exclude the possibility of behaviors that involve an oral route, such as oral sex which presented a borderline significance. In addition, the HHV‐8 was more easily detected by PCR in the saliva than in sperm of HIV infected patients, whether they had KS, or not [Phipps et al, ].…”