Prevalence of Kaposi Sarcoma–Associated Herpesvirus Infection in Homosexual Men at Beginning of and During the HIV Epidemic

Abstract

Infection with KSHV was already highly prevalent in homosexual men when the HIV epidemic began in San Francisco, and its prevalence has been maintained at a nearly constant level. Any declines in the incidence of Kaposi sarcoma do not appear to be caused by a decline in KSHV transmission.

Molecular Genetics of Kaposi's Sarcoma-Associated Herpesvirus (Human Herpesvirus 8) Epidemiology and Pathogenesis

“…However, virtually 100% of the population reported at least one occurrence of unprotected oral sex in every year of the study, with an increasing number of partners over that period. Studies of three different populations with high STD and AIDS prevalences in San Francisco agree with this behavioral risk factor, suggesting that insertive oral sex may be the highest risk behavior, as inferred from the easy detection of KSHV in saliva but a low viral load in semen (386). In agreement, many studies have found KSHV in the saliva of seropositive patients (45,266,392,481,513), and KSHV has been detected in prostate tissue and the male urogenital tract (132,348,481,483); detection of KSHV in the ejaculate has been reported but remains controversial (255,300,348,396,481; P. Gupta, M. K. Singh, C. Rinaldo, M. Ding, H. Farzadegan, A. Saah, D. Hoover, P. Moore, and L. Kingsley, Letter, AIDS 10:1596-1598, 1996).…”

“…The incidence of AIDS-associated KS in homosexual men in San Francisco in the early 1980s was nearly 40% (325), but the decline in new infections reduced its frequency in AIDS patients in the mid-1990s to about 15 to 25% (137,336,425). Recent data suggest that KSHV was highly prevalent in the homosexual population prior to the AIDS epidemic: in San Francisco in the first 6 months of 1978, the prevalence of KSHV was 24.6%, with a concurrent HIV-1 prevalence of only 1.8% (386).…”

Kaposi sarcoma incidence in the Swiss HIV Cohort Study before and after highly active antiretroviral therapy

“…Similar reductions in the incidence of KS among PWHA were seen in many other studies (International Collaboration on HIV and Cancer, 2000) although the decrease started earlier (i.e., even before the introduction of HAART) in the United States (Biggar et al, 1996;Engels et al, 2006) and Australia (Grulich et al, 2001) than in Europe (Dal Maso et al, 1995). The prevalence of KS herpesvirus, the cause of KS (IARC, 1997), may have been especially high in the first wave of HIV infection in MSM in the United States and Australia (Osmond et al, 2002).…”

Viruses, chemicals and co-carcinogenesis

“…The prevalence of HHV-8 antibodies varies widely across populations with good correlation between seroprevalence and incidence of KS. The prevalence of antibodies to HHV-8 is common among gay men in the USA (15-60%), but infrequent among heterosexuals (0-9%) (Osmond et al, 2002). Gay men with KS are more likely to have HHV-8 DNA in peripheral blood than gay men without KS (35 versus 6%) (Cannon et al, 2003), found that the prevalence of HHV-8 in 1978 and 1979 was 26.5% among gay men in one San Francisco cohort, and that its prevalence did not change through 1996 (Osmond et al, 2002).…”

“…The prevalence of antibodies to HHV-8 is common among gay men in the USA (15-60%), but infrequent among heterosexuals (0-9%) (Osmond et al, 2002). Gay men with KS are more likely to have HHV-8 DNA in peripheral blood than gay men without KS (35 versus 6%) (Cannon et al, 2003), found that the prevalence of HHV-8 in 1978 and 1979 was 26.5% among gay men in one San Francisco cohort, and that its prevalence did not change through 1996 (Osmond et al, 2002). On the other hand, the rapid increase in the incidence of HIV-associated KS in the early 1980s and its decline in the United States prior to the era of highly active antiretroviral therapy suggests that HHV-8 alone does not cause KS.…”