Seroprevalence and viral quantification of Kaposi Sarcoma-associated Herpes Virus (KSHV) in a Human Immunodeficiency Virus (HIV) infected adult South African cohort.

Abstract

Background Kaposi sarcoma-associated herpes virus (KSHV), also known as human herpes virus 8 (HHV8), is aetiologically implicated in Kaposi’s sarcoma (KS). Although HIV associated KS has increased in incidence and is a public health problem in South Africa, serological studies of KSHV have not been extensively documented in this population. This cross-sectional study investigates the seroprevalence and viral load of KSHV in an adult South African cohort. Method Cross-sectional data of 140 participants attending an urban research HIV counseling and testing (HCT) clinic site in Durban, KwaZulu-Natal, between July and October 2013 was analyzed. Detection of antibodies against latent (Orf73) and lytic (K8.1) KSHV antigens was performed on 70 HIV-seropositive and 70 HIV-seronegative participants. Subjects reactive to either antigen were considered KSHV seropositive and analyzed for salivary KSHV DNA, which was quantified using primers for the K6 gene region. Results The demographic characteristics of the two groups were similar, with 36% males (median age, 35yrs.) and 64% females (med. age, 34yrs.) in the HIV-positive group, and 31% males (med. age, 36.5yrs.) and 69% females (med. age, 36.5yrs.) in the HIV-negative group. Of 70 HIV-positive participants, 100% were black Africans, as was 97% of the HIV-negative group, with the remaining 3% being Indian/Asian and Mixed race. Only 24% of HIV-positive patients were on Anti-retro viral treatment. Fifty-four percent of all participants tested positive for KSHV, with 33% reactive to lytic K8.1, 37% to latent Orf73 and 21% to both. Of those HIV-positive, 50% were seropositive for K8.1 and 46% for Orf73. In those HIV-negative, 16% were seropositive for K8.1 and 29% for Orf73. The HIV-positive group demonstrated a significantly higher percentage KSHV seropositivity (70% vs. 37%, p=0.0001). Amongst the KSHV seropositive participants, KSHV DNA was detected in 41 % HIV-positive and 23% HIV-negative participants. Conclusion KSHV seroprevalence was high in South African adults attending an urban HCT clinic. HIV positive status was associated with a higher KSHV seropositivity and a greater KSHV salivary shedding. HIV positive individuals should be tested for KSHV infection and those found infected, be monitored aggressively for development of KS.