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NEWS AND NEW DEVELOPMENTS
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Interaction of Human Immunodeficiency Virus Type
1 and Human Herpesvirus Type 8 Infections on the Incidence of Kaposi's
Sarcoma [Jacobson LP, et al. JID 2000; 181: 1940]: This is
a report from the Multicenter AIDS Cohort Study (MACS) to determine the
risk of Kaposi's sarcoma in relationship to the time of acquisition of
HIV and HHV-8 infections. Stored sera that was collected longitudinally
from 400 gay men with known dates of HIV-1 seroconversion were tested
for HHV-8 antibody. The time from HHV-8 seroconversion to clinical KS
was compared for 69 men who developed HHV-8 infection after HIV to 182
men who were seropositive for HHV-8 before HIV-1 infection. The former
group, those with HHV-8 seroconversion after HIV-1 infection, had an increased
rate of KS with a risk ratio of 2.6. Other risk factors associated with
the development of KS were a more rapid decline in CD4 cell counts and
high HIV-1 RNA plasma levels.
Comment: This is an extraordinary study that illustrates the advantage
of a cohort with longitudinally collected samples over a sustained period.
The findings in this review include the following:
- Most of the patients, 73%, acquired HHV-8 before HIV-1 infection.
- There are several behavioral risk factors for acquiring HHV-8 including
large numbers of sex partners, multiple sexually transmitted diseases
and recreational drug use. None of these were risk factors for progression
to KS.
- HHV-8 appears to be similar to other herpesviruses such as CMV, EBV
and HSV: They all remain latent in the immune-competent host and then
cause severe disease reflecting viral reactivation or primary infection
when there is immunosuppression.
- Among the 400 men who participated, 37% were HHV-8 seropositive at
baseline, and 102 (40%) became infected with HHV-8 during a follow-up
period of approximately 10 years. This shows the high rate of HHV-8
infection in this population.
- Of the 251 patients with HHV-8, 42 (17%) developed KS.
- The median CD4 cell count was 120/mm3
at the time of KS.
- The high rate of HHV-8 infection and the low rate of KS in the absence
of immunosuppression indicates that persons with HHV-8 infection do
not need to be monitored unless they have a condition that will compromise
cell-mediated immunity such as HIV-1.
- The association of immunosuppression with the development of KS indicates
that the risk of KS should be reduced with immune reconstitution, and
this has been shown [AIDS 1998; 12: F45; JAIDS 1999; 21:
S34]. posted 8/3/2000
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