Review of the distribution of Kaposi's sarcoma-associated herpesvirus (KSHV) in Africa in relation to the incidence of Kaposi's sarcoma

Liverpool School of Tropical Medicine, Hlabisa Hospital and the Africa Centre for Population Studies and Reproductive Health, PO Box 252, Hlabisa 3937, KwaZulu/Natal, South Africa.
British Journal of Cancer (Impact Factor: 4.84). 02/2003; 88(1):1-3. DOI: 10.1038/sj.bjc.6600745
Source: PubMed


In the years before human immunodeficiency virus (HIV) infection, the incidence of Kaposi's sarcoma varied markedly across the African continent, and it was a disease primarily affecting men. In contrast, the evidence reviewed here shows that the causal virus-Kaposi's sarcoma associated herpesvirus (KSHV)-is prevalent in many African countries, including places where Kaposi's sarcoma was almost unknown before HIV, and that it is as common in women as in men. Therefore, the geographical distribution of Kaposi's sarcoma in Africa before the spread of HIV and its predominance as a disease affecting men are not a simple reflection of the distribution of KSHV. Since the epidemic of HIV in Africa, Kaposi's sarcoma has become relatively more frequent in women, and the incidence has increased in countries where it was previously rare, but where KSHV is prevalent, as well as in countries where it was already common. These changes point to a role for other (as yet unknown) factors in the aetiology of Kaposi's sarcoma that may have the most effect in the absence of concurrent HIV infection.

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Available from: Martin Dedicoat, Jan 21, 2015
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    • "Kaposi sarcoma–associated herpesvirus (KSHV) seroprevalence exhibits marked worldwide geographical variation,1,2 which may represent regional differences in modes of transmission, or point to the existence of cofactors for infection or reactivation. Studies from sub-Saharan Africa report high KSHV prevalence, with primary infection beginning in childhood and increasing with age.3,4 "
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    ABSTRACT: Background: Determinants of Kaposi sarcoma–associated herpesvirus (KSHV) seropositivity among children living in sub-Saharan African populations where infection is endemic are not well understood. Local environmental factors, including other infectious agents, may be key. Methods: Within the context of a well-characterized birth cohort, we examined associations between various factors and antibodies against KSHV, measured in stored plasma samples from 1823 mother–child pairs in Entebbe, Uganda. Results: Seroprevalence increased with increasing age of the child (P = 0.0003) and was higher among those with KSHV seropositive mothers than in those without (12% vs 9%; odds ratio: 1.4, 95% confidence interval: 1.1 to 2.0). It was also higher among children with HIV infection (29% vs 10%; odds ratio: 3.1, 95% confidence interval: 1.2 to 8.3) or malaria parasitemia (30% vs 10%; odds ratio: 4.1, 95% confidence interval: 2.4 to 7.0) than in children without. These associations were not explained by socioeconomic status. Conclusions: The finding that KSHV serostatus is associated with malaria parasitemia in children is novel. In a country endemic for KSHV, malaria may be a cofactor for KSHV infection or reactivation among children.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 02/2013; 63(2). DOI:10.1097/QAI.0b013e31828a7056 · 4.56 Impact Factor
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    • "KSHV seropositivity is highest (>50-80%) in equatorial Africa [6,7], including in Uganda, where 1 in every 2 persons is KSHV seropositive by adult age [8,9]. KSHV seropositivity is intermediate (10%) in Mediterranean Europe [10] and rare (<3%) in the North America and Northern Europe [11,12], except among homosexual men in whom up to 1 in every 3 men may be KSHV seropositive, most likely due to transmission via sexual contact [13]. "
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    ABSTRACT: Background Kaposi sarcoma-associated herpesvirus (KSHV) seropositivity is associated with sexual, environmental, and socioeconomic exposures. Whether these characteristics are independent risk factors is uncertain because of reliance on selected high-risk or hospital-based populations and incomplete adjustment for confounding. Therefore, we evaluated risk factors for KSHV seropositivity in a population-based study in Uganda using principal components analysis (PCA). Methods The study population comprised 2,681 individuals randomly selected from a nationally-representative population-based HIV/AIDS sero-behavioral survey conducted in 2004/05. Questionnaire and laboratory data (97 variables) were transformed into a smaller set of uncorrelated variables using PCA. Multivariable logistic regression models were fitted to estimate odds ratios and 95% confidence intervals for the association between components and KSHV seropositivity. Results Data were reduced to three principal components (PCs) labeled as Sexual behavioral, Socioeconomic, and Knowledge PCs. In crude analysis, KSHV seropositivity was associated with the Knowledge (ptrend = 0.012) and Socioeconomic components (ptrend = 0.0001), but not with the Sexual-behavioral component (ptrend = 0.066). KSHV seropositivity was associated with the Socioeconomic PC (ptrend = 0.037), but not with the Sexual-behavioral and Knowledge PCs, in the models including PCs, age, gender and geographic region. Conclusions Our results fit with the view that in Uganda socioeconomic characteristic may influence KSHV seropositivity. Conversely, the results fit with the interpretation that in Uganda sexual-behavioral characteristics, if relevant, contribute minimally.
    Infectious Agents and Cancer 01/2013; 8(1):3. DOI:10.1186/1750-9378-8-3 · 2.36 Impact Factor
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    • "While progressive increases in HHV-8 load precede development of disease in HIV-1-infected persons (Campbell et al., 2000; Laney et al., 2007), evidence is lacking for a direct association between control of HHV-8 load and HHV- 8-specific, T cell immunity (Guihot et al., 2006). Nevertheless, an increased incidence of KS in organ transplant recipients and HIV-1-infected persons (Dedicoat and Newton, 2003) suggest a role for T cell immunity in prevention of KS, similar to T cell immunity in EBV-related cancers (Gottschalk et al., 2005). "
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    ABSTRACT: Professional antigen presenting cells (APC), i.e., dendritic cells (DC), monocytes/macrophages, and B lymphocytes, are critically important in the recognition of an invading pathogen and presentation of antigens to the T cell-mediated arm of immunity. Human herpesvirus 8 (HHV-8) is one of the few human viruses that primarily targets these APC for infection, altering their cytokine profiles, manipulating their surface expression of MHC molecules, and altering their ability to activate HHV-8-specific T cells. This could be why T cell responses to HHV-8 antigens are not very robust. Of these APC, only B cells support complete, lytic HHV-8 infection. However, both complete and abortive virus replication cycles in APC could directly affect viral pathogenesis and progression to Kaposi's sarcoma (KS) and HHV-8-associated B cell cancers. In this review, we discuss the effects of HHV-8 infection on professional APC and their relationship to the development of KS and B cell lymphomas.
    Frontiers in Immunology 01/2012; 3:427. DOI:10.3389/fimmu.2012.00427
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