Risk factors for human Herpesvirus 8 infection and AIDS-associated Kaposi's sarcoma among men who have sex with men in a European multicentre study

Authors

  • Elisa Martró,

    1. Centre d'Estudis Epidemiològics sobre l'HIV/SIDA de Catalunya, Departament de Salut, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
    2. Microbiology Service, Hospital Universitari Germans Trias i Pujol, Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona, Badalona, Spain
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  • Anna Esteve,

    1. Centre d'Estudis Epidemiològics sobre l'HIV/SIDA de Catalunya, Departament de Salut, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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  • Thomas F. Schulz,

    1. Department of Virology, Hannover Medical School, Hannover, Germany
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  • Julie Sheldon,

    1. Department of Virology, Hannover Medical School, Hannover, Germany
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  • Gemma Gambús,

    1. Centre d'Estudis Epidemiològics sobre l'HIV/SIDA de Catalunya, Departament de Salut, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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  • Rafael Muñoz,

    1. Centre d'Estudis Epidemiològics sobre l'HIV/SIDA de Catalunya, Departament de Salut, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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  • Denise Whitby,

    1. Institute for Cancer Research, Chester Beatty Laboratories, London, United Kingdom
    Current affiliation:
    1. Viral Epidemiology Section, AIDS Vaccine Program, SAIC-Frederick, NCI-Frederick, Frederick, Maryland, USA
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  • Jordi Casabona,

    Corresponding author
    1. Centre d'Estudis Epidemiològics sobre l'HIV/SIDA de Catalunya, Departament de Salut, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
    2. Epidemiology and Public Health Department, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
    • Centre d'Estudis Epidemiològics sobre l'HIV/sida de Catalunya (CEESCAT), Hospital Universitari Germans Trias i Pujol, Ctra de Canyet, s/n. Badalona 08916, Spain
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    • Fax: +34-934-978-889 or +34-934-978-895.

  • Euro-Shaks study group

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    • The Euroshaks working group is composed of the members listed above, as well as: Dra. M. Alsina, Dra. E. Buira and Dr. J.M. Gatell (Hospital Clínic, Barcelona, Spain); Dr. M. Vall (SAP Drassanes, Barcelona, Spain); Dra. Anna Rodés (Departament de Salut, Barcelona, Spain); Dr. P. Hermans and Dr. N. Clumeck (St. Pierre Hospital, Brussels, Belgium); Dra. C. Tural, J.C. Martínez, Dr. B. Clotet, (Hospital Universitari Germans Trias i Pujol, Badalona, Spain); Dra. I. Ocaña, Dra. I. Ruiz and Dra. M. Díaz (Hospital de Vall d'Hebron, Barcelona, Spain); Dr. J. Cadafalch, Dra. M. Fusté, Dra. E. Baselga and Dra. M. Alegre (Hospital de Sant Pau, Barcelona, Spain); Dr. F. Bolao, Dra. E. Ferrer and Dr. D. Podzamczer (Hospital de Bellvitge, l'Hospitalet del Llobregat, Spain); Prof. A. Lazzarin, Dr. A. Saracco, Dr. M. Moro and Dr. M.G. Viganó (Hospital San Raffaele, Milan, Italy); Prof. J. Stratigos, Prof. N. Stavrianeas, Dr. D. Polydorou and Dr. C. Botsis (A. Sygros Hospital, Athens, Greece); Dr. D.A. Hawkins and Dr. K. Fife (St. Stephen's Centre, Chelsa & Westminster Hospital, London, UK); Dr. C. Boshoff (Wolfson Institute for Biomedical Research, University College London, UK); Dr. R. Rubio (Hospital 12 de Octubre, Madrid, Spain); Dr. J.L. Colomer (Hospital del Mar, Barcelona, Spain). Laboratory participants: Dr. A. Gaya, Dr. J. Martorell, Dr. J.J. McCarthy, Dr. G. Tambussi, Dr. M. Vounatsou and Dr. M. Hadjivassiliou-Pappa. Interviewers: H. Colpin, M. Vicinanza, and P. Damascos.


Abstract

We aimed to identify risk factors for Kaposi's sarcoma (KS) among HIV-positive patients and behaviors associated with human Herpesvirus 8 (HHV-8) infection, as well as to assess KS incidence and mortality rates longitudinally. To fulfill the first objective, a European case-control study was designed in the early 1990s (each KS case was matched to 2 controls with another AIDS indicative disease). After the discovery of HHV-8, serology testing enabled us to assess risk factors for KS development among HHV-8 and HIV-1 coinfected men who have sex with men (MSM), as well as risk factors for HHV-8 infection. HHV-8 seroprevalence was determined using a latent immunofluorescence assay. Relevant information was obtained by means of a questionnaire and medical charts review. Assessment of risk factors for KS development and HHV-8 infection was performed using conditional and unconditional logistic regression models, respectively. A low CD4 count was the only significant risk factor for KS. HHV-8 infection was most strongly linked to the number of life-time sex partners, and multiple body fluids such as saliva and semen are quite likely involved in sexual transmission. Longitudinal follow up showed a significant protective role for highly-active antiretroviral therapy (HAART) both on KS development and mortality of KS patients. Although more conclusive data from cohort studies are needed to better define specific transmission mechanisms for HHV-8, our results contribute to explain why KS incidence is higher among MSM, and the decreasing KS incidence trend observed in countries with universal access to HAART. © 2006 Wiley-Liss, Inc.

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