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Kaposi's Sarcoma in Uganda: Risk Factors for Human Herpesvirus 8 Infection Among Blood Donors

Hladik tWolfgang; Dollard, Sheila C.; Downing, Robert G.; Kataaha, Peter; Pellett, Philip E.; Karon, John M.; Mermin, Jonathan; Lackritz, Eve M.
JAIDS Journal of Acquired Immune Deficiency Syndromes: June 1st, 2003

Summary:Human herpesvirus 8 (HHV-8) is etiologically linked to Kaposi's sarcoma, a common cancer in Uganda. The authors assessed HHV-8 seroprevalence, risk factors for infection, and HHV-8 assays in a cross-sectional study of Ugandan blood donors. Of 3,736 specimens, the authors selected 203 reactive for HIV, hepatitis B surface antigen (HBsAg), or syphilis, and, randomly, 203 nonreactive specimens. For HHV-8 testing, the authors used two peptide-based enzyme-linked immunosorbent assays (EIAs), ORFK8.1 and ORF65, and an immunofluorescence assay (IFA). Specimens reactive in at least two assays or on IFA alone were considered HHV-8-seropositive. Prevalence estimates were weighted to account for the sampling scheme. Overall HHV-8 seroprevalence was 40%. HHV-8 seroprevalence was higher among HBsAg-positive donors (53%) than HBsAg-negative donors (39%; p = .02) and higher among HIV-positive donors (63%) than HIV-negative donors (39%; p < .001). HHV-8 seroreactivity showed no trend with age. Kappa values for assay concordances were 0.68 (ORFK8.1 EIA and IFA), 0.37 (ORF65 EIA and K8.1 EIA), and 0.29 (ORF65 EIA and IFA). The association between HHV-8 and HBsAg positivity and the lack of association between HHV-8 and age point to primarily nonsexual HHV-8 transmission during childhood. The association with HIV indicates sexual transmission may also occur. The role of ORF65 EIA in testing specimens from Africa warrants further evaluation.

Wolfgang Hladik, Eve Lackritz, and Phil Pellett take responsibility for the study's integrity as a whole. All authors substantially contributed to the study's design and conduct as well as the article's drafting or revision and approved the final version for publication. More specifically, Wolfgang Hladik was responsible for data collection, specimen selection, initial analysis, and manuscript writing; Eve Lackritz was responsible for study preparation and design; Sheila Dollard was responsible for conduct of HHV-8 testing and interpretation of HHV-8 test data; Peter Kataaha was responsible for specimen collection and screening at Nakasero Blood Bank; Robert Downing was responsible for specimen selection and transport; John Karon was responsible for design and conduct of the weighted analysis of study data; and Phil Pellett was responsible for technical oversight of HHV-8 testing, critical review of data, and revision of the manuscript.

Address correspondence and reprint requests to W. Hladik, Global AIDS Program, National Center for HIV, STD, and TB Prevention, CDC, MS E-30, 1600 Clifton Road, Atlanta, GA 30333. E-mail:

Manuscript received October 1, 2002; accepted January 30, 2003.

© 2003 Lippincott Williams & Wilkins, Inc.