title: Kaposi's sarcoma and human herpesvirus 8 infection do not protect HIV-1 infected homosexual men from AIDS dementia complex.
abstract: OBJECTIVE
  To examine the association between Kaposi's sarcoma (KS), human herpes virus 8 (HHV8) and AIDS dementia complex (ADC).
  
  
  METHODS
  A total of 599 HIV-1 infected homosexual men participated in a prospective cohort study (Amsterdam, 1984-1996).
  
  
  METHODS
  The risk for ADC in patients with prior KS or HHV8 infection was estimated using the Cox proportional hazards method with adjustments for antiretroviral medication and low CD4 cell counts.
  
  
  RESULTS
  Of the 599 participants, 290 (48.4%) had HHV8 antibodies, 99 (16.5%) had KS and 30 (5.0%) had ADC. ADC was diagnosed in 5.2% of participants with KS and 5.0% of those without KS, and in 4.8% of HHV8 seropositive compared to 5.2% seronegative individuals and thus was not associated with KS or HHV8 infection. Using a time-dependent Cox proportional hazards analysis with the date of KS as risk factor, the risk for ADC was 2.7 [95% confidence interval (CI), 0.92-7.96; P = 0.07) and when only definite ADC was considered it was 3.5 (95% CI, 1.00-12.26;P = 0.05). After adjusting for decreases in CD4 cell count and use of medication, the hazards ratio for participants with KS to develop ADC was 2.0 (95% CI, 0.66-5.77; P = 0.23) and 2.6 (95% CI, 0.73-9.12; P = 0.14), respectively. HHV8 seropositivity, adjusted for the same variables, showed a risk for ADC of 0.85 (95% CI, 0.41-1.77;P = 0.66) and for definite ADC 0.69 (95% CI, 0.27-1.73; P = 0.42). The expected neuroprotective effects of antiretroviral medication were observed.
  
  
  CONCLUSIONS
  KS or HHV8 does not significantly influence the risk for developing ADC in a group with a uniform risk for developing KS therefore we recommend caution in searching for a KS-associated or HHV8-derived therapy for ADC.
authors.affiliation: Department of Human Retrovirology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Renwick
authors.forename: G J
authors.initials: GJ
authors.lastname: Weverling
authors.forename: T
authors.initials: T
authors.lastname: Halaby
authors.forename: P
authors.initials: P
authors.lastname: Portegies
authors.forename: M
authors.initials: M
authors.lastname: Bakker
authors.forename: T F
authors.initials: TF
authors.lastname: Schulz
authors.forename: J
authors.initials: J
authors.lastname: Goudsmit
mesh_terms: D015526:AIDS Dementia Complex / Q000175:diagnosis / Q000453:epidemiology*; D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology*; D000914:Antibodies, Viral / Q000097:blood; D003430:Cross-Sectional Studies; D015483:HIV Antibodies / Q000097:blood; D015497:HIV-1 / Q000276:immunology; D006566:Herpesviridae Infections / Q000175:diagnosis / Q000453:epidemiology*; D019288:Herpesvirus 8, Human / Q000276:immunology*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012514:Sarcoma, Kaposi / Q000175:diagnosis / Q000453:epidemiology*
chemical_list: D000914:Antibodies, Viral; D015483:HIV Antibodies