title: Risk factors for high anti-HHV-8 antibody titers (> or =1:51,200) in black, HIV-1 negative South African cancer patients: a case control study.
abstract: BACKGROUND
  Infection with human herpesvirus 8 (HHV-8), also known as Kaposi's sarcoma-associated herpesvirus (KSHV), is the necessary causal agent in the development of Kaposi's sarcoma (KS). Infection with HIV-1, male gender and older age all increase risk for KS. However, the geographic distribution of HHV-8 and KS both prior to the HIV/AIDS epidemic and with HIV/AIDS suggest the presence of an additional co-factor in the development of KS.
  
  
  METHODS
  Between January 1994 and October 1997, we interviewed 2576 black in-patients with cancer in Johannesburg and Soweto, South Africa. Blood was tested for antibodies against HIV-1 and HHV-8 and the study was restricted to 2191 HIV-1 negative patients. Antibodies against the latent nuclear antigen of HHV-8 encoded by orf73 were detected with an indirect immunofluorescence assay. We examined the relationship between high anti-HHV-8 antibody titers (> or =1:51,200) and sociodemographic and behavioral factors using unconditional logistic regression models. Variables that were significant at p = 0.10 were included in multivariate analysis.
  
  
  RESULTS
  Of the 2191 HIV-1 negative patients who did not have Kaposi's sarcoma, 854 (39.0%) were positive for antibodies against HHV-8 according to the immunofluorescent assay. Among those seropositive for HHV-8, 530 (62.1%) had low titers (1:200), 227 (26.6%) had medium titers (1:51,200) and 97 (11.4%) had highest titers (1:204,800). Among the 2191 HIV-1 negative patients, the prevalence of high anti-HHV-8 antibody titers (> or =1:51,200) was independently associated with increasing age (p-trend = 0.04), having a marital status of separated or divorced (p = 0.003), using wood, coal or charcoal as fuel for cooking 20 years ago instead of electricity (p = 0.02) and consuming traditional maize beer more than one time a week (p = 0.02; p-trend for increasing consumption = 0.05) although this may be due to chance given the large number of predictors considered in this analysis.
  
  
  CONCLUSIONS
  Among HIV-negative subjects, patients with high anti-HHV-8 antibody titers are characterized by older age. Other associations that may be factors in the development of high anti-HHV-8 titers include exposure to poverty or a low socioeconomic status environment and consumption of traditional maize beer. The relationship between these variables and high anti-HHV-8 titers requires further, prospective study.
authors.affiliation: Center for AIDS Prevention Studies, University of California, San Francisco, United States. jwojcicki@psg.ucsf.edu
authors.forename: Janet M
authors.initials: JM
authors.lastname: Wojcicki
authors.forename: Rob
authors.initials: R
authors.lastname: Newton
authors.forename: Margaret I
authors.initials: MI
authors.lastname: Urban
authors.forename: Lara
authors.initials: L
authors.lastname: Stein
authors.forename: Martin
authors.initials: M
authors.lastname: Hale
authors.forename: Moosa
authors.initials: M
authors.lastname: Patel
authors.forename: Paul
authors.initials: P
authors.lastname: Ruff
authors.forename: Ranjan
authors.initials: R
authors.lastname: Sur
authors.forename: Dimitra
authors.initials: D
authors.lastname: Bourboulia
authors.forename: Freddy
authors.initials: F
authors.lastname: Sitas
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood*; D016022:Case-Control Studies; D005260:Female; D018023:HIV Seronegativity; D015497:HIV-1 / Q000276:immunology*; D019288:Herpesvirus 8, Human / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012514:Sarcoma, Kaposi / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D013019:South Africa
chemical_list: D000914:Antibodies, Viral