title: Human herpesvirus 8 infection and transfusion history in children with sickle-cell disease in Uganda.
abstract: BACKGROUND
  Although human herpesvirus 8 (HHV-8), the etiologic agent for Kaposi's sarcoma, can be detected in peripheral blood, blood-borne transmission of this virus has not been demonstrated. We studied the association between HHV-8 seropositivity and transfusion history among children with sickle-cell disease in Uganda, where HHV-8 infection is common in blood donors.
  
  
  METHODS
  We studied 600 children (aged 0-16 years) with sickle-cell disease at Mulago Hospital, Kampala, from November 2001 through April 2002. By design, about half had previously been transfused. HHV-8 serostatus was determined using enzyme-linked immunosorbent assays for antibodies against HHV-8 proteins K8.1 and orf 73. We used logistic regression to test for an association between HHV-8 serostatus and transfusion history and a Markov model to estimate the transmission risk per transfusion and the cumulative risk from community (i.e., nontransfusion) sources. Statistical tests were two-sided.
  
  
  RESULTS
  HHV-8 antibodies were detected in 117 of 561 (21%) children with unambiguous K8.1 results. HHV-8 seroprevalence among the never-transfused children increased with age from 7% in children aged 0-2 years to 32% in those aged 13-16 years (P(trend)<.001). HHV-8 seropositivity was more frequent in transfused than never-transfused children (24% versus 17%, odds ratio = 1.48, 95% confidence interval [CI] = 0.97 to 2.26; P =.07). Seropositivity increased with number of reported transfusions, with age-adjusted odds ratios of 0.97 (95% CI = 0.54 to 1.75), 1.13 (95% CI = 0.59 to 2.17), 1.76 (95% CI = 0.81 to 3.83), and 2.17 (95% CI = 1.18 to 3.99) for children with one, two, three, or four or more transfusions, respectively (P(trend) =.007). Overall, the estimated HHV-8 transmission risk was 2.6% per transfusion (95% CI = 1.9% to 3.3%), whereas the annual risk of infection unrelated to transfusion was 2.7% (95% CI = 1.7% to 3.7%).
  
  
  CONCLUSIONS
  Our study suggests that blood transfusion is associated with a small risk of HHV-8 transmission. In Uganda, this risk is approximately equivalent to the 1-year cumulative risk of infection from community sources.
authors.affiliation: Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. mbulaits@mail.nih.gov
authors.forename: Sam M
authors.initials: SM
authors.lastname: Mbulaiteye
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Biggar
authors.forename: Paul M
authors.initials: PM
authors.lastname: Bakaki
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Pfeiffer
authors.forename: Denise
authors.initials: D
authors.lastname: Whitby
authors.forename: Anchilla M
authors.initials: AM
authors.lastname: Owor
authors.forename: Edward
authors.initials: E
authors.lastname: Katongole-Mbidde
authors.forename: James J
authors.initials: JJ
authors.lastname: Goedert
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Ndugwa
authors.forename: Eric A
authors.initials: EA
authors.lastname: Engels
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006566:Herpesviridae Infections / Q000209:etiology* / Q000821:virology; D019288:Herpesvirus 8, Human; D006801:Humans; D007223:Infant; D008297:Male; D008390:Markov Chains; D016017:Odds Ratio; D016036:Seroepidemiologic Studies; D065227:Transfusion Reaction