title: 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.
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.
authors.affiliation: Centre d'Estudis Epidemiològics sobre l'HIV/SIDA de Catalunya, Departament de Salut, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
authors.forename: Elisa
authors.initials: E
authors.lastname: Martró
authors.forename: Anna
authors.initials: A
authors.lastname: Esteve
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Schulz
authors.forename: Julie
authors.initials: J
authors.lastname: Sheldon
authors.forename: Gemma
authors.initials: G
authors.lastname: Gambús
authors.forename: Rafael
authors.initials: R
authors.lastname: Muñoz
authors.forename: Denise
authors.initials: D
authors.lastname: Whitby
authors.forename: Jordi
authors.initials: J
authors.lastname: Casabona
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D005060:Europe; D019288:Herpesvirus 8, Human / Q000276:immunology / Q000302:isolation & purification*; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors; D012514:Sarcoma, Kaposi / Q000453:epidemiology* / Q000821:virology*; D016036:Seroepidemiologic Studies