title: Kaposi sarcoma-associated herpes virus and response to antiretroviral therapy: a prospective study of HIV-infected adults.
abstract: BACKGROUND
  The possible impact of coinfection with the Kaposi sarcoma-associated herpes virus (KSHV) on the response to antiretroviral therapy (ART) is unknown. Prospective studies are rare, particularly in Africa.
  
  
  METHODS
  We enrolled a prospective cohort of HIV-infected adults initiating ART in Johannesburg, South Africa. The subjects were defined as seropositive to KSHV if they were reactive to either KSHV lytic K8.1 or latent Orf73 antigen or to both. The subjects were followed from ART initiation until 18 months of treatment. HIV viral load and CD4 counts were tested 6 monthly. Linear generalized estimating and log-binomial regression models were used to estimate the effect of KSHV infection on immunologic recovery and response and HIV viral load suppression within 18 months after ART initiation.
  
  
  RESULTS
  Three hundred eighty-five subjects initiating ART from November 2008 to March 2009 were considered to be eligible including 184 (48%) KSHV+. The KSHV+ group was similar to the KSHV- in terms of age, gender, initiating CD4 count, body mass index, tuberculosis, and hemoglobin levels. The KSHV+ group gained a similar number of cells at 6 [difference of 10 cells per cubic millimeter, 95% confidence interval (CI): -11 to 31], 12 (3 cells per cubic millimeter, 95% CI: -19 to 25), and 18 months (24 cells per cubic millimeter, 95% CI: -13 to 61) compared with that gained by the KSHV- group. Adjusted relative risk of failure to suppress viral load to <400 copies per milliliter (1.03; 95% CI: 0.90 to 1.17) were similar for KSHV+ and KSHV- by 6 months on treatment.
  
  
  CONCLUSIONS
  In a population with a high KSHV prevalence, HIV-positive adults coinfected with KSHV achieved similar immunologic and virologic responses to ART early after treatment initiation compared with those with KSHV-.
authors.affiliation: Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.mmaskew@heroza.org
authors.forename: Mhairi
authors.initials: M
authors.lastname: Maskew
authors.forename: A Patrick
authors.initials: AP
authors.lastname: MacPhail
authors.forename: Denise
authors.initials: D
authors.lastname: Whitby
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Fox
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D034961:Antigens, Nuclear / Q000276:immunology; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D005260:Female; D006023:Glycoproteins / Q000276:immunology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D006566:Herpesviridae Infections / Q000150:complications* / Q000276:immunology; D019288:Herpesvirus 8, Human / Q000276:immunology*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019562:Viral Load; D014764:Viral Proteins / Q000276:immunology
chemical_list: D044966:Anti-Retroviral Agents; D034961:Antigens, Nuclear; D006023:Glycoproteins; C113454:K8.1 protein, Human herpesvirus 8; D014764:Viral Proteins; C583446:latent Orf73 antigen, human herpesvirus 8