title: Patterns of human herpesvirus-8 oral shedding among diverse cohorts of human herpesvirus-8 seropositive persons.
abstract: BACKGROUND
  Human herpesvirus-8 (HHV-8), the etiologic agent of Kaposi sarcoma (KS), establishes lifelong latent infection with periodic lytic replication ("shedding") at mucosal sites, especially the oropharynx. Patterns of HHV-8 shedding are not well understood, and require elucidation to better predict risk of HHV-8 related malignancies in those infected. We sought to characterize patterns of HHV-8 oropharyngeal shedding among diverse cohorts that enrolled HHV-8 seropositive persons.
  
  
  METHODS
  We quantified HHV-8 oral shedding using PCR among HHV-8 seropositive persons who collected at least 14 days of oral swabs in 22 studies on 3 continents. We excluded persons taking antivirals during sampling or any prior use of antiretrovirals in those who were HIV-infected.
  
  
  RESULTS
  248 participants were enrolled from the US, Peru, Cameroon, Uganda, and Kenya; 61 % were men, 58 % were HIV seropositive, and 16 % had KS. Overall, 3,123 of 10,557 samples (29.6 %) had HHV-8 detected. Quantity of virus shed was highly correlated with shedding rate, (ρ = 0.72, p < 0.0001). HHV-8 was detected in ≥1 sample in 55 % of participants with a median of 7 % of days in the US and Kenya, 0 % in Uganda and Peru, and 18 % in Cameroon. Median episode duration was three days, and episodes with high median quantity lasted longer (42 vs 3 days, p < 0.0001). In persons with multiple observations over time, 66 % of shedding rate variance was attributable to differences between individuals.
  
  
  CONCLUSIONS
  In HHV-8 infected individuals from diverse settings, oral mucosal shedding rate, quantity, and duration were correlated; individual shedding was highly variable. Studies are needed to determine factors accounting for between-person variation and the relationship of HHV-8 shedding to development of associated diseases.
authors: Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.|Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA.|Department of Epidemiology, School of Public Health, Seattle, WA USA.
authors: Rachel A
authors: RA
authors: Bender Ignacio
authors: Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.|Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA.|Department of Epidemiology, School of Public Health, Seattle, WA USA.
authors: Jason D
authors: JD
authors: Goldman
authors: Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.|Department of Biostatistics, School of Public Health, Seattle, WA USA.|Department of Laboratory Medicine, University of Washington, Seattle, WA USA.
authors: Amalia S
authors: AS
authors: Magaret
authors: Department of Laboratory Medicine, University of Washington, Seattle, WA USA.
authors: Stacy
authors: S
authors: Selke
authors: Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.|Department of Laboratory Medicine, University of Washington, Seattle, WA USA.
authors: Meei-Li
authors: ML
authors: Huang
authors: Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, BC Canada.
authors: Soren
authors: S
authors: Gantt
authors: Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.|Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA.
authors: Christine
authors: C
authors: Johnston
authors: Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.|Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA.
authors: Warren T
authors: WT
authors: Phipps
authors: Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.|Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA.
authors: Joshua T
authors: JT
authors: Schiffer
authors: Section of Infectious Disease and International Health, Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH USA.
authors: Richard A
authors: RA
authors: Zuckerman
authors: Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA.|Department of Epidemiology, School of Public Health, Seattle, WA USA.|Department of Global Health, University of Washington, Seattle, WA USA.
authors: R Scott
authors: RS
authors: McClelland
authors: Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA.|Department of Global Health, University of Washington, Seattle, WA USA.
authors: Connie
authors: C
authors: Celum
authors: Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.|Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA.|Department of Laboratory Medicine, University of Washington, Seattle, WA USA.
authors: Larry
authors: L
authors: Corey
authors: Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.|Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA.|Department of Epidemiology, School of Public Health, Seattle, WA USA.|Department of Laboratory Medicine, University of Washington, Seattle, WA USA.
authors: Anna
authors: A
authors: Wald
authors: Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA USA.|Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA USA.|Department of Epidemiology, School of Public Health, Seattle, WA USA.|Department of Global Health, University of Washington, Seattle, WA USA.
authors: Corey
authors: C
authors: Casper
keywords: HIV infections; Herpesviridae infections; Herpesvirus 8, Human; Kaposi sarcoma-associated herpesvirus (KSHV); Sarcoma, Kaposi; Virus replication