1396. Frequent Human Herpesvirus-8 Replication among Ugandan Adults with and without HIV and Kaposi Sarcoma
Session: Oral Abstract Session: Complications of HIV
Sunday, October 23, 2011: 8:45 AM
Room: 151AB
Background: Human herpesvirus-8 (HHV-8) replication is important in the transmission of HHV-8 and the development of Kaposi sarcoma (KS) in people with and without HIV.  We sought to characterize the frequency and correlates of HHV-8 detection in the oropharynx, genital mucosa, and plasma of adults in Uganda, where the burden of KS is among the highest in the world.

Methods: Participants with and without HIV and KS collected oral swabs daily and clinicians collected weekly anogenital swabs and plasma samples over 28 days to quantify HHV-8 DNA by polymerase chain reaction.

Results: 297 participants collected a total of 8,045 oral swabs, 1,320 genital swabs, and 1,392 plasma samples.  HHV-8 DNA was detected in 1,561 (19%) oral swabs, 65 (5%) genital swabs, and 419 (30%) plasma samples. The frequency of detecting any HHV-8 differed among participants by KS status:  HHV-8 was detected in the oropharynx of 70% (64/92) persons with KS vs. 27% (52/194) without KS (p<0.001), in the genital mucosa of 42% (39/92) persons with KS vs. 4% (7/194) without KS (p<0.001), and in the plasma of 96% (88/92) persons with KS vs. 20% (38/194) without KS (p<0.001).

Factors associated with an increased per person rate of oral HHV-8 detection in multivariate analysis included KS (IRR=2.32, CI 1.54-3.50, p<0.001), plasma HIV RNA >4 log10 copies/mL (IRR=1.67, CI 1.06-2.63 p=0.03), and report of no condom use with sexual activity in prior 3 months (IRR=2.11, CI 1.05-4.23, p=0.04).  Increased rate of genital HHV-8 shedding was associated with KS (IRR=10.8, CI 3.97-29.35, p<0.001), plasma HIV RNA >4 log10 copies/mL (IRR=2.05, CI 0.96-4.37, p=0.06), and BMI<18.5 (IRR=2.14, CI 1.00-4.62, p=0.05). Higher rate of HHV-8 plasma viremia was also associated with KS (IRR=12.5, CI 9.1-17.2, p<0.001) and plasma HIV RNA >4 log10 copies/mL (IRR=1.28, CI 1.00-1.64, p=0.05).

Conclusion: In this largest prospective cohort to examine HHV-8 replication to date, the virus is frequently detected in the oropharynx and plasma of Ugandan adults, which may in part explain the high rate of KS in Uganda. KS, elevated HIV viral load, and under-nutrition are all associated with more frequent HHV-8 replication, suggesting antiretroviral therapy or nutrition supplementation may have an effect on the control of HHV-8.


Subject Category: V. Virology including clinical and basic studies of viral infections, including hepatitis

Warren Phipps, MD, MPH1,2, Jackson Orem, MBChB, MMed3,4, Innocent Mutyaba, MBChB3, James Kafeero, MBChB3, Meei-Li Huang, PhD2, Stacy Selke, MA2, Lisa Bunts2, Marla Husnik, MS1, Anna Wald, MD, MPH, FIDSA1,2, Larry Corey, MD1,2 and Corey Casper, MD, MPH, FIDSA1,2, (1)Fred Hutchinson Cancer Research Center, Seattle, WA, (2)University of Washington, Seattle, WA, (3)Uganda Cancer Institute, Kampala, Uganda, (4)Makerere University, Kampala, Uganda

Disclosures:

W. Phipps, None

J. Orem, None

I. Mutyaba, None

J. Kafeero, None

M. L. Huang, None

S. Selke, None

L. Bunts, None

M. Husnik, None

A. Wald, None

L. Corey, None

C. Casper, None

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