Subject(s)
Heart Valve Prosthesis/adverse effects , Mitral Valve/diagnostic imaging , Pregnancy Complications, Cardiovascular/diagnostic imaging , Thrombosis/diagnostic imaging , Warfarin/therapeutic use , Adult , Africa South of the Sahara , Female , Heart Valve Prosthesis Implantation/adverse effects , Humans , Infant, Newborn , Male , Mitral Valve/surgery , Pregnancy , Pregnancy Complications, Cardiovascular/therapy , Rheumatic Heart Disease/complications , Rheumatic Heart Disease/diagnostic imaging , Rheumatic Heart Disease/therapy , Thrombosis/etiology , Thrombosis/therapy , Uganda , UltrasonographyABSTRACT
INTRODUCTION: Human herpesvirus 8 (HHV8) is necessary for Kaposi sarcoma (KS) to develop, but whether peripheral blood viral load is a marker of KS burden (total number of KS lesions), KS progression (the rate of eruption of new KS lesions), or both is unclear. We investigated these relationships in persons with AIDS. METHODS: Newly diagnosed patients with AIDS-related KS attending Mulago Hospital, in Kampala, Uganda, were assessed for KS burden and progression by questionnaire and medical examination. Venous blood samples were taken for HHV8 load measurements by PCR. Associations were examined with odds ratio (OR) and 95% confidence intervals (CI) from logistic regression models and with t-tests. RESULTS: Among 74 patients (59% men), median age was 34.5 years (interquartile range [IQR], 28.5-41). HHV8 DNA was detected in 93% and quantified in 77% patients. Median virus load was 3.8 logs10/10(6) peripheral blood cells (IQR 3.4-5.0) and was higher in men than women (4.4 vs. 3.8 logs; p=0.04), in patients with faster (>20 lesions per year) than slower rate of KS lesion eruption (4.5 vs. 3.6 logs; p<0.001), and higher, but not significantly, among patients with more (>median 20 KS lesions) than fewer KS lesions (4.4 vs. 4.0 logs; p=0.16). HHV8 load was unrelated to CD4 lymphocyte count (p=0.23). CONCLUSIONS: We show significant association of HHV8 load in peripheral blood with rate of eruption of KS lesions, but not with total lesion count. Our results suggest that viral load increases concurrently with development of new KS lesions.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Herpesvirus 8, Human/isolation & purification , Sarcoma, Kaposi/virology , Viral Load , Adult , CD4 Lymphocyte Count , Disease Progression , Female , Humans , Male , Middle AgedABSTRACT
Kaposi sarcoma (KS) occurs with relatively high frequency in immunosuppressed transplant recipients and in patients with AIDS. Recently, Italian investigators reported transplant-related KS tumors bearing donor-derived antigens, suggesting possible parenteral transmission of KS as whole cells, i.e., chimeric tumors. To investigate the hypothesis that KS whole cells may also be transmitted into immunocompromised persons via heterosexual acts, we tested nodular KS lesions and matched normal tissue obtained from female patients with AIDS for the presence of the Y-chromosome specific sex determining sequence (SRY). Among 25 unique tumors tested, none was positive for SRY sequence. While our results do not exclude sexual cellular transmission of whole KS cells, they suggest that if it occurs, it is rare.
