HIV and human herpesvirus 8 co-infection across the globe: Systematic review and meta-analysis
Meetings where this work was presented: 14th International Conference on Malignancies in AIDS and Other Acquired Immunodeficiencies (ICMAOI); November 12–13, 2013; Bethesda, Maryland, USA. 18th International Workshop on HIV Observational Databases (IWHOD); March 27–29, 2014; Sitges, Spain. 18th International Workshop on Kaposi's Sarcoma Herpesvirus and Related Agents; June 30–July 3, 2015; Miami, Florida, USA.
Abstract
HIV-infection is an important risk factor for developing Kaposi sarcoma (KS), but it is unclear whether HIV-positive persons are also at increased risk of co-infection with human herpesvirus 8 (HHV-8), the infectious cause of KS. We systematically searched literature up to December 2012 and included studies reporting HHV-8 seroprevalence for HIV-positive and HIV-negative persons. We used random-effects meta-analysis to combine odds ratios (ORs) of the association between HIV and HHV-8 seropositivity and conducted random-effects meta-regression to identify sources of heterogeneity. We included 93 studies with 58,357 participants from 32 countries in sub-Saharan Africa, North and South America, Europe, Asia, and Australia. Overall, HIV-positive persons were more likely to be HHV-8 seropositive than HIV-negative persons (OR 1.99, 95% confidence interval [CI] 1.70–2.34) with considerable heterogeneity among studies (I2 84%). The association was strongest in men who have sex with men (MSM, OR 3.95, 95% CI 2.92–5.35), patients with hemophilia (OR 3.11, 95% CI 1.19–8.11), and children (OR 2.45, 95% CI 1.58–3.81), but weaker in heterosexuals who engage in low-risk (OR 1.42, 95% CI 1.16–1.74) or high-risk sexual behavior (OR 1.66, 95% CI 1.27–2.17), persons who inject drugs (OR 1.66, 95% CI 1.28–2.14), and pregnant women (OR 1.68, 95% CI 1.15–2.47), p value for interaction <0.001. In conclusion, HIV-infection was associated with an increased HHV-8 seroprevalence in all population groups examined. A better understanding of HHV-8 transmission in different age and behavioral groups is needed to develop strategies to prevent HHV-8 transmission.
Abstract
What's new?
Immunodeficiency sets the stage for human herpesvirus 8 (HHV-8) infection, which can lead to Kaposi sarcoma. Compared with the general population, HHV-8 infection is common in HIV-positive individuals and in men who have sex with men (MSM). Those associations are corroborated by the present meta-analysis, which also shows that HHV-8 seroprevalence is highest in MSM and in children. Sexual transmission of HIV and HHV-8 is likely in MSM. In children, who typically acquire HHV-8 via nonsexual transmission, infection may occur as a result of HHV-8 shedding from HIV-positive family members. Further studies are needed to clarify HHV-8 transmission routes.
