SKIN SURFACE LIPIDS IN HIV-POSITIVE PATIENTS WITH AND WITHOUT SEBORRHEIC DERMATITIS

Background. Seborrheic dernnatitis (SD) is a frequent complication of infection with the human immunodeficiency virus (HIV). Most studies examining the cause of SD have concentrated on the roles of Pityrosporum ovale and sebaceous lipids. Previous studies of skin surface lipid from patients with SD have produced conflicting results, with some authors reporting an abnormal lipid composition and others finding little or no abnormality. Methods. The composition of skin surface lipid was studied in 15 HIV-positive and 10 HIV-negative men with SD, in 14 HIV-positive men without SD, and in 16 unaffected controls. Total lipids were extracted from unaffected forehead skin into petroleum ether and separated into lipid classes by thin layer chromatography. The lipid classes were quantitated by densitometry after charring with sulfuric acid. Results. Patients, HIV-positive with SD, had significantly lower proportions of free fatty acid (FFA) and higher levels of triglyceride than normal controls. Patients, HIV-positive without SD, had a significantly increased proportion of FFA compared to HIV-positive patients with SD. Patients with SD, both HIV-positive and HIV-negative, had a similar pattern of skin surface lipid. Levels of FFA were lower and those of triglyceride higher than in the patients unaffected by SD, whether HIV-positive or not. There was no significant difference found between groups in free cholesterol, wax esters, and squalene. Conclusions. Abnormalities of skin surface lipid composition may play a part in the development of SD in both HIV-positive and HIV-negative men.     

Early-stage HIV infection and hepatitis C virus infection are associated with elevated serum porphyrin levels

Background: Porphyria cutanea tarda is known to be associated with HIV infection and hepatitis C virus (HCV). Objective: Our purpose was to evaluate whether early infection with HIV, with or without HCV infection, is associated with elevated serum porphyrin levels. Methods: Serum porphyrin levels were measured in samples obtained from 103 patients with early HIV infection. The results were compared with those of 89 late-stage HIV–positive patients and 78 HIV-negative patients. Results: The highest median porphyrin level was in early-stage HIV-positive/HCV-positive samples, followed in decreasing order by those in early-stage HIV-positive/HCV-negative, late-stage HIV-positive/HCV-positive, late-stage HIV-positive/HCV-negative, HIV-negative/HCV-positive, and HIV-negative/HCV-negative groups. Elevated porphyrin levels were independently associated with early-stage HIV infection (P < .0001) and HCV infection (P = .03). Conclusion: This finding suggests abnormal porphyrin metabolism is most noticeable in early-stage HIV infection; it becomes less severe with the progression of HIV disease. (J Am Acad Dermatol 1998;39:956-9.)     

Mucocutaneous manifestations in Japanese HIV-positive hemophiliacs

BACKGROUND: Although various mucocutaneous manifestations have been reported in patients infected with HIV by sexual transmission or intravenous drug use, the prevalence and characteristics of skin disorders in HIV-positive hemophiliacs coinfected with hepatitis C virus (HCV) have rarely been described. OBJECTIVE: The purpose of this study was to clarify the characteristics of skin disorders in HIV-positive hemophiliacs and to identify differences in comparison with other HIV-positive groups. METHODS: A prospective study of the prevalence of mucocutaneous manifestations in 110 Japanese hemophiliacs (53 HIV-positive hemophiliacs including 24 AIDS and 57 HIV-negative hemophiliacs) was performed from July 1997 to July 1998. RESULT: None of the hemophiliacs developed Kaposi's sarcoma or sexually transmitted skin diseases. Eosinophilic folliculitis was observed in 3 AIDS patients. The incidence of folliculitis, common warts, seborrheic dermatitis, generalized eczema, oral candidiasis and herpes zoster was higher in HIV-positive than in HIV-negative hemophiliacs (p < 0.05). Although anti-HCV antibody was positive in all HIV-positive hemophiliacs, HCV-related dermatoses such as lichen planus and porphyria cutanea tarda were not observed. CONCLUSION: Although Kaposi's sarcoma and sexually transmitted skin diseases such as molluscum contagiosum, condyloma, and scabies are frequently associated with HIV, they were not found in the HIV-positive hemophiliacs in our study. HIV infection-related mucocutaneous manifestations are influenced not only by the presence of HIV but also by other factors such as the mode of transmission and sexual habit.     

马尔尼菲青霉感染皮损局部Th1型细胞免疫功能的研究

目的 探讨马尔尼菲青霉感染皮损局部的免疫病理损伤及细胞免疫反应。方法　应用免疫组化法检测50例马尔尼菲青霉病患者［人类免疫缺陷病毒（HIV）阳性30例,HIV阴性20例］皮损组织和10例健康人局部皮肤肿瘤坏死因子α（TNF-α）、干扰素γ（IFN-γ）、白介素2（IL-2）及炎性细胞CD4、CD8的表达。应用SPSS13.0统计软件,对标记结果进行组间非参数Mann-Whitney检验。 结果　50例马尔尼菲青霉病患者的皮损按组织病理学表现分为肉芽肿性反应9例、化脓性反应19例、无反应或坏死性反应22例。9例肉芽肿性反应均见于HIV阴性患者;19例化脓性反应者中HIV阳性10例,HIV阴性9例;22例无反应或坏死性反应者中HIV阳性20例,HIV阴性2例。健康对照组皮肤CD4、CD8、TNF-α、IFN-γ、IL-2免疫组化检测均为阴性。HIV阳性组皮损中见明显的CD8+细胞浸润（3例 +++、8例 ++、7例 +、12例 －）,表达强度显著高于健康对照组（P ＜ 0.01）,而其余各项与健康对照组比较差异均无统计学意义（P ＞ 0.05）。HIV阴性组皮损中CD4 （2例 +++、2例 ++、9例 +、9例 －）、IL-2（1例 ++、8例 +、11例 －）、IFN-γ（4例 ++、7例 +、9例 －）、TNF-α（3例 +++、2例 ++、5例 +、10例 －）表达强度显著高于健康对照组（P ＜ 0.05）。CD4、IFN-γ表达在HIV阳性组低于HIV阴性组（P ＜ 0.05）。肉芽肿反应者中CD4、IL-2、IFN-γ表达明显高于无反应或坏死性反应者（P ＜ 0.05）,而化脓性反应与肉芽肿反应、无反应或坏死性反应比较,各指标之间差异无统计学意义（P ＞ 0.05）。 结论　马尔尼菲青霉病患者皮损组织病理学改变与机体免疫状态密切相关;Th1型细胞免疫在皮损局部抵御马尔尼菲青霉的过程中起重要作用。     

Langerhans cell density and high-grade vulvar intraepithelial neoplasia in women with human immunodeficiency virus infection

BACKGROUND: Decreased numbers of Langerhans cells (LCs) in the cervix of human immunodeficiency virus (HIV)-infected women are believed to contribute to the progression of human papilloma virus (HPV)-related squamous intraepithelial lesions. However, this impairment of local immunity has not been well studied in the vulva. The objective of this study was to compare the S100+ LC density in high-grade vulvar intraepithelial neoplasia (VIN) in HIV-positive and HIV-negative women. METHODS: HIV-positive and HIV-negative patients with high-grade VIN, 48 (55%) and 40 (45%), respectively, were identified by retrospective chart review. Smoking status of patients was noted. The mean LC count per high-power field (HPF) was determined using S100 immunohistochemical staining. In situ hybridization was performed to detect HPV DNA types 16 and 18. RESULTS: Mean S100+ LC counts for HIV-positive and HIV-negative patients were 5.82 and 9.86 per HPF, respectively (p = 0.0026). LC counts in HIV-positive and HIV-negative patients were compared between smoking and nonsmoking groups (HIV-positive p = 0.4812, HIV-negative p = 0.2821). CONCLUSIONS: HIV-positive patients with high-grade VIN had significantly lower LC counts compared with HIV-negative patients. This suggests that local vulvar immunity as evaluated by S100+ LCs is impaired in HIV-positive women, possibly contributing to the progression of HPV-related vulvar lesions.     

Similar serological response to conventional therapy for syphilis among HIV-positive and HIV-negative women.

OBJECTIVES--To compare characteristics of syphilis serological reactivity in HIV positive (+) and HIV negative (-) female sex workers, as well as the serological response to therapy after treatment with intramuscular benzathine penicillin, 2.4 million U weekly, for three consecutive weeks. METHODS--Rapid plasma reagin (RPR) and Treponema pallidum haemagglutination assay (TPHA) results of 72 HIV-positive and 121 HIV-negative women reactive in both tests were assessed. The response to therapy was prospectively monitored with quantitative RPR serology in 47 HIV-positive and 73 HIV-negative patients. Cumulative probabilities of becoming nonreactive by RPR were compared at six months, one and two years after therapy. RESULTS--At enrolment, the geometric mean titres of RPR and TPHA were lower in HIV-positive patients (RPR, 1:2.6) than in HIV-negative patients (RPR, 1:3.8; p < 0.01). The evolution over time of RPR titres was similar among HIV-positive patients as compared to HIV-negative patients. Among patients with an initial RPR titre of < 1:8, 53% of HIV-positive and 44% of HIV-negative patients became RPR negative two years after therapy. Among patients with an RPR titre of 1:8 or greater at enrolment, 83% of HIV-positive and 90% of HIV-negative patients had reached at least a fourfold decline of RPR titres two years after therapy. CONCLUSIONS--Syphilis serology findings (both RPR and TPHA) may be altered in the presence of HIV infection, but the serological response to therapy was similar in HIV-positive and HIV-negative patients.     

Concurrent Cytomegalovirus,M. Tuberculosis and M. Avium-Intracellulare Cutaneous Infection in an HIV Patient

We report a 25-year-old HIV-positive man with a past medical history of disseminated cytomegalovirus (CMV) infection, who developed cutaneous lesions during a disseminated mycobacterium infection. The histological changes of CMV and acid-fast bacilli were seen on histopathology of the lesions. Cultures were positive for M. tuberculosis and M. avium-intracellulare (MAI). CMV is frequently isolated from HIV patients, but skin involvement is rare. The association of CMV and mycobacteria can occur in cutaneous lesions of AIDS patients, but concurrent cutaneous involvement of CMV, M. tuberculosis, and MAI is unusual. These findings emphasize the polymorphous presentation of infectious disorders in AIDS patients and the need for multiple biopsies and for special stains in such patients.     

Skin diseases and sexually transmitted diseases in HIV‐infected patients on HAART compared to a non‐infected population – results of a retrospective study

Background: The prevalence of skin diseases and sexually transmitted diseases has always played a special role in studying HIV infections, both because of immunosuppression and simultaneous transmission. In the early years of the HIV epidemic, skin diseases were often a pathognomonic sign in heavily immunosuppressed patients. With highly active antiretroviral therapy (HAART), HIV infection has become a treatable chronic disease. For this reason the spectrum as well as the prevalence of skin diseases has changed. Pathognomonic skin diseases have become rare and the wide spectrum today ranges from infectious to iatrogenic skin diseases. Patients and methods: From April to October 2007 166 HIV‐infected patients and 173 patients of a comparison group were surveyed in retrospect by means of a questionnaire about skin diseases and sexually transmitted diseases that appeared over the entire year 2006. Results and conclusions: The study confirmed the shift to a wide variety of mostly trivial skin diseases and away from severe opportunistic skin diseases. HIV‐infected patients today have more numerous skin problems than the non‐infected population and thus need regular dermatologic control examinations.     

Human papillomavirus-associated induction of human β-defensins in anal intraepithelial neoplasia

Background  Antimicrobial peptides and proteins (AMPs) are widely distributed effector molecules of the innate immune system with well-known antibacterial activity. However, there is a paucity of information regarding antiviral effects of AMPs.
Objectives  The present study was performed to analyse expression of AMPs in human papillomavirus (HPV)-associated anal skin lesions of human immunodeficiency virus (HIV)-positive men who have sex with men (MSM), a special high-risk group for persistent HPV infections and anal dysplasia.
Methods  Skin lesions were analysed for the presence of LL-37, RNase 7, and human β-defensin (hBD)-1, hBD-2 and hBD-3. Moreover, HPV typing and HPV DNA load determination for HPV types 6, 11, 16, 18, 31 and 33 were performed to evaluate possible correlations between expression of AMPs and lesional HPV types.
Results  Skin biopsies of 45 HIV-positive MSM with anal intraepithelial neoplasia (AIN), anal condylomata acuminata or unaffected anal mucosa, as well as condylomata acuminata of eight HIV-negative MSM, were analysed for AMP mRNA expression. Additionally, immunohistochemical analysis for hBD-2 and hBD-3 was performed in a total of 45 samples. hBD-2 and hBD-3 gene and protein expression was significantly increased in both AIN and condyloma, whereas LL-37, RNase 7 and hBD-1 gene expression did not differ significantly from unaffected anal mucosa. AMP expression correlated neither with the number of HPV types nor with the high-risk and low-risk HPV DNA loads of the quantified types. No significant differences in AMP expression were observed in condylomata of HIV-positive and HIV-negative MSM.
Conclusions  hBD-2 and hBD-3 expression was shown to be significantly upregulated in HPV-associated anal skin lesions of both HIV-positive and HIV-negative MSM. Their biological significance in the innate immunity against these lesions needs further research.     

REITER'S SYNDROME-LIKE PATTERN IN AIDS-ASSOCIATED PSORIASIFORM DERMATITIS

Background. The prevalence of psoriasiform dermatitis in HIV-infected patients is similar to that in the general population, but its clinical severity and the immunosuppression in these patients pose special problems of therapeutic management. Furthermore, a distinctive clinical pattern has been reported in some cases. In order to assess these features in our clinical setting, we have done a retrospective study on the clinical records of all human immunodeficiency virus (HIV)-positive patients with psoriasiform dermatitis requiring systemic treatment. Methods. The clinical records were reviewed of seven HIV-positive patients who were referred between 1988 and 1994 to a University Hospital Dermatology Department from an HIV-clinic because of psoriasiform dermatitis, resistant to topical treatment. Results. The clinical appearance was rather uniform, with the following common features: facial seborrhea, flexural and acral involvement, with pustulosis of the palms and soles, and frequent arthritis. Lesions appeared in nonterminal stages of acquired immunodeficiency syndrome (AIDS). Three patients developed cutaneous lesions after the diagnosis of HIV infection was made and showed the most severe clinical involvement and arthritis. Etretinate, followed by RePUVA, proved to be the most effective systemic therapy prescribed, with only rare adverse effects. Methotrexate was shown to be effective, but its use was accompanied by hematologic toxicity. Cyclosporine A treatment was moderately effective and was not associated with progression of AIDS. Conclusions. A characteristic Reiter-like clinical picture was observed in AIDS-related psoriasiform dermatitis. Etretinate and RePUVA were effective and safe in controlling the lesions. Physiopathologic mechanisms involved in the development of AIDS-related psoriasis might provide an explanation for the outstanding similarity of the clinical pattern in those patients.     

Anal human papillomavirus DNA screening by Hybrid Capture II in human immunodeficiency virus-positive patients with or without anal intercourse

High risk human papillomaviruses (HPVs) have emerged as risk factors for anal carcinoma, of which incidence is higher in HIV-positive patients than in the general population. The aim of our study was to investigate the prevalence and risk factors for anal HPV infections in HIV-positive patients with or without history of anal intercourse. Fifty HIV 1-infected patients (36 men and 14 women) were tested at entry and followed-up every 3 months for one year for the presence of anal HPV DNA by the Hybrid Capture II trade mark assay. A series of 50 HIV-negative subjects matched for age and sex served as controls. At enrollment, anal HPV DNA was present in 29/50 HIV-positive patients (58 %) and in 3/50 control subjects (6 %). High risk (HR) HPV genotypes were detected in 20/50 HIV-positive patients (40 %) with no difference in homosexual men and other HIV-positive patients. Risk factors for HPV infection were CD4 + cell counts less than 500/microL (RR: 2.13 [95 % CI: 1.0-4.7]) and history of anogenital warts (RR: 2.36 [95 % CI: 1.2-4.6]). The HPV load was higher in patients with CD4+ < or = 500/microL than in patients with CD4 + > 500/microL (p < 0.04). During the follow-up, anal HR HPV DNA was repeatedly identified at high levels in 5 HIV-positive patients. There is some convincing evidence that HIV-positive patients with low CD4+ cells, whatever the routes of HIV transmission, have a high rate of anal HPV infection and might be at increased risk of developing anal neoplastic lesions. Identifying HR HPV infection might be warranted in immunosuppressed patients.     

Altered clinical course of malignant melanoma in HIV-positive patients

OBJECTIVE: To determine whether the natural history of melanoma is different in patients who test positive for human immunodeficiency virus (HIV) compared with matched control subjects. DESIGN: Retrospective cohort analysis. SETTING: Ambulatory care at 2 university-affiliated medical centers. PATIENTS: Each HIV-positive melanoma patient (n = 17) was randomly matched with 2 HIV-negative patients (HIV status unknown, but without risk factors for HIV) based on the melanoma subtype, tumor thickness, Clark level, tumor location, and sex and age of the patient. MAIN OUTCOME MEASURES: Disease-free survival and overall survival of HIV-positive and HIV-negative melanoma patients were compared using a matched-pairs analysis. CD4 cell counts were recorded at the time of melanoma diagnosis and disease recurrence. RESULTS: Melanoma patients who were HIV positive had a significantly shorter disease-free survival (P =.03) and overall survival (P =.045) compared with HIV-negative melanoma patients by matched-pairs analysis. There was an inverse relationship between CD4 cell counts and time to first melanoma recurrence. CONCLUSIONS: The natural history of malignant melanoma in HIV-positive patients is more aggressive compared with matched HIV-negative melanoma patients. Altered immune response and comorbid disease may play a role in the poor clinical outcome of HIV-positive patients. These findings have important implications in the management of melanoma in the setting of HIV disease.     

Does HIV disease progression influence epidermal Langerhans cell density?

Langerhans cells (LC) are antigen-presenting CD4⁺ dendritic cells in the skin which may become infected by the human Immunodeficiency virus (HIV). Decreased LC function could account for the cutaneous manifestations seen in HIV disease. Previous studies of epidermal LC density in HIV-infected subjects have produced conflicting results. A definitive, prospective, case-control study was performed lo determine whether there is an association between epidermal LC density mid HIV clinical disease stage. Skin cryosections were stained with the CD1 monoclonal antibody using a three-step immunoperoxidase method. LC were counted by light microscopy and epidermal dimensions calculated with computer-assisted planimetry. The stage of the HIV clinical disease correlated with epidermal LC densities was quantified by three different methods: mean LC numbers per mm length of basement membrane, mean LC per mm² of epidermal area, and mean LC population per mm of epidermal surface length. Seventy-one subjects, recruited from a large out-patient HIV clinic in London, comprised 56 HIV-positive men and 15 male HIV-negative controls. Contrary to previous smaller studies, there was no detectable association between epidermal LC density (quantified by any of the three methods) and the stage of the HIV clinical disease. Given that HIV infects large numbers of CD4⁺ cells, we propose possible hypotheses to account for the apparent preservation of static LC numbers in the skin, further studies of LC kinetics and function are required to elucidate their role in the natural history of HIV infection.     

抗γ干扰素自身抗体阳性伴Sweet综合征的马尔尼菲篮状菌病九例临床分析

【摘要】 目的 报道9例HIV阴性伴Sweet综合征的马尔尼菲篮状菌病（TSM）,及其与抗γ干扰素自身抗体的关系。方法 回顾分析广西医科大学第一附属医院2013—2018年确诊的HIV阴性伴Sweet综合征TSM患者的临床资料。以19例HIV阳性TSM患者及107例健康人为对照,检测外周血抗γ干扰素自身抗体。结果 9例中男5例,女4例,TSM发病年龄38 ~ 60岁。患者均呈播散性感染,临床表现为长期不规则发热、多部位淋巴结肿大、咳嗽、消瘦、贫血。9例均符合经典型Sweet综合征的诊断标准,Sweet综合征皮疹微生物学检查阴性。除马尔尼菲篮状菌感染之外,还合并非结核分支杆菌（6例）、水痘-带状疱疹病毒（4例）、沙门氏菌（2例）感染。患者组9例外周血抗γ干扰素自身抗体检测结果均阳性,而107例健康人及19例HIV阳性TSM患者均阴性。结论 抗γ干扰素自身抗体阳性可能与HIV阴性伴Sweet综合征的TSM相关。     

HELISTAT ABSORBABLE COLLAGEN HEMOSTATIC SPONGES IN CUTANEOUS SURGERY IN HIV–1+ PATIENTS

Background. While biopsies are often required for adequate diagnosis of skin lesions in HIV–1 infected patients, these procedures result in the possible exposure of medical personnel to blood and contaminated instruments. To reduce exposure of medical personnel to contaminated needles we have used collagen sponges instead of sutures to control bleeding from punch biopsy sites in HIV–1 infected patients. Methods. A collagen sponge was placed in all punch biopsy sites in HIV–1 infected patients. In cases where there was clinical evidence of local infection the sponges were removed 5–6 minutes after hemostasis was obtained. Results. In over 500 biopsies in which Helistat collagen sponges were used, there have been no cases of secondary infection, and there have been no delays in healing. Conclusions. We believe that the use of these sponges provides a high degree of safety for the physician, which may assure that the commonly atypical clinical lesions seen in HIV–1 disease are biopsied. In addition, these sponges provide hemostasis, particularly significant in this patient population, and convenience, without a significant risk of secondary infection, and may provide some benefit in healing.     

马尔尼菲青霉病皮肤损害的临床与组织病理分析

目的了解马尔尼菲青霉病皮肤损害的临床与组织病理学特征。方法回顾性分析2004年1月-2011年4月本院收治的75例马尔尼菲青霉病患者的临床资料,包括皮肤损害的临床和组织病理特征及表现形式和免疫功能的关系。结果 39例出现皮肤损害,主要位于躯干上部和颜面部。HIV阴性的马尔尼菲青霉病患者CD4+T细胞平均计数为(520.52±262.56)×106/L;多数表现为结节;组织病理见肉芽肿样病变。HIV阳性的马尔尼菲青霉病患者CD4+T细胞平均计数(25.65±12.23)×106/L;多数表现为水肿性脐窝状丘疹,伴中央坏死;组织病理见坏死样改变。结论马尔尼菲青霉病皮肤损害的临床和组织病理学表现形式与免疫功能相关。     

Cutaneous disseminated histoplasmosis in AIDS patients in south Florida

Background Histoplasma capsulatum is a dimorphic pathogenic fungus endemic to the Mississippi and Ohio river valleys. In the immunocompetent it causes a self-limited disease, but in the immunocompromised may lead to disseminated disease (disseminated histoplasmosis (DH)). It is one of the opportunistic infections which defines the acquired immunodeficiency syndrome (AIDS) and is rarely encountered outside endemic regions. Methods Clinical, laboratory, and histologic information concerning seven patients with DH and AIDS in South Florida was recorded. Results We report seven cases of DH with mucocutaneous lesions in patients infected with the human immunodeficiency virus (HIV). All patients had markedly depressed CD4 counts of less than 40 cells/mm3, and only two had traveled to endemic areas. Two out of the seven patients were diagnosed with HIV/AIDS at the time DH was identified. All of our patients had mucocutaneous lesions at the time of diagnosis, which clinically presented as a generalized papular eruption, ulcers, and erythematous scaly plaques. Conclusions Even in non-endemic regions, HIV-positive patients presenting with fever, chills, weight loss, hepatosplenomegaly, anemia, cough, lymphadenopathy, and mucocutaneous lesions should have an early skin biopsy specimen taken for mycologic tissue culture and histopathologic evaluation for disseminated fungal infections.     

Relation of allergy to HIV infection

In this retrospective study on 141 HIV-positive subjects, allergy was studied by a specific questionnaire and the Phadia-Top-Test, an in vitro screening test detecting specific IgE; both were correlated to the patient's history, clinical symptoms and the treatment used. Allergy was studied in reference to HIV-negative controls and in relation to the clinical and biological subgroups of HIV patients.
The application of the x² test demonstrated a high incidence of allergy and a specific relation to the HIV infection compared to the controls as well as in relation to the clinical stage of the infection. Atopy was not specifically related to the HIV infection despite the higher frequency found in the AIDS-IKEL group.
A significant number (21%) of patients with T4 > 300/μ1 considered immunocompetent presented clinical manifestations of AIDS-IKEL and 100% of these patients were allergic. A significant number (19%) of patients with T4 < 300/μ1 considered immunodeficient were asymptomatic and 75% of them were allergic.
Thus allergic symptoms may transiently be the only clinical manifestations in HIV infection and possibly a co-factor for the evolution of the disease due to the immunomodulatory function of the mediators, the cytokines and the proteases released during allergic reaction.     

Quantitation of human herpes virus 8 DNA in paraffin-embedded biopsies of HIV-associated and classical Kaposi's sarcoma by PCR

BACKGROUND: Kaposi's sarcoma occurs in patients seropositive and seronegative for the human immunodeficiency virus (HIV) and has been associated with human herpes virus 8 (HHV8). The purpose of this study was to determine and to compare the amount of HHV8 DNA in formalin-fixed tissue sections of Kaposi's sarcoma. METHODS: From 27 biopsies of Kaposi's sarcoma patients, tissue sections were taken and deparaffinized. Four patients were HIV seronegative and 13 were HIV seropositive. After extraction of DNA copy numbers of HHV8 and beta-globin were determined in every sample by quantitative PCR ELISA using an internal quantitation standard. Results were expressed as HHV8 per beta-globin. RESULTS: No significant differences were found between biopsies from HIV-positive and HIV-negative patients (14.8+/-19.6 HHV8 per 1000 beta-globin in HIV-positive versus 18.0+/-23.5 in HIV-negative patients). CONCLUSIONS: These data suggest that HHV8 viral load in Kaposi's sarcoma is relatively low and does not differ in HIV-positive and HIV-negative samples. The importance of viral load determination for prognosis or treatment monitoring remains to be elucidated.