Substantial regional differences in human herpesvirus 8 seroprevalence in sub‐Saharan Africa: Insights on the origin of the “Kaposi's sarcoma belt” |
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| Authors: | Sheila C. Dollard Lisa M. Butler Alison M. Graves Jones Jonathan H. Mermin Midion Chidzonga Tsungai Chipato Caroline H. Shiboski Christian Brander Anisa Mosam Photini Kiepiela Wolfgang Hladik Jeffrey N. Martin |
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| Affiliation: | 1. Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA;2. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA;3. Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, CDC, Centers for Disease Control and Prevention, Atlanta, GA;4. College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe;5. Department of Orofacial Sciences, Division of Oral Medicine, Oral Pathology, and Oral Radiology, University of California, San Francisco, CA;6. Partners AIDS Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA;7. Institucio Catalana de Recerca i Estudis Avancats (ICREA), Barcelona, Spain;8. Irsicaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain;9. Department of Dermatology, University of KwaZulu‐Natal, Durban, South Africa;10. Medical Research Council, HIV Prevention and Research Unit, Durban, South Africa;11. Epidemiology Unit, Centers for Disease Control and Prevention, Entebbe, Uganda |
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| Abstract: | Equatorial Africa has among the highest incidences of Kaposi's sarcoma (KS) in the world, thus earning the name “KS Belt.” This was the case even before the HIV epidemic. To date, there is no clear evidence that HHV‐8 seroprevalence is higher in this region but interpretation of the available literature is tempered by differences in serologic assays used across studies. We examined representatively sampled ambulatory adults in Uganda, which is in the “KS Belt,” and in Zimbabwe and South Africa which are outside the Belt, for HHV‐8 antibodies. All serologic assays were uniformly performed in the same reference laboratory by the same personnel. In the base‐case serologic algorithm, seropositivity was defined by reactivity in an immunofluorescence assay or in 2 enzyme immunoassays. A total of 2,375 participants were examined. In Uganda, HHV‐8 seroprevalence was high early in adulthood (35.5% by age 21) without significant change thereafter. In contrast, HHV‐8 seroprevalence early in adulthood was lower in Zimbabwe and South Africa (13.7 and 10.8%, respectively) but increased with age. After age adjustment, Ugandans had 3.24‐fold greater odds of being HHV‐8 infected than South Africans (p < 0.001) and 2.22‐fold greater odds than Zimbabweans (p < 0.001). Inferences were unchanged using all other serologic algorithms evaluated. In conclusion, HHV‐8 infection is substantially more common in Uganda than in Zimbabwe and South Africa. These findings help to explain the high KS incidence in the “KS Belt” and underscore the importance of a uniform approach to HHV‐8 antibody testing. |
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| Keywords: | KSHV HHV‐8 Africa adults |
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