Human herpesvirus 8 infection and transfusion history in children with sickle-cell disease in Uganda.

BACKGROUND Although human herpesvirus 8 (HHV-8), the etiologic agent for Kaposi's sarcoma, can be detected in peripheral blood, blood-borne transmission of this virus has not been demonstrated. We studied the association between HHV-8 seropositivity and transfusion history among children with sickle-cell disease in Uganda, where HHV-8 infection is common in blood donors. METHODS We studied 600 children (aged 0-16 years) with sickle-cell disease at Mulago Hospital, Kampala, from November 2001 through April 2002. By design, about half had previously been transfused. HHV-8 serostatus was determined using enzyme-linked immunosorbent assays for antibodies against HHV-8 proteins K8.1 and orf 73. We used logistic regression to test for an association between HHV-8 serostatus and transfusion history and a Markov model to estimate the transmission risk per transfusion and the cumulative risk from community (i.e., nontransfusion) sources. Statistical tests were two-sided. RESULTS HHV-8 antibodies were detected in 117 of 561 (21%) children with unambiguous K8.1 results. HHV-8 seroprevalence among the never-transfused children increased with age from 7% in children aged 0-2 years to 32% in those aged 13-16 years (P(trend)<.001). HHV-8 seropositivity was more frequent in transfused than never-transfused children (24% versus 17%, odds ratio = 1.48, 95% confidence interval [CI] = 0.97 to 2.26; P =.07). Seropositivity increased with number of reported transfusions, with age-adjusted odds ratios of 0.97 (95% CI = 0.54 to 1.75), 1.13 (95% CI = 0.59 to 2.17), 1.76 (95% CI = 0.81 to 3.83), and 2.17 (95% CI = 1.18 to 3.99) for children with one, two, three, or four or more transfusions, respectively (P(trend) =.007). Overall, the estimated HHV-8 transmission risk was 2.6% per transfusion (95% CI = 1.9% to 3.3%), whereas the annual risk of infection unrelated to transfusion was 2.7% (95% CI = 1.7% to 3.7%). CONCLUSION Our study suggests that blood transfusion is associated with a small risk of HHV-8 transmission. In Uganda, this risk is approximately equivalent to the 1-year cumulative risk of infection from community sources.

[1]  W. F. Bischof,et al.  Bootstrap variance estimators for the parameters of small-sample sensory-performance functions , 1987, Biological Cybernetics.

[2]  P. Pellett,et al.  Kaposi's sarcoma in Uganda: risk factors for human herpesvirus 8 infection among blood donors. , 2003, Journal of acquired immune deficiency syndromes.

[3]  R. Pfeiffer,et al.  Human herpesvirus 8 infection within families in rural Tanzania. , 2003, The Journal of infectious diseases.

[4]  H. Osugi,et al.  Immunologic Effects of Allogeneic versus Autologous Blood Transfusion in Patients Undergoing Radical Oesophagectomy , 2003, European Surgical Research.

[5]  T. O'Brien,et al.  Seroprevalence of human herpesvirus 8 among injection drug users in San Francisco. , 2003, The Journal of infectious diseases.

[6]  J. Goedert,et al.  Risk factors for Kaposi's sarcoma-associated herpesvirus infection among HIV-1-infected pregnant women in the USA , 2003, AIDS.

[7]  L. Goodnough,et al.  Transfusion medicine: looking to the future , 2003, The Lancet.

[8]  R. Biggar,et al.  Transmission of human herpesvirus 8 by sexual activity among adults in Lagos, Nigeria , 2002, AIDS.

[9]  F. Mhalu,et al.  Detection of human herpesvirus 8 DNA in serum from blood donors with HHV‐8 antibodies indicates possible bloodborne virus transmission , 2002, Journal of medical virology.

[10]  M. Prins,et al.  Risk factors for human herpesvirus 8 infection in a cohort of drug users in the Netherlands, 1985-1996. , 2002, The Journal of infectious diseases.

[11]  A. Wald,et al.  Correlates of prevalent and incident Kaposi's sarcoma-associated herpesvirus infection in men who have sex with men. , 2002, The Journal of infectious diseases.

[12]  E. Nicastri,et al.  Primary human herpesvirus 8 infection in immunocompetent children. , 2002, JAMA.

[13]  Dorothy N. Kakoola,et al.  Recombination in human herpesvirus-8 strains from Uganda and evolution of the K15 gene. , 2001, The Journal of general virology.

[14]  R. Greenblatt,et al.  Human herpesvirus 8 infection and Kaposi's sarcoma among human immunodeficiency virus-infected and -uninfected women. , 2001, The Journal of infectious diseases.

[15]  D. Vlahov,et al.  Blood-borne and sexual transmission of human herpesvirus 8 in women with or at risk for human immunodeficiency virus infection. , 2001, The New England journal of medicine.

[16]  J. Goedert,et al.  Kaposi's sarcoma herpes virus and Kaposi's sarcoma in the elderly populations of 3 Mediterranean islands. , 2001, International journal of cancer.

[17]  A. Opio,et al.  Fighting HIV/AIDS: is success possible? , 2001, Bulletin of the World Health Organization.

[18]  J J Goedert,et al.  Latent class analysis of human herpesvirus 8 assay performance and infection prevalence in sub‐Saharan Africa and Malta , 2000, International journal of cancer.

[19]  A. Wald,et al.  Mucosal shedding of human herpesvirus 8 in men. , 2000, The New England journal of medicine.

[20]  D. Trégouët,et al.  Human herpesvirus 8 transmission from mother to child and between siblings in an endemic population , 2000, The Lancet.

[21]  J. Goedert,et al.  Identifying Human Herpesvirus 8 Infection: Performance Characteristics of Serologic Assays , 2000, Journal of acquired immune deficiency syndromes.

[22]  P. Hervé.  Sécurité transfusionnelle: Risques émergents ou hypothétiques* , 2000 .

[23]  ntonio,et al.  Bone Marrow Failure Associated with Human Herpesvirus 8 Infection after Transplantation , 2000 .

[24]  P. Hervé.  [Transfusion safety: emergent or hypothetical risks]. , 2000, Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine.

[25]  D Commenges,et al.  Multi-state Models in Epidemiology , 1999, Lifetime data analysis.

[26]  R. Wilks,et al.  Risk of transfusion-associated transmission of human herpesvirus 8. , 1999, Journal of the National Cancer Institute.

[27]  J. Goedert,et al.  Evidence for concurrent epidemics of human herpesvirus 8 and human immunodeficiency virus type 1 in US homosexual men: rates, risk factors, and relationship to Kaposi's sarcoma. , 1999, The Journal of infectious diseases.

[28]  E. Cesarman,et al.  The role of Kaposi's sarcoma-associated herpesvirus (KSHV/HHV-8) in lymphoproliferative diseases. , 1999, Seminars in cancer biology.

[29]  R. Biggar,et al.  Increasing Kaposi's sarcoma‐associated herpesvirus seroprevalence with age in a highly Kaposi's sarcoma endemic region, Zambia in 1985 , 1998, AIDS.

[30]  L. Cuevas,et al.  Prevalence and transmission of Kaposi's sarcoma‐associated herpesvirus (human herpesvirus 8) in Ugandan children and adolescents , 1998, International journal of cancer.

[31]  R. Biggar,et al.  Interassay correlation of human herpesvirus 8 serologic tests. HHV-8 Interlaboratory Collaborative Group. , 1998, The Journal of infectious diseases.

[32]  J. Morvan,et al.  High prevalence in Central Africa of blood donors who are potentially infectious for human herpesvirus 8 , 1998, Transfusion.

[33]  J. Effrey,et al.  SEXUAL TRANSMISSION AND THE NATURAL HISTORY OF HUMAN HERPESVIRUS 8 INFECTION , 1998 .

[34]  E. Operskalski,et al.  Blood donations and viruses , 1997, The Lancet.

[35]  J. Ambroziak,et al.  Infectious human herpesvirus 8 in a healthy North American blood donor , 1997, The Lancet.

[36]  C. Boshoff,et al.  Kaposi's sarcoma-associated herpesvirus and Kaposi's sarcoma in Africa. Uganda Kaposi's Sarcoma Study Group. , 1996, Archives of internal medicine.

[37]  J. Seeley,et al.  Human immunodeficiency virus (HIV-1) seropositivity among children in a rural population of south-west Uganda: probable routes of exposure. , 1995, Annals of tropical paediatrics.

[38]  M. Ho,et al.  Epidemiology of cytomegalovirus infections. , 1990, Reviews of infectious diseases.

[39]  P. Kataaha,et al.  Revival of the Ugandan Blood Transfusion System 1989: an example of international cooperation. , 1990, Transfusion science.

[40]  B. Achinstein,et al.  Journal of the National Cancer Institute, Vol. 29, 1962: Action of bacterial polysaccharide on tumors. II. Damage of sarcoma 37 by serum of mice treated with Serratia marcescens polysaccharide, and induced tolerance. , 2009, Nutrition reviews.

[41]  I. Tizard.  Serologic assays. , 1982, Journal of the American Veterinary Medical Association.