THE SEROPREVALENCE OF HHV8 IN THE HAART NAVE HIV PATIENTS AT KENYATTA NATIONAL HOSPITAL COMPREHENSIVE CARE CLINIC Einstein

M. Tsuma, Omu Anzala, Erastus O. Amayo, Gladwell K. Kiarie, Marybeth C. Maritim and Peter Wanzala

a Dissertation to be Submitted in Partial Fulfillment to the Award of the Degree of Masters in Medicine in Internal Medicine, University of Nairobi

1.HHV8 causes KS
HHV8 is the causative agent for KS1
LANA Viral G IL6 Viral flip

KS is the 2nd most frequent tumor in HIV patients world

wide.2 Most common cancer in HIV in sub Saharan Africa. Synergy HIV and HHV8 Seroconversion to HHV8 seropositivity associated with development of KS.3,4

1. Chang, Y. et al. Science 1994 2. Martellotta, F.et al Curr HIV Res. 2009 3. Edelman, D et al. Virology Journal 2005 4. QIN, D., LU, C. Virologica sinica.2008

Immunological status and HHV8

Low CD4 counts faster progression to

KS.1,2 Low CD4 counts associated with increased risk for HHV8 seropositivity.3

1. Guiguet, M et al. Lancet oncology. 2009 2. Jacobson et al. J Infect Dis. 2000 3. Guadalupe M., et al .J Acquir Immune Dec Syndr. 2011

2.HHV8 is a common infection

Seroprevalence of HHV8 >40 %

sub-Saharan Africa.1,2 Kenya-HHV8 prevalence is about 43-44%.3,4 No studies in the HIV population.

1. Ahmadpoor, P. Iranian Journal of Kidney Diseases.2009 2. Dukers, et al. Am J Epidemiol Vol. 2000 3. Baeten, J. M. et al. AIDS. 2002 4. Lavreys, L, et al. The Journal of Infectious Diseases. 2003 4

What are the association to HHV8 seropositivity?

HHV8 transmitted thro various mechanisms.1
Sexual( heterosexual, homosexual) Horizontal Parenteral2 Age STI Circumcision Condom use Smoking Low socioeconomic status

Seropositivity has been associated3,4

1. Sullivan, R. J. et al. Clinical Infectious Diseases 2008 2. Hladik, W et al . N Engl J Med. 2006 3. Baeten, J. M. et al. AIDS. 2002 4. Campbell, T.B. et al. Clin Infect Dis. 2009

3.Treatment of HHV8 infection is available

Antiviral agents1,2
Foscarnet and ganciclovir Valganciclovir

HAART 3,4
Decreased KS incidence since HAART in 1996
1. Casper, C. Rev. Med. Virol. 2008 2. Casper, C. et al. Jour Inf. Dis.2008 3. Bourboulia, D. et al. AIDS 2004
4. Appleby, P. et al. J Natl Cancer Inst. 2000 6

Incidence rates (99% confidence intervals [CIs]) for Kaposi's sarcoma. Rates are adjusted for study, age at seroconversion, time since seroconversion, sex, and HIV transmission group.1

Figure 2

1.Appleby, P. et al. J Natl Cancer Inst. 2000 92(22):1823-30

Study Objectives
To determine the seroprevalence of HHV8 Cross sectional descriptive study design Site - KNH CCC. HAART naive HIV patients Consecutively recruited.
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METHODS
Patients recruited from December
2010 to April 2011 Ethical approval was obtained from ERC/KNH Pretested questionnaire Blood drawn for analysis.HHV8 serology and CD4 counts Data analyze SPSS version 17
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Results
Baseline characteristics

HHV8 seroprevalence 200(54.4%) of the population tested positive for HHV8.

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Demographic characteristics and HHV8 seropositivity

HHV8 status n Gender Marital status Male Female Divorced Married Separated Single Widowed Education level College None Primary Secondary Religion Employment status Christian Muslim Govt Non-Govt Self-employed Unemployed 120 247 29 206 6 85 38 87 8 121 148 355 9 44 86 144 90 (78) (122) (14) (115) (3) (46) (21) (47) (5) (71) (76) (195) (4) (22) (53) (73) (51) Positive % 65.0% 49.4% 48.3% 55.8% 50.0% 54.1% 55.3% 54.0% 62.5% 58.7% 51.4% 54.9% 44.4% 50.0% 61.6% 50.7% 56.7% 0.372 P value 0.005 0.956

0.647

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CD4 counts and HHV8 seropositivity

HHV8 status n Positive P value Row N % CD4 Count grouped 0-49 14 (4) 28.6% <0.0001 0.272

50-99
100-199 200-349 350-499 >=500 Age groups <30 years 30-40 years >40 years

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26 82 102 133 76 163 121

(6)
(18) (64) (59) (49) (40) (83) (73)

66.7%
69.2% 78.0% 57.8% 36.8% 52.6% 50.9% 60.3%

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Multivariate analysis
The male gender was an independent
predictor of HHV8 seropositivity. odds ratio 2.77(1.75-4.38) [95%CI]

Lower CD4 counts was also an

independent predictor of HHV8 seropositivity. odds ratio 1.881 (1.182.99)[95% CI]
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Discussion of results.
Seroprevalence of HHV8 is 54.4% Male gender is an independent risk
factor for HHV8 seropositivity. low CD4(<350cells/mm3) count is an independent risk factor for HHV8 seropositivity.

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Study limitations
Lack of gold standard diagnostic tests. Because the study was conducted in a
hospital during a specific period, there is potential for confounding by regional or temporal differences in HHV-8 seroprevalence.

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