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THE SEROPREVALENCE OF HHV8 IN THE HAART NAVE HIVPATIENTS 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 ofMasters in Medicine in Internal Medicine, University of Nairobi

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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 worldwide.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 19942. Martellotta, F.et al Curr HIV Res. 20093. Edelman, D et al. Virology Journal20054. QIN, D., LU, C. Virologica sinica.2008

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Immunological status and HHV8

Low CD4 counts faster progression to

KS.1,2

Low CD4 counts associated withincreased 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 Defic Syndr. 2011

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2.HHV8 is a common infection

Seroprevalence of HHV8 >40 %

sub-Saharan Africa.1,2

Kenya-HHV8 prevalence is about43-44%.3,4

No studies in the HIV population.

1. Ahmadpoor, P. Iranian Journal of Kidney Diseases.2009

2. Dukers, et al.Am J EpidemiolVol. 2000

3. Baeten, J. M. et al.AIDS. 2002

4. Lavreys, L, et al. The Journal of Infectious Diseases. 2003

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What are the association to HHV8seropositivity?

HHV8 transmitted thro various mechanisms.1 Sexual( heterosexual, homosexual)

Horizontal

Parenteral2

Seropositivity has been associated3,4

Age

STI

Circumcision

Condom use

Smoking

Low socioeconomic status

1. Sullivan, R. J. et al. Clinical Infectious Diseases 20082. Hladik, Wet al . N Engl J Med. 20063. Baeten, J. M. et al.AIDS. 2002

4. Campbell, T.B. et al. Clin Infect Dis. 2009

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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

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Incidence rates (99% confidence intervals [CIs]) for Kaposi'ssarcoma. Rates are adjusted for study, age at seroconversion, time

since seroconversion, sex, and HIV transmission group.1

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

Figure 2

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Study Objectives

To determine the seroprevalenceof HHV8

Cross sectional descriptive studydesign

Site - KNH CCC.

HAART naive HIV patients

Consecutively recruited.

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METHODS

Patients recruited from December2010 to April 2011

Ethical approval was obtained fromERC/KNH

Pretested questionnaire

Blood drawn for analysis.HHV8serology and CD4 counts

Data analyze SPSS version 179

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Results

Baseline characteristics HHV8 seroprevalence

200(54.4%) of the

population tested

positive for HHV8.

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Demographic characteristicsand HHV8 seropositivity

HHV8 status

n Positive

% P value

Gender Male 120 (78) 65.0% 0.005

Female 247 (122) 49.4%

Marital status Divorced 29 (14) 48.3% 0.956

Married 206 (115) 55.8%

Separated 6 (3) 50.0%

Single 85 (46) 54.1%

Widowed 38 (21) 55.3%

Education level College 87 (47) 54.0% 0.647

None 8 (5) 62.5%

Primary 121 (71) 58.7%

Secondary 148 (76) 51.4%

Religion Christian 355 (195) 54.9%

Muslim 9 (4) 44.4%

Employment status Govt 44 (22) 50.0% 0.372

Non-Govt 86 (53) 61.6%

Self-employed

144

(73)

50.7%

Unemployed 90 (51) 56.7%11

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CD4 counts and HHV8seropositivity

HHV8 status

n Positive

Row N %P value

CD4 Count grouped 0-49 14 (4) 28.6% =500 133 (49) 36.8%

Age groups 40 years 121 (73) 60.3%

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Multivariate analysis

The male gender was an independentpredictor of HHV8 seropositivity. oddsratio 2.77(1.75-4.38) [95%CI]

Lower CD4 counts was also anindependent predictor of HHV8

seropositivity. odds ratio 1.881 (1.18-2.99)[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(

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Study limitations

Lack of gold standard diagnostic tests.

Because the study was conducted in a

hospital during a specific period, thereis potential for confounding by regional

or temporal differences in HHV-8

seroprevalence.

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