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Mukasine MC, Mulundu G, Kawimbe M, Mutale K, Mumba C, Lidenge SJ, Ngalamika O. Association between KSHV-Specific Humoral and T Cell Responses with Recurrence of HIV-Associated Kaposi Sarcoma. Trop Med Infect Dis 2024; 9:134. [PMID: 38922046 PMCID: PMC11209129 DOI: 10.3390/tropicalmed9060134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/28/2024] [Accepted: 06/11/2024] [Indexed: 06/27/2024] Open
Abstract
Kaposi sarcoma (KS) is an AIDS-defining angio-proliferative malignancy, with the Kaposi sarcoma-associated herpes virus (KSHV) as its etiologic agent. Upon treatment with chemotherapy, a proportion of HIV-associated KS patients experience disease recurrence within a few months of completing treatment. We aimed at determining whether KSHV-specific adaptive immune responses were associated with KS recurrence upon complete remission. We conducted a prospective cohort study. The primary outcome was the recurrence of HIV-associated KS. An immunofluorescence assay was used to determine anti-KSHV antibodies, an enzyme-linked immunospot was conducted for T cell responses, PCR was carried out to determine KSHV status, and flow cytometry was used for CD4 counting and immunophenotyping. KSHV detection in PBMCs was high and not associated with KS recurrence-free survival (p = 0.29). Anti-KSHV antibody titers were high and not associated with recurrence-free survival (p = 0.63). KSHV-specific T cell responses dropped from baseline levels among individuals with recurrence, but the drop was not statistically significant. Individuals experiencing KS recurrence had a significantly higher proportion of T cell subsets expressing PD1, while those with sustained remission had a significant increase in CD4 T cell counts from baseline levels during the follow-up period (p = 0.02). Anti-KSHV antibodies are not a good correlate of protection from KS recurrence. T cells in individuals experiencing KS recurrence hadhigh PD1 expression, while an increase in CD4 counts was associated with sustained KS remission.
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Affiliation(s)
- Marie-Claire Mukasine
- Department of Pathology and Microbiology, University of Zambia School of Medicine, Lusaka P.O. Box 50110, Zambia; (M.-C.M.); (G.M.); (C.M.)
- HHV8 Research Molecular Virology Laboratory, University Teaching Hospital, Lusaka P.O. Box 50110, Zambia; (M.K.); (K.M.)
| | - Gina Mulundu
- Department of Pathology and Microbiology, University of Zambia School of Medicine, Lusaka P.O. Box 50110, Zambia; (M.-C.M.); (G.M.); (C.M.)
| | - Musonda Kawimbe
- HHV8 Research Molecular Virology Laboratory, University Teaching Hospital, Lusaka P.O. Box 50110, Zambia; (M.K.); (K.M.)
| | - Keagan Mutale
- HHV8 Research Molecular Virology Laboratory, University Teaching Hospital, Lusaka P.O. Box 50110, Zambia; (M.K.); (K.M.)
| | - Chibamba Mumba
- Department of Pathology and Microbiology, University of Zambia School of Medicine, Lusaka P.O. Box 50110, Zambia; (M.-C.M.); (G.M.); (C.M.)
| | - Salum J. Lidenge
- Ocean Road Cancer Institute, Dar es Salaam P.O. Box 3592, Tanzania;
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
| | - Owen Ngalamika
- HHV8 Research Molecular Virology Laboratory, University Teaching Hospital, Lusaka P.O. Box 50110, Zambia; (M.K.); (K.M.)
- Dermatology and Venereology Division, University Teaching Hospital, University of Zambia School of Medicine, Lusaka P.O. Box 50110, Zambia
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Epidemiology of Kaposi’s sarcoma in sub-Saharan Africa. Cancer Epidemiol 2022; 78:102167. [DOI: 10.1016/j.canep.2022.102167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/18/2022] [Accepted: 04/20/2022] [Indexed: 12/24/2022]
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Motlhale M, Sitas F, Bradshaw D, Chen WC, Singini MG, de Villiers CB, Lewis CM, Muchengeti M, Waterboer T, Mathew CG, Newton R, Singh E. Lifestyle factors associated with sex differences in Kaposi sarcoma incidence among adult black South Africans: A case-control study. Cancer Epidemiol 2022; 78:102158. [PMID: 35421713 DOI: 10.1016/j.canep.2022.102158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 11/15/2022]
Abstract
Kaposi Sarcoma (KS) is endemic in several countries in Southern and Eastern Africa, relatively rare worldwide but a leading cancer among people living with HIV. KS has always been more common in adult males than females. We assessed the prevalence of known cancer modifying factors (parity, hormonal contraceptive use in females, sex-partners, smoking and alcohol consumption in both sexes), and their relationship to KS, and whether any of these could account for the unequal KS sex ratios. We calculated logistic regression case-control adjusted odds ratios (ORadj), and 95% confidence intervals (95%CI), between KS and each of the modifying factors, using appropriate comparison controls. Controls were cancer types that had no known relationship to exposures of interest (infection or alcohol or smoking or contraceptive use). The majority of the 1275 KS cases were HIV positive (97%), vs. 15.7% in 10,309 controls. The risk of KS among those with HIV was high in males (ORadj=116.70;95%CI=71.35-190.88) and females (ORadj=93.91;95%CI=54.22-162.40). Among controls, the prevalence of smoking and alcohol consumption was five and three times higher in males vs. females. We found a positive association between KS and heavy vs. non-drinking (ORadj=1.31;95%CI=1.03-1.67), and in current heavy vs. never smokers (ORadj=1.82;95%CI=1.07-3.10). These associations remained positive for alcohol consumption (but with wider CIs) after stratification by sex, and restriction to HIV positive participants. We found no evidence of interactions of smoking and alcohol by sex. Smoking and alcohol consumption may provide a possible explanation for the KS sex differences, given both exposures are more common in men, but confounding and bias cannot be fully ruled out. The role smoking and alcohol play in relation to viral loads of HIV/KSHV, differences in immunological responses or other genetic differences between males and females warrant further studies.
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Affiliation(s)
- Melitah Motlhale
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Freddy Sitas
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Centre for Primary Health Care and Equity, School of Population Health, University of New South Wales Sydney, Australia; Menzies Centre of Health Policy, School of Public Health, University of Sydney, Australia
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Wenlong Carl Chen
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mwiza Gideon Singini
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Chantal Babb de Villiers
- Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8AF, United Kingdom; Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, SE1 9RT, United Kingdom
| | - Mazvita Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christopher G Mathew
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, SE1 9RT, United Kingdom
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda; University of York, York, United Kingdom
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Epidemiology of Kaposi's Sarcoma. Cancers (Basel) 2021; 13:cancers13225692. [PMID: 34830846 PMCID: PMC8616388 DOI: 10.3390/cancers13225692] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 12/24/2022] Open
Abstract
Kaposi's sarcoma is an angioproliferative tumor caused by human herpesvirus 8 in the context of immunodeficiency, such as that induced by HIV infection or immunosuppressive therapy. Its incidence has dramatically fallen in patients living with HIV (PLHIV) since the introduction of potent antiretroviral combinations 25 years ago due to the restoration of immunity and better control of HIV replication. However, KS is still one of the most frequently occurring cancers in PLHIV, in particular in men who have sex with men and in sub-Saharan Africa, where it is still endemic. Even in the context of restored immunity, the risk of KS is still more than 30 times higher in PLHIV than in the general population. Recent evidence indicates that early initiation of antiretroviral treatment, which is recommended by current guidelines, may reduce the risk of KS but it needs to be accompanied by early access to care. This review mainly focuses on the recent epidemiological features of KS in the context of HIV infection.
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Prevalence of Kaposi's sarcoma-associated herpesvirus and transfusion-transmissible infections in Tanzanian blood donors. Int J Infect Dis 2020; 95:204-209. [PMID: 32294540 DOI: 10.1016/j.ijid.2020.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Kaposi's sarcoma-associated herpesvirus (KSHV) is the causative agent for Kaposi's sarcoma (KS), one of the most common cancers in Tanzania. We have investigated KSHV prevalence and factors associated with KSHV infection in Tanzania. METHODS This is a cross-sectional study of voluntary blood-donors from Dar es Salaam, Tanzania. Plasma was screened for KSHV, HIV-1, HBV, HCV and Treponema pallidum (syphilis). Associations between KSHV sero-status and risk factors were analyzed. Odds ratios (OR) and 95% confidence intervals (CI) are reported to evaluate risk factors of KSHV infection. All tests were 2-tailed, and P-values <0.05 were considered statistically significant. RESULTS The overall KSHV seroprevalence was 56.9%. Significantly increased risk of KSHV infection was detected in persons from the Lake and Central Zones (OR=6.4, 95% CI=1.6-25.3, P=0.008 and OR=5.7, 95% CI=1.0-32.5, P=0.048 respectively). A trend toward increased risk of KSHV infection with HIV-1 co-infection was not significant (OR=2.8, 95% CI=1.0-8.0, P=0.06). Seroreactivity to T. pallidum was surprisingly high (14.9%). CONCLUSION The prevalence of KSHV infection and syphilis was high among Tanzanian blood-donors. The most common transfusion-transmissible infections did not associate with KSHV infection. Regions of focal KSHV infection need further investigation for underappreciated risk factors.
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Lidenge SJ, Tso FY, Ngalamika O, Ngowi JR, Mortazavi Y, Kwon EH, Shea DM, Minhas V, Mwaiselage J, Wood C, West JT. Similar Immunological Profiles Between African Endemic and Human Immunodeficiency Virus Type 1-Associated Epidemic Kaposi Sarcoma (KS) Patients Reveal the Primary Role of KS-Associated Herpesvirus in KS Pathogenesis. J Infect Dis 2020; 219:1318-1328. [PMID: 30452681 DOI: 10.1093/infdis/jiy654] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 11/09/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Kaposi sarcoma (KS)-associated herpesvirus (KSHV) is etiologically linked to all KS forms, but mechanisms underlying KS development are unclear. The incidence of KS in human immunodeficiency virus type 1-infected (HIV-1+) individuals implicates immune dysregulation; however, the lack of characterization of KSHV immune responses in endemic KS makes the role of HIV-1 unclear. The study objective was to investigate the HIV-1 and KSHV roles in viral nucleic acid detection, antibody responses, and cytokine responses in polymerase chain reaction-confirmed epidemic KS and endemic KS patients and non-cancer controls from sub-Saharan Africa. METHODS KSHV viral DNA (vDNA), total anti-KSHV antibody, KSHV neutralizing antibody (nAb), and cytokines were quantified. RESULTS KSHV vDNA was detectable in tumors but variably in plasma and peripheral blood mononuclear cells. Consistent with elevated antibody-associated cytokines (interleukin [IL] 6, IL-5, and IL-10), nAb titers were higher in epidemic KS and endemic KS patients than in controls (P < .05). Despite HIV-1 coinfection in epidemic KS, nAb titers were similar between epidemic KS and endemic KS patients (P = 0.3). CONCLUSIONS Similarities in antibody and cytokine responses between epidemic and endemic KS patients suggest that KSHV drives KS pathogenesis, whereas HIV-1 exacerbates it.
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Affiliation(s)
- Salum J Lidenge
- Nebraska Center for Virology, University of Nebraska-Lincoln, Dar es Salaam, Tanzania.,School of Biological Sciences, University of Nebraska-Lincoln, Dar es Salaam, Tanzania.,Ocean Road Cancer Institute, Dar es Salaam, Tanzania.,Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - For Yue Tso
- Nebraska Center for Virology, University of Nebraska-Lincoln, Dar es Salaam, Tanzania.,School of Biological Sciences, University of Nebraska-Lincoln, Dar es Salaam, Tanzania
| | - Owen Ngalamika
- Dermatology and Venereology Section, University Teaching Hospitals, University of Zambia School of Medicine, Lusaka
| | - John R Ngowi
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Yasaman Mortazavi
- Nebraska Center for Virology, University of Nebraska-Lincoln, Dar es Salaam, Tanzania.,School of Biological Sciences, University of Nebraska-Lincoln, Dar es Salaam, Tanzania
| | - Eun Hee Kwon
- Nebraska Center for Virology, University of Nebraska-Lincoln, Dar es Salaam, Tanzania
| | - Danielle M Shea
- Nebraska Center for Virology, University of Nebraska-Lincoln, Dar es Salaam, Tanzania
| | - Veenu Minhas
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha
| | - Julius Mwaiselage
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania.,Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Charles Wood
- Nebraska Center for Virology, University of Nebraska-Lincoln, Dar es Salaam, Tanzania.,School of Biological Sciences, University of Nebraska-Lincoln, Dar es Salaam, Tanzania
| | - John T West
- Nebraska Center for Virology, University of Nebraska-Lincoln, Dar es Salaam, Tanzania
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Labo N, Marshall V, Miley W, Davis E, McCann B, Stolka KB, Ndom P, Hemingway-Foday JJ, Abassora M, Newton R, Smith JS, Whitby D. Mutual detection of Kaposi's sarcoma-associated herpesvirus and Epstein-Barr virus in blood and saliva of Cameroonians with and without Kaposi's sarcoma. Int J Cancer 2019; 145:2468-2477. [PMID: 31265124 DOI: 10.1002/ijc.32546] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/24/2019] [Accepted: 06/14/2019] [Indexed: 02/06/2023]
Abstract
Kaposi's sarcoma-associated herpesvirus (KSHV) and Epstein-Barr virus (EBV) are prevalent in sub-Saharan Africa, together with HIV; the consequent burden of disease is grave. The cofactors driving transmission of the two viruses and pathogenesis of associated malignancies are not well understood. We measured KSHV and EBV DNA in whole blood and saliva as well as serum antibodies levels in 175 Cameroonians with Kaposi's sarcoma and 1,002 age- and sex-matched controls with and without HIV. KSHV seroprevalence was very high (81%) in controls, while EBV seroprevalence was 100% overall. KSHV DNA was detectable in the blood of 36-46% of cases and 6-12% of controls; EBV DNA was detected in most participants (72-89%). In saliva, more cases (50-58%) than controls (25-28%) shed KSHV, regardless of HIV infection. EBV shedding was common (75-100%); more HIV+ than HIV- controls shed EBV. Cases had higher KSHV and EBV VL in blood and saliva then controls, only among HIV+ participants. KSHV and EBV VL were also higher in HIV+ than in HIV- controls. Cases (but not controls) were more likely to have detectable KSHV in blood if they also had EBV, whereas shedding of each virus in saliva was independent. While EBV VL in saliva and blood were modestly correlated, no correlation existed for KSHV. Numerous factors, several related to parasitic coinfections, were associated with detection of either virus or with VL. These findings may help better understand the interplay between the two gammaherpesviruses and generally among copathogens contributing to cancer burden in sub-Saharan Africa.
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Affiliation(s)
- Nazzarena Labo
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Inc. Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Vickie Marshall
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Inc. Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Wendell Miley
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Inc. Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Eliza Davis
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Inc. Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Brendan McCann
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Inc. Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | | | | | | | - Robert Newton
- University of York, York, United Kingdom.,MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | | | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Inc. Frederick National Laboratory for Cancer Research, Frederick, MD
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Newton R, Whitby D. Beral et al's 1990 paper on Kaposi's sarcoma among persons with AIDS: demonstrating the power of descriptive epidemiology. Cancer Epidemiol 2016; 44:222-225. [PMID: 27554680 DOI: 10.1016/j.canep.2016.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/18/2016] [Accepted: 07/21/2016] [Indexed: 11/16/2022]
Abstract
Here we discuss the impact of Beral et al's 1990 paper "Kaposi's sarcoma among persons with AIDS: a sexually transmitted infection?" Not only did this paper galvanise research into the underlying infectious cause of Kaposi's sarcoma, it also demonstrated the power of observational epidemiology in pointing the way towards major discoveries.
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Affiliation(s)
- Robert Newton
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda; Department of Health Sciences, University or York, UK.
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
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Iroezindu MO, Achusi IB. Classical Kaposi's Sarcoma in a Nigerian Farmer: A Case Report. Eurasian J Med 2015; 47:158-60. [PMID: 26180504 DOI: 10.5152/eurasianjmed.2015.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 12/30/2014] [Indexed: 11/22/2022] Open
Abstract
Classical Kaposi's sarcoma (KS) typically affects elderly men of Mediterranean and Jewish origin. We present an unusual case of classical KS in a human immunodeficiency virus (HIV) negative elderly farmer from rural Nigeria. He had multiple brownish nodules and plaques on both lower extremities associated with lymphoedema. Histopathological examination of a biopsy of the skin nodule confirmed the diagnosis of KS. The lesions only showed marginal improvement on chemotherapy which necessitated a referral for radiotherapy. There is a need to look beyond the traditional geographical distinction of KS variants as we continue to experience a dynamic role for environmental co-factors in the development of KS.
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Affiliation(s)
- Michael O Iroezindu
- Department of Medicine, University of Nigeria College of Medicine, Enugu, Nigeria ; Federal Medical Centre, Owerri, Imo State, Nigeria
| | - Izuchukwu B Achusi
- Department of Anatomic Pathology, Federal Staff Hospital, Abuja, Nigeria
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McDonald AC, Jenkins FJ, Bunker CH, Wilson JW, Patrick AL, Weissfeld JL. Human herpesvirus 8 seroconversion in a population-based cohort of men in Tobago. J Med Virol 2015; 87:642-7. [PMID: 25612304 DOI: 10.1002/jmv.24128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 12/31/2022]
Abstract
Human herpesvirus 8 (HHV-8) is the causal agent of Kaposi's sarcoma (KS). In Tobago, KS is not common; however, HHV-8 seropositivity has been reported to be 39.9% in men with prostate cancer compared to <22.9% in healthier women and men. To understand HHV-8 transmission, we examined HHV-8 seroconversion and seroreversion, and risk factors for these changes in Tobago men. Serum specimens from a sub-cohort of Tobago Prostate Survey men, aged 40-81 years (n = 381/442), were collected at baseline and a subsequent visit between 3 and 9 years and tested for HHV-8 seropositivity using an immunofluorescence assay for antibodies against HHV-8 lytic antigens. Poisson distribution was used to calculate HHV-8 seroconversion and seroreversion rates and their 95% confidence intervals. Differences in baseline characteristics between HHV-seroconverters versus persistent HHV-8 seronegative men and HHV-8 seroreverters versus HHV-8 seropositive men were examined. HHV-8 seropositivity was 12.3% (N = 381) at baseline, with HHV-8 seropositivity significantly higher in increasing age groups, 40-49 (4.0%) to 70-81 (37.5%) years (P-value trend <0.0001). HHV-8 seroconversion and seroreversion rates were 0.23 per 100 person-years (95% C.I., 0.06-0.58) and 2.42 per 100 person-years (95% C.I., 0.89-5.26), respectively. There were significantly more HHV-8 seroconverters who reported "ever smoked cigarettes of >6 months" at baseline compared to HHV-8 persistent seronegative men (P-value = 0.03). Baseline characteristics of HHV-8 seroreverters did not differ from persistent seropositive men. Low HHV-8 seroconversion and seroreversion rates were found. Data suggest that HHV-8 transmission occurred at earlier ages, <40 years, in Tobago men.
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Affiliation(s)
- Alicia C McDonald
- Department of Population Health, Hofstra North Shore Long Island Jewish School of Medicine, Great Neck, New York; Feinstein Institute for Medical Research, North Shore Long Island Jewish Health System, Manhasset, New York
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Abstract
BACKGROUND Noncommunicable diseases, and especially cancers, are recognized as an increasing problem for low and middle income countries. Effective control programs require adequate information on the size, nature, and evolution of the health problem that they pose. METHODS We present estimates of the incidence and mortality of cancer in Africa in 2012, derived from "GLOBOCAN 2012," published by the International Agency for Research on Cancer. RESULTS There were 847,000 new cancer cases (6% of the world total) and 591,000 deaths (7.2% of the world total) in the 54 countries of Africa in 2012, with about three quarters in the 47 countries of Sub-Saharan Africa. While the cancer profiles often differ markedly between regions, the most common cancers in men were prostate (16.4% of new cancers), liver (10.7%), and Kaposi sarcoma (6.7%); in women, by far the most important are cancers of the breast (27.6% of all cancers) and cervix uteri (20.4%). CONCLUSIONS There are still deficiencies in surveillance systems, particularly in Sub-Saharan Africa and, specifically, of their most vital component, population-based cancer registries. With the number of annual cancer cases and deaths likely to increase by at least 70% by 2030, there is a pressing need for a coordinated approach to improving the extent and quality of services for cancer control in Africa, and better surveillance systems with which they can be planned and monitored. IMPACT The results are the best data currently available and provide a reasonable appraisal of the cancer situation in Africa.
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Affiliation(s)
- D Maxwell Parkin
- Authors' Affiliations: African Cancer Registry Network, INCTR African Registry Programme; Clinical Trials Service Unit & Epidemiological Studies Unit, Nuffield Department of Public Health, University of Oxford, Richard Doll Building, Oxford, United Kingdom; Section of Cancer Information, International Agency for Research on Cancer, Lyon, France; and Surveillance & Health Services Research, American Cancer Society, Inc., Atlanta, GeorgiaAuthors' Affiliations: African Cancer Registry Network, INCTR African Registry Programme; Clinical Trials Service Unit & Epidemiological Studies Unit, Nuffield Department of Public Health, University of Oxford, Richard Doll Building, Oxford, United Kingdom; Section of Cancer Information, International Agency for Research on Cancer, Lyon, France; and Surveillance & Health Services Research, American Cancer Society, Inc., Atlanta, Georgia
| | - Freddie Bray
- Authors' Affiliations: African Cancer Registry Network, INCTR African Registry Programme; Clinical Trials Service Unit & Epidemiological Studies Unit, Nuffield Department of Public Health, University of Oxford, Richard Doll Building, Oxford, United Kingdom; Section of Cancer Information, International Agency for Research on Cancer, Lyon, France; and Surveillance & Health Services Research, American Cancer Society, Inc., Atlanta, Georgia
| | - Jacques Ferlay
- Authors' Affiliations: African Cancer Registry Network, INCTR African Registry Programme; Clinical Trials Service Unit & Epidemiological Studies Unit, Nuffield Department of Public Health, University of Oxford, Richard Doll Building, Oxford, United Kingdom; Section of Cancer Information, International Agency for Research on Cancer, Lyon, France; and Surveillance & Health Services Research, American Cancer Society, Inc., Atlanta, Georgia
| | - Ahmedin Jemal
- Authors' Affiliations: African Cancer Registry Network, INCTR African Registry Programme; Clinical Trials Service Unit & Epidemiological Studies Unit, Nuffield Department of Public Health, University of Oxford, Richard Doll Building, Oxford, United Kingdom; Section of Cancer Information, International Agency for Research on Cancer, Lyon, France; and Surveillance & Health Services Research, American Cancer Society, Inc., Atlanta, Georgia
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12
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Stolka K, Ndom P, Hemingway-Foday J, Iriondo-Perez J, Miley W, Labo N, Stella J, Abassora M, Woelk G, Ryder R, Whitby D, Smith JS. Risk factors for Kaposi's sarcoma among HIV-positive individuals in a case control study in Cameroon. Cancer Epidemiol 2014; 38:137-43. [PMID: 24631417 PMCID: PMC4075442 DOI: 10.1016/j.canep.2014.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 01/08/2014] [Accepted: 02/17/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Individuals co-infected with Kaposi's sarcoma herpesvirus (KSHV) and Human Immunodeficiency Virus (HIV) are at greatly increased risk of developing Kaposi's sarcoma (KS). The objective of the current analysis is to identify risk cofactors for KS among HIV-positive individuals. METHODS We conducted a case-control study of KS in Cameroon on 161 HIV-positive and 14 HIV-negative cases and 680 HIV-positive and 322 HIV-negative controls. Participants answered a physician-administered questionnaire and provided blood and saliva specimens. Antibodies against KSHV lytic, K8.1, and latent, ORF73, antigens were measured by ELISA to determine KSHV serostatus. Conditional logistic regression was performed to determine multivariate odds ratios (OR) and 95% confidence intervals (CI) for risk factors associated with KS among HIV-positive cases and controls. RESULTS Overall, 98% (158) of HIV-positive cases, 100% (14) of HIV-negative cases, 81% (550) of HIV-positive controls, and 80% (257) of HIV-negative controls were KSHV seropositive. Risk factors for KS among HIV-positive individuals included KSHV seropositivity (OR=9.6; 95% CI 2.9, 31.5), non-use of a mosquito bed net (OR 1.9; 95% CI 1.2, 2.9), minority ethnicity (OR=3.1; 95% CI 1.1, 9.3), treatment from a traditional healer (OR=2.3; 95% CI 1.5, 3.7), history of transfusion (OR=2.4; 95% CI 1.5, 3.9), and family history of cancer (OR=1.9; 95% CI 1.1, 3.1). CONCLUSION KSHV seroprevalence of ≥80% indicates a high prevalence in the general population in Cameroon. Among HIV-positive individuals, the strong association of KS with non-use of mosquito nets and treatment from traditional healers are compelling findings, consistent with recently reported data from East Africa.
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Affiliation(s)
- Kristen Stolka
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, United States.
| | - Paul Ndom
- SOCHIMIO, Rue EMIA, après Gendarmerie Nationale, Box 25513, Yaoundé, Cameroon
| | | | - Jeniffer Iriondo-Perez
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, United States
| | - Wendell Miley
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, BLDG 535, 4th floor, Frederick, MD 21702, United States
| | - Nazzarena Labo
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, BLDG 535, 4th floor, Frederick, MD 21702, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, United States
| | - Jennifer Stella
- University of California, 55 Laguna Street, San Francisco, CA 94102, United States
| | | | - Godfrey Woelk
- Expanded Program on Immunization, BP 186, Garoua, Cameroon; Elizabeth Glaser Pediatric AIDS Foundation, 1140 Connecticut Avenue NW, Washington, DC 20036, United States
| | - Robin Ryder
- University of California, 200 West Arbor Drive #8485, San Diego, CA 92103, United States
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, BLDG 535, 4th floor, Frederick, MD 21702, United States
| | - Jennifer S Smith
- 2103 McGavran-Greenberg, Department of Epidemiology, University of North Carolina at Chapel Hill, Campus Box 7435, Chapel Hill, NC 27599, United States
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Van Bogaert LJ. Does the knowledge of the human immunodeficiency virus serostatus influence the clinical diagnostic proficiency of Kaposi's sarcoma? S Afr Fam Pract (2004) 2013. [DOI: 10.1080/20786204.2013.10874398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- LJ Van Bogaert
- National Health Laboratory Service, Polokwane Mankweng Hospital Complex and University of Limpopo
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14
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Wakeham K, Webb EL, Sebina I, Nalwoga A, Muhangi L, Miley W, Johnston WT, Ndibazza J, Whitby D, Newton R, Elliott AM. Risk factors for seropositivity to Kaposi sarcoma-associated herpesvirus among children in Uganda. J Acquir Immune Defic Syndr 2013; 63:228-33. [PMID: 23403859 PMCID: PMC3707567 DOI: 10.1097/qai.0b013e31828a7056] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 01/18/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Determinants of Kaposi sarcoma-associated herpesvirus (KSHV) seropositivity among children living in sub-Saharan African populations where infection is endemic are not well understood. Local environmental factors, including other infectious agents, may be key. METHODS Within the context of a well-characterized birth cohort, we examined associations between various factors and antibodies against KSHV, measured in stored plasma samples from 1823 mother-child pairs in Entebbe, Uganda. RESULTS Seroprevalence increased with increasing age of the child (P = 0.0003) and was higher among those with KSHV seropositive mothers than in those without (12% vs 9%; odds ratio: 1.4, 95% confidence interval: 1.1 to 2.0). It was also higher among children with HIV infection (29% vs 10%; odds ratio: 3.1, 95% confidence interval: 1.2 to 8.3) or malaria parasitemia (30% vs 10%; odds ratio: 4.1, 95% confidence interval: 2.4 to 7.0) than in children without. These associations were not explained by socioeconomic status. CONCLUSIONS The finding that KSHV serostatus is associated with malaria parasitemia in children is novel. In a country endemic for KSHV, malaria may be a cofactor for KSHV infection or reactivation among children.
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Affiliation(s)
- Katie Wakeham
- Medical Research Council, Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda.
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15
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Conant KL, Kaleeba JAR. Dangerous liaisons: molecular basis for a syndemic relationship between Kaposi's sarcoma and P. falciparum malaria. Front Microbiol 2013; 4:35. [PMID: 23487416 PMCID: PMC3594938 DOI: 10.3389/fmicb.2013.00035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 02/07/2013] [Indexed: 11/13/2022] Open
Abstract
The most severe manifestations of malaria (caused by Plasmodium falciparum) occur as a direct result of parasitemia following invasion of erythrocytes by post-liver blood-stage merozoites, and during subsequent cyto-adherence of infected erythrocytes to the vascular endothelium. However, the disproportionate epidemiologic clustering of severe malaria with aggressive forms of endemic diseases such as Kaposi's sarcoma (KS), a neoplasm that is etiologically linked to infection with KS-associated herpesvirus (KSHV), underscores the significance of previously unexplored co-pathogenetic interactions that have the potential to modify the overall disease burden in co-infected individuals. Based on recent studies of the mechanisms that P. falciparum and KSHV have evolved to interact with their mutual human host, several new perspectives are emerging that highlight a surprising convergence of biological themes potentially underlying their associated co-morbidities. Against this background, ongoing studies are rapidly constructing a fascinating new paradigm in which the major host receptors that control parasite invasion (Basigin/CD147) and cyto-adherence (CD36) are, surprisingly, also important targets for exploitation by KSHV. In this article, we consider the major pathobiological implications of the co-option of Basigin/CD147 and CD36 signaling pathways by both P. falciparum and KSHV, not only as essential host factors for parasite persistence but also as important mediators of the pro-angiogenic phenotype within the virus-infected endothelial microenvironment. Consequently, the triangulation of interactions between P. falciparum, KSHV, and their mutual human host articulates a syndemic relationship that points to a conceptual framework for prevalence of aggressive forms of KS in malaria-endemic areas, with implications for the possibility of dual-use therapies against these debilitating infections in resource-limited parts of the world.
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Affiliation(s)
| | - Johnan A. R. Kaleeba
- Department of Microbiology and Immunology, Uniformed Services University of the Health SciencesBethesda, MD, USA
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16
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Okuku F, Omoding A, Walusansa V, Origa M, Mutungi G, Orem J. Infection-related cancers in sub-saharan Africa: a paradigm for cancer prevention and control. Oncology 2012; 84:75-80. [PMID: 23128067 DOI: 10.1159/000343151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 08/31/2012] [Indexed: 11/19/2022]
Abstract
There is much commonality between chronic noncommunicable and communicable diseases which is best exemplified by cancers of infectious origin. It provides the perfect opportunity for harnessing the advances that have been made in the control of communicable diseases to attempt the control of noncommunicable diseases. There are possibilities at various levels of intervention, at primary, secondary and tertiary levels, which fit well within a well-planned national cancer control strategy. Prevention should proceed through steps of disruption of transmission, improvement in disease recognition and diagnosis, as well as through prompt effective treatment. This principle should work for both infection and the resultant cancer. Research is very important in understanding how best to use the available knowledge and how best to sequentially implement strategies. Finally, policies that acknowledge infection-related cancers as a major problem in the region should be in place.
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Affiliation(s)
- Fred Okuku
- Uganda Cancer Institute, Kampala, Uganda
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17
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Burningham Z, Hashibe M, Spector L, Schiffman JD. The epidemiology of sarcoma. Clin Sarcoma Res 2012; 2:14. [PMID: 23036164 PMCID: PMC3564705 DOI: 10.1186/2045-3329-2-14] [Citation(s) in RCA: 404] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 04/18/2012] [Indexed: 12/12/2022] Open
Abstract
Sarcomas account for over 20% of all pediatric solid malignant cancers and less than 1% of all adult solid malignant cancers. The vast majority of diagnosed sarcomas will be soft tissue sarcomas, while malignant bone tumors make up just over 10% of sarcomas. The risks for sarcoma are not well-understood. We evaluated the existing literature on the epidemiology and etiology of sarcoma. Risks for sarcoma development can be divided into environmental exposures, genetic susceptibility, and an interaction between the two. HIV-positive individuals are at an increased risk for Kaposi's sarcoma, even though HHV8 is the causative virus. Radiation exposure from radiotherapy has been strongly associated with secondary sarcoma development in certain cancer patients. In fact, the risk of malignant bone tumors increases as the cumulative dose of radiation to the bone increases (p for trend <0.001). A recent meta-analysis reported that children with a history of hernias have a greater risk of developing Ewing's sarcoma (adjusted OR 3.2, 95% CI 1.9, 5.7). Bone development during pubertal growth spurts has been associated with osteosarcoma development. Occupational factors such as job type, industry, and exposures to chemicals such as herbicides and chlorophenols have been suggested as risk factors for sarcomas. A case-control study found a significant increase in soft tissue sarcoma risk among gardeners (adjusted OR 4.1, 95% CI 1.00, 14.00), but not among those strictly involved in farming. A European-based study reported an increased risk in bone tumors among blacksmiths, toolmakers, or machine-tool operators (adjusted OR 2.14, 95% CI 1.08, 4.26). Maternal and paternal characteristics such as occupation, age, smoking status, and health conditions experienced during pregnancy also have been suggested as sarcoma risk factors and would be important to assess in future studies. The limited studies we identified demonstrate significant relationships with sarcoma risk, but many of these results now require further validation on larger populations. Furthermore, little is known about the biologic mechanisms behind each epidemiologic association assessed in the literature. Future molecular epidemiology studies may increase our understanding of the genetic versus environmental contributions to tumorigenesis in this often deadly cancer in children and adults.
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Affiliation(s)
- Zachary Burningham
- Department of Family And Preventive Medicine, University of Utah, 2000 Circle of Hope, HCI-4245, Salt Lake City, UT, 84112, USA
| | - Mia Hashibe
- Department of Family And Preventive Medicine, University of Utah, 2000 Circle of Hope, HCI-4245, Salt Lake City, UT, 84112, USA
| | - Logan Spector
- Division of Epidemiology/Clinical Research, Department of Pediatrics and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Joshua D Schiffman
- Division of Pediatric Hematology/Oncology, Center for Children's Cancer Research, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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18
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Jemal A, Bray F, Forman D, O'Brien M, Ferlay J, Center M, Parkin DM. Cancer burden in Africa and opportunities for prevention. Cancer 2012; 118:4372-84. [PMID: 22252462 DOI: 10.1002/cncr.27410] [Citation(s) in RCA: 264] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 10/24/2011] [Accepted: 11/10/2011] [Indexed: 12/14/2022]
Abstract
Cancer is an emerging public health problem in Africa. About 715,000 new cancer cases and 542,000 cancer deaths occurred in 2008 on the continent, with these numbers expected to double in the next 20 years simply because of the aging and growth of the population. Furthermore, cancers such as lung, female breast, and prostate cancers are diagnosed at much higher frequencies than in the past because of changes in lifestyle factors and detection practices associated with urbanization and economic development. Breast cancer in women and prostate cancer in men have now become the most commonly diagnosed cancers in many Sub-Saharan African countries, replacing cervical and liver cancers. In most African countries, cancer control programs and the provision of early detection and treatment services are limited despite this increasing burden. This paper reviews the current patterns of cancer in Africa and the opportunities for reducing the burden through the application of resource level interventions, including implementation of vaccinations for liver and cervical cancers, tobacco control policies for smoking-related cancers, and low-tech early detection methods for cervical cancer, as well as pain relief at the palliative stage of cancer.
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Wakeham K, Webb EL, Sebina I, Muhangi L, Miley W, Johnson WT, Ndibazza J, Elliott AM, Whitby D, Newton R. Parasite infection is associated with Kaposi's sarcoma associated herpesvirus (KSHV) in Ugandan women. Infect Agent Cancer 2011; 6:15. [PMID: 21962023 PMCID: PMC3197512 DOI: 10.1186/1750-9378-6-15] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 09/30/2011] [Indexed: 12/20/2022] Open
Abstract
Background Immune modulation by parasites may influence susceptibility to bacteria and viruses. We examined the association between current parasite infections, HIV and syphilis (measured in blood or stool samples using standard methods) and antibodies against Kaposi's sarcoma herpesvirus (KSHV), measured by ELISA, in 1915 stored plasma samples from pregnant women in Entebbe, Uganda. Results Seroprevalence of KSHV was higher in women with malaria parasitaemia (73% vs 60% p = 0.01), hookworm (67% vs 56% p = 0.001) and Mansonella perstans (69% vs 59% p = 0.05); seroprevalence increased with increasing intensity of hookworm infection (p < 0.001[trend]). No associations were found for HIV, five other parasites or active syphilis. These effects were not explained by socioeconomic status or education. Conclusions Specific parasite infections are associated with presence of antibodies against KSHV, perhaps mediated via their effect on immune function.
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Affiliation(s)
- Katie Wakeham
- Co-infections Studies Programme, Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.,Epidemiology and Genetics Unit, Department of Health Sciences, Area 3 Seebohm Rowntree Building, University of York, York, YO10 5DD, UK
| | - Emily L Webb
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppal Street, London, WC1E 7HT, UK
| | - Ismail Sebina
- Co-infections Studies Programme, Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda
| | - Lawrence Muhangi
- Co-infections Studies Programme, Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda
| | - Wendell Miley
- Viral Oncology Section, AIDS and Cancer Virus Program, SAIC_Frederick, National Cancer Institute, PO Box B, Frederick, MD 21702, USA
| | - W Thomas Johnson
- Epidemiology and Genetics Unit, Department of Health Sciences, Area 3 Seebohm Rowntree Building, University of York, York, YO10 5DD, UK
| | - Juliet Ndibazza
- Co-infections Studies Programme, Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda
| | - Alison M Elliott
- Co-infections Studies Programme, Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppal Street, London, WC1E 7HT, UK
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, SAIC_Frederick, National Cancer Institute, PO Box B, Frederick, MD 21702, USA
| | - Robert Newton
- Epidemiology and Genetics Unit, Department of Health Sciences, Area 3 Seebohm Rowntree Building, University of York, York, YO10 5DD, UK.,Hull York Medical School, University of York, Heslington, YO10 5DD, UK
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20
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Taylor GS, Blackbourn DJ. Infectious agents in human cancers: lessons in immunity and immunomodulation from gammaherpesviruses EBV and KSHV. Cancer Lett 2011; 305:263-78. [PMID: 21470769 DOI: 10.1016/j.canlet.2010.08.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/23/2010] [Accepted: 08/22/2010] [Indexed: 01/13/2023]
Abstract
Members of the herpesvirus family have evolved the ability to persist in their hosts by establishing a reservoir of latently infected cells each carrying the viral genome with reduced levels of viral protein synthesis. In order to spread within and between hosts, in some cells, the quiescent virus will reactivate and enter lytic cycle replication to generate and release new infectious virus particles. To allow the efficient generation of progeny viruses, all herpesviruses have evolved a wide variety of immunomodulatory mechanisms to limit the exposure of cells undergoing lytic cycle replication to the immune system. Here we have focused on the human gammaherpesviruses Epstein-Barr virus (EBV) and Kaposi's sarcoma-associated herpesvirus (KSHV) that, uniquely among the eight human herpesviruses identified to date, have growth transforming potential. Most people infected with these viruses will not develop cancer, viral growth-transforming activity being kept under control by the host's antigen-specific immune responses. Nonetheless, EBV and KSHV are associated with several malignancies in which various viral proteins, either predominantly or exclusively latency-associated, are expressed; at least some of these proteins also have immunomodulatory activities. Of these malignancies, some are the result of a disrupted virus/immune balance through genetic, infectious or iatrogenic immune suppression. Others develop in people that are not overtly immune suppressed and likely modulate the immunological response. This latter aspect of immune modulation by EBV and KSHV forms the basis of this review.
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Affiliation(s)
- Graham S Taylor
- CR UK Cancer Centre, School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Vincent Drive, Edgbaston, Birmingham, UK
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21
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Phipps W, Ssewankambo F, Nguyen H, Saracino M, Wald A, Corey L, Orem J, Kambugu A, Casper C. Gender differences in clinical presentation and outcomes of epidemic Kaposi sarcoma in Uganda. PLoS One 2010; 5:e13936. [PMID: 21103057 PMCID: PMC2980479 DOI: 10.1371/journal.pone.0013936] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 08/29/2010] [Indexed: 11/18/2022] Open
Abstract
Introduction The incidence of Kaposi sarcoma (KS) has increased dramatically among women in sub-Saharan Africa since the onset of the HIV pandemic, but data on KS disease in women are limited. To identify gender-related differences in KS presentation and outcomes, we evaluated the clinical manifestations and response in men and women with AIDS-associated KS in Uganda. Methods and Findings HIV-infected adults with KS attending the Infectious Diseases Institute (IDI) and Uganda Cancer Institute (UCI) in Kampala, Uganda between 2004 and 2006 were included in a retrospective cohort. Evaluation of KS presentation was based on the clinical features described at the initial KS visit. Response was evaluated as the time to “improvement”, as defined by any decrease in lesion size, lesion number, or edema. The cohort consisted of 197 adults with HIV and KS: 55% (108/197) were women. At presentation, the median CD4 T-cell count was significantly lower in women (58 cells/mm3; IQR 11–156 cells/mm3) than men (124 cells/mm3; IQR 22–254 cells/mm3) (p = 0.02). Women were more likely than men to present with lesions of the face (OR 2.8, 95% CI, 1.4, 5.7; p = 0.005) and hard palate (OR 2.0, 95% CI, 1.1, 3.7; p = 0.02), and were less likely than men to have lower extremity lesions (OR 0.54, 95% CI, 0.3, 0.99; p = 0.05). Women were less likely than men to demonstrate clinical improvement (HR = 0.52, CI 0.31, 0.88; p = 0.01) in multivariate analysis. Conclusions The clinical presentation and response of KS differs between men and women in Uganda. These data suggest that gender affects the pathophysiology of KS, which may have implications for the prevention, diagnosis, and treatment of KS in both men and women. Prospective studies are needed to identify predictors of response and evaluate efficacy of treatment in women with KS, particularly in Africa where the disease burden is greatest.
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Affiliation(s)
- Warren Phipps
- Department of Medicine, University of Washington, Seattle, Washington, United States of America.
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Abstract
Over the last 30 years, the increasing use of organ and stem cell transplantation and the AIDS epidemic have led to the realization that some, but not all, human cancers occur more frequently in immunosuppressed individuals. With the notable exception of non-melanoma skin cancer (NMSC), most tumors that show strongly increased incidence rates in both transplant recipients and AIDS patients have been found to have a viral etiology. Among these are Kaposi sarcoma, diffuse large cell B-cell lymphoma, cervical cancer, liver cancer, Merkel cell carcinoma and a subset of Hodgkin's disease. A viral etiology for NMSC, i.e., beta- and gamma-subtypes of human papillomavirus, has been suggested and investigated for many years, but remains controversial. In addition, the moderately increased incidence rates of several other cancers in immunosuppressed individuals (e.g., Vajdic and van Leeuwen, Int J Cancer, in press) could indicate that additional infectious causes for at least some human cancers remain to be discovered. The controversy surrounding the role of cutaneous papillomavirus subtypes in the pathogenesis of NMSC illustrates the difficulties encountered when weighing the epidemiological and molecular biology evidence arguing for an involvement of highly prevalent viruses in certain types of cancer.
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Affiliation(s)
- Thomas F Schulz
- Institute of Virology, Hannover Medical School, Hannover 60325, Germany.
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Ascoli V, Senis G, Zucchetto A, Valerio L, Facchinelli L, Budroni M, Dal Maso L, Coluzzi M. Distribution of 'promoter' sandflies associated with incidence of classic Kaposi's sarcoma. MEDICAL AND VETERINARY ENTOMOLOGY 2009; 23:217-225. [PMID: 19712152 DOI: 10.1111/j.1365-2915.2009.00811.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The patchy geographical distributions of classic Kaposi's sarcoma (KS) and human herpesvirus type 8 (HHV-8), better known as Kaposi's sarcoma-associated herpesvirus (KSHV) remain unexplained. It has been proposed that certain species of bloodsucking insects ('promoter arthropods') promote the reactivation of HHV-8/KSHV and facilitate both HHV-8/KSHV transmission and KS development. This hypothesis was tested by sampling the presence and density of human-biting Diptera with CDC light traps in two areas of Sardinia with contrasting incidence rates of classic KS. In total, 11,030 specimens (99.9% sandflies and 0.1% mosquitoes) belonging to 10 species were collected from 40 rural sites. Five of these species are considered to be possible promoter arthropods because of the irritation their bites cause: Phlebotomus perniciosus Newstead; Phlebotomus perfiliewi Parrot (Diptera: Psychodidae); Aedes berlandi Seguy; Culiseta annulata (Schrank) and Culex theileri Theobald (Diptera: Culicidae). Five species are probable 'non-promoters' because their bites are not particularly irritating: Culiseta longiareolata (Macquart); Culex pipiens s.l.; Anopheles algeriensis Theobald; Anopheles maculipennis s.l., and Anopheles plumbeus Stephens. A significant correlation was found between the geographical distribution of promoter arthropods and incidence rates of KS (Spearman's r = 0.59,P < 0.01). Promoter arthropods were more likely to be caught in areas with cutaneous leishmaniasis and a past high prevalence of malaria, and in areas of limestone, acid volcanic soil and cereal cultivation. The study supports the association between promoter arthropods and classic KS, which may explain the geographic variability of KS and HHV-8/KSHV, and highlights the links with a number of variables previously associated with the incidence of KS.
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Affiliation(s)
- V Ascoli
- Anatomia Patologica, Dipartimento di Medicina Sperimentale, Università La Sapienza, Rome, Italy.
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Affiliation(s)
- Harry W Haverkos
- Captain US Public Health Service (Retired)Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
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25
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Tian RR, Liao QJ, Chen X. Prevention and treatment of KSHV-associated diseases with antiviral drugs. Virol Sin 2008. [DOI: 10.1007/s12250-008-2995-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Casper C. New approaches to the treatment of human herpesvirus 8-associated disease. Rev Med Virol 2008; 18:321-9. [PMID: 18615774 DOI: 10.1002/rmv.583] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Human herpesvirus 8 (HHV-8, also known as Kaposi sarcoma-associated herpesvirus or KSHV) is the etiologic agent of Kaposi sarcoma (KS) and primary effusion lymphoma (PEL), as well as many cases of Castleman disease. Despite significant advances in understanding the biology and natural history of these diseases, current treatment options have important limitations, and strategies to prevent their development in high-risk individuals are lacking. This article reviews the scope of HHV-8-associated disease, as well as the efficacy of current treatment options. Finally, novel approaches to treatment and prevention are described, including antiviral agents, targeted molecular therapy and a combination of these modalities.
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Affiliation(s)
- Corey Casper
- Vaccine and Infectious Disease Institute, Fred Hutchinson Cancer Research Center, and the Department of Medicine, University of Washington, Seattle, Washington 98109, USA.
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27
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Schwartz RA, Micali G, Nasca MR, Scuderi L. Kaposi sarcoma: a continuing conundrum. J Am Acad Dermatol 2008; 59:179-206; quiz 207-8. [PMID: 18638627 DOI: 10.1016/j.jaad.2008.05.001] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 04/20/2008] [Accepted: 05/05/2008] [Indexed: 12/11/2022]
Abstract
UNLABELLED Kaposi sarcoma (KS) remains a challenge. Its classic or Mediterranean form tends to be benign. In transplant recipients it may be less so. As part of the AIDS pandemic, of which it was an original defining component, it may be life-threatening. It is due to human herpesvirus-8, which is necessary but not sufficient to produce the disease. KS has a low prevalence in the general population of the United States and United Kingdom, with an intermediate rate in Italy and Greece, and a high one in parts of Africa. In Italy, hot spots include its southern regions, the Po River Valley, and Sardinia, possibly related to a high density of blood-sucking insects. An important challenge is to treat KS patients without immunocompromising them. The potential of effective anti-herpes virus therapy and the use of sirolimus in transplantation recipients have added new opportunities for KS prevention. LEARNING OBJECTIVES At the conclusion of this learning activity, participants should be able to provide the most recent information about Kaposi sarcoma in the context in which it occurs. Its classic or Mediterranean form, its pattern in transplant recipients and others iatrogenically immunosuppressed, and its occurrence as a potentially life-threatening part of the AIDS pandemic will be stressed. Its etiology and transmission will be discussed in detail to facilitate understanding of Kaposi sarcoma and of human herpesvirus-8 infection in the general population of the United States and United Kingdom, in Italy and Greece, and in certain parts of Africa. Its therapy, including the concept of doing it without immunocompromising the patient, will be stressed. New opportunities for Kaposi sarcoma prevention will also be discussed.
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Affiliation(s)
- Robert A Schwartz
- Department of Dermatology, New Jersey Medical School, Newark, New Jersey 07103-2714, USA.
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Abstract
As part of an epidemiological study of cancer in Uganda, we investigated social, sexual and reproductive factors in relation to the risk of cancer of the uterine cervix. Patients with all cancer types or with benign tumours were recruited from hospitals in Kampala, Uganda, interviewed about various demographic and lifestyle factors and tested for antibodies against the human immunodeficiency virus-1 (HIV). The case-control study reported here involves 702 HIV-seronegative women, 343 of whom were diagnosed with cancer of the uterine cervix. Key findings were that the risk of cervical cancer increased linearly with the number of pregnancies [chi2(1)=44.7; P<0.0001]; a woman reporting having had 10 or more children had a roughly seven-fold increase in risk of the tumour as compared with women reporting fewer than four pregnancies (odds ratio=7.1; 95% confidence interval 3.8-13.2). The risk also varied inversely with age at first reported sexual intercourse [chi2(1)=8.4; P=0.004], perhaps reflecting an earlier age of infection with human papillomavirus, the main causal agent. These results are in line with those reported from studies in other countries.
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Kasolo FC, Spinks J, Bima H, Bates M, Gompels UA. Diverse genotypes of Kaposi's sarcoma associated herpesvirus (KSHV) identified in infant blood infections in African childhood-KS and HIV/AIDS endemic region. J Med Virol 2007; 79:1555-61. [PMID: 17705172 PMCID: PMC2683451 DOI: 10.1002/jmv.20952] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2007] [Indexed: 11/08/2022]
Abstract
Kaposi's sarcoma-associated herpesvirus (KSHV or HHV-8) has been associated with several neoplasias, including childhood endemic Kaposi's sarcoma (KS). It is possible that strain genotypes could contribute to the differences in regional presentation (mainly sub-Saharan Africa), childhood infection, lack of male sex bias, distinct disseminated forms and rapid fatality observed for childhood endemic KS. Early studies, at the advent of the HIV/AIDS epidemic, identified only the K1-A5 genotype in childhood KS biopsies as well as blood of a few HIV positive and negative febrile infants in Zambia, a highly endemic region. This current enlarged study analyses blood infections of 200 hospitalized infants (6-34 months age) with symptoms of fever as well as upper respiratory tract infection, diarrhoea, rash or rhinitis. KSHV and HIV viraemia and were prevalent in this group, 22% and 39%, respectively. Multiple markers at both variable ends of the genome (K1, K12, and K14.1/K15) were examined, showing diverse previously adult-linked genotypes (K1 A2, A5, B, C3, D, with K12 B1 and B2 plus K14.1/K15 P or M) detected in both HIV positive and negative infants, demonstrating little restriction on KSHV genotypes for infant/childhood transmission in a childhood endemic KS endemic region. This supports the interpretation that the acquisition of childhood KSHV infections and subsequent development of KS are due to additional co-factors.
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Affiliation(s)
- FC Kasolo
- Virology Department, University Teaching Hospital, University of Zambia Medical SchoolLusaka, Zambia
| | - J Spinks
- Pathogen Molecular Biology Unit, Department of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St., University of LondonLondon WC1E 7HT, United Kingdom
| | - H Bima
- Virology Department, University Teaching Hospital, University of Zambia Medical SchoolLusaka, Zambia
| | - M Bates
- Pathogen Molecular Biology Unit, Department of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St., University of LondonLondon WC1E 7HT, United Kingdom
| | - UA Gompels
- Pathogen Molecular Biology Unit, Department of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel St., University of LondonLondon WC1E 7HT, United Kingdom
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Newton R, Ribeiro T, Alvarez E, Ziegler J, Casabonne D, Carpenter L, Beral V, Mbidde E, Parkin DM, Wabinga H, Mbulaiteye S, Jaffe H, Touzé A, Coursaget P. BK virus and cancer in Uganda. Eur J Cancer Prev 2007; 15:285-9. [PMID: 16835499 DOI: 10.1097/00008469-200608000-00002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As part of an epidemiological study of cancer in Uganda, we investigated the titre of antibodies against BK virus among 821 people with different cancer types and benign tumours. Among study participants, 790 were considered seropositive for anti-BK virus antibodies and all analyses were conducted on transformed data. The mean optical density (a measure of antibody titre) for all patients combined (including the 31 who were considered seronegative) was 1.03 (standard error 0.01), but was 5% higher in women than in men (P=0.05), and 8% higher among HIV seropositive than seronegative people (P=0.002). Otherwise, there were few consistent associations between anti-BK virus antibodies and any social and lifestyle factor investigated. Differences in the mean optical density for each cancer type were estimated using multivariate analysis of variance with adjustment for sex, age group and HIV serostatus, using all other patients as controls. The mean optical density was about 17% lower among those with oral cancer (optical density 0.86, standard error 0.06; P=0.01, based on 30 patients) and about 20% higher among those with prostate cancer (optical density 1.22, standard error 0.09; P=0.01, based on 11 cases) than among all other patients combined. The number of cases of each cancer was too small to exclude the possibility of these findings arising by chance. No other cancer site or type was significantly associated with low, or with high anti-BK virus antibody titres.
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Affiliation(s)
- Robert Newton
- Epidemiology and Genetics Unit, Department of Health Sciences, University of York, Heslington, York, UK.
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Orem J, Otieno MW, Remick SC. Challenges and opportunities for treatment and research of AIDS-related malignancies in Africa. Curr Opin Oncol 2006; 18:479-86. [PMID: 16894296 DOI: 10.1097/01.cco.0000239887.90665.10] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Following our review of AIDS-associated cancer in developing nations in 2004, we sought to update recent publications and review data on the challenges and opportunities for the treatment and research of AIDS malignancies in Africa. RECENT FINDINGS It is apparent that the burden of AIDS-related malignancies and other virus-associated tumors is significant and increasing in Africa. Several recent studies report findings on conjunctival squamous cell carcinoma and there is a report that Hodgkin's disease, a non-AIDS-defining neoplasm, is increasing in incidence. International collaborative partnerships dedicated to AIDS malignancies in developing countries are feasible and invaluable for clinical strategies to address this aspect of the pandemic. A departure point is the ongoing work of the East Africa - Case Western Reserve University Collaboration in AIDS malignancies. SUMMARY The burden of neoplastic complications of HIV infection and endemic virus-associated tumors are assuming increasing significance in Africa. There is a need to develop nonmyelotoxic therapies and approaches that are hypothesis-driven and pathogenesis-based. The scarcity and shortages in this region demand that our scientific and therapeutic strategies are both suitable and pragmatic for testing in this setting. It is also imperative that African investigators lead us in this important endeavor.
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Affiliation(s)
- Jackson Orem
- Uganda Cancer Institute, Mulago Hospital and the Makerere University School of Medicine, Kampala, Uganda.
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Newton R, Ziegler JL, Casabonne D, Carpenter L, Gold BD, Owens M, Beral V, Mbidde E, Parkin DM, Wabinga H, Mbulaiteye S, Jaffe H. Helicobacter pylori and cancer among adults in Uganda. Infect Agent Cancer 2006; 1:5. [PMID: 17150134 PMCID: PMC1660530 DOI: 10.1186/1750-9378-1-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Accepted: 11/07/2006] [Indexed: 12/27/2022] Open
Abstract
Data from Africa on infection with Helicobacter pylori (H. pylori) are sparse. Therefore, as part of an epidemiological study of cancer in Uganda, we investigated the prevalence and determinants of antibodies against H. pylori among 854 people with different cancer types and benign tumours. Patients were recruited from hospitals in Kampala, Uganda, interviewed about various demographic and lifestyle factors and tested for antibodies against H. pylori. In all patients combined, excluding those with stomach cancer (which has been associated with H. pylori infection), the prevalence of antibodies was 87% (723/833) overall, but declined with increasing age (p = 0.02) and was lower among people who were HIV seropositive compared to seronegative (p < 0.001). Otherwise, there were few consistent epidemiological associations. Among those with stomach cancer, 18/21 (86%) had anti-H. pylori antibodies (odds ratio 0.8, 95% confidence intervals 0.2-2.9, p = 0.7; estimated using all other patients as controls, with adjustment for age, sex and HIV serostatus). No other cancer site or type was significantly associated with anti-H. pylori antibodies. The prevalence of H. pylori reported here is broadly in accord with results from other developing countries, although the determinants of infection and its' role in the aetiology of gastric cancer in Uganda remain unclear.
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Affiliation(s)
- Robert Newton
- Epidemiology and Genetics Unit, Dept. of Health Sciences, First Floor, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD, UK
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - John L Ziegler
- Uganda Cancer Institute and Makerere University Medical School, Kampala, Uganda
- Dept. of Veterans Affairs and the University of California, San Francisco, to the International Agency for Research on Cancer, France
| | - Delphine Casabonne
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Lucy Carpenter
- MRC Programme on AIDS, Uganda Virus Research Institute, PO Box 49, Entebbe, Uganda
- Dept. of Public Health, Oxford University, to the MRC Programme on AIDS, Entebbe, Uganda
| | - Benjamin D Gold
- Division of Pediatric Gastroenterology and Nutrition, Department, Pediatrics, Emory University School of Medicine, 2040 Ridgewood Dr., NE, Atlanta, GA 30322, USA
| | - Marilyn Owens
- Division of Pediatric Gastroenterology and Nutrition, Department, Pediatrics, Emory University School of Medicine, 2040 Ridgewood Dr., NE, Atlanta, GA 30322, USA
| | - Valerie Beral
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Edward Mbidde
- Uganda Cancer Institute and Makerere University Medical School, Kampala, Uganda
| | - D Maxwell Parkin
- International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon, France
| | - Henry Wabinga
- Uganda Cancer Institute and Makerere University Medical School, Kampala, Uganda
| | - Sam Mbulaiteye
- Uganda Cancer Institute and Makerere University Medical School, Kampala, Uganda
| | - Harold Jaffe
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia, 30333, USA
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Simonart T. Role of environmental factors in the pathogenesis of classic and African-endemic Kaposi sarcoma. Cancer Lett 2006; 244:1-7. [PMID: 16542773 DOI: 10.1016/j.canlet.2006.02.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Revised: 02/05/2006] [Accepted: 02/07/2006] [Indexed: 01/10/2023]
Abstract
Kaposi sarcoma (KS) is a mesenchymal tumour associated with human herpesvirus-8 (HHV-8) infection. However, the incidence of HHV-8 infection is far higher than the prevalence of KS, suggesting that viral infection per se is not sufficient for the development of aggressive phenotype and that one or more additional cofactors are required. The great geographical variation in African-endemic and classic KS incidence points to a role for environmental factors in the etiology of Kaposi sarcoma. However, there are few unequivocably established environmental factors involved in KS pathogenesis. This review focuses on the environmental factors thought to be associated with KS, more particularly iron exposure and facilitation of transmission of HHV-8 infection by contact with blood-sucking arthropods.
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Affiliation(s)
- Thierry Simonart
- Department of Dermatology, Erasme University Hospital, Route de Lennik 808, B-1070 Brussels, Belgium.
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Newton R, Carpenter L, Casabonne D, Beral V, Babiker A, Darbyshire J, Weller I, Weiss R, Kwan A, Bourboulia D, Munoz F, Lagos D, Boshoff C. A prospective study of Kaposi's sarcoma-associated herpesvirus and Epstein-Barr virus in adults with human immunodeficiency virus-1. Br J Cancer 2006; 94:1504-9. [PMID: 16705315 PMCID: PMC2361279 DOI: 10.1038/sj.bjc.6603100] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Antibody titres against Kaposi's sarcoma associated herpesvirus (KSHV or human herpesvirus 8 (HHV-8)) and Epstein–Barr virus (EBV) were examined in people who subsequently developed Kaposi's sarcoma and non-Hodgkin's lymphoma, within randomised controlled trials of antiretroviral therapy in adults infected with the human immunodeficiency virus-1 (HIV). For each case of Kaposi's sarcoma (n=189) and each case of non-Hodgkin's lymphoma (n=67), which developed after randomisation, one control was randomly selected from other trial participants, after matching for age, sex, ethnicity, mode of HIV transmission, type of treatment received and period of follow-up. Using sera taken an average of two and a half years before the diagnosis of cancer, titres of antibodies against KSHV latent (LANA) and lytic (K8.1) antigens and against EBV (VCA) antigens were investigated in relation to subsequent risks of cancer by calculating odds ratios (OR) using conditional logistic regression. Latent antibodies against KSHV were detectable among 38% (72 out of 189) of Kaposi's sarcoma cases and 12% (23 out of 189) of their controls (OR=4.4, 95% confidence intervals (CI) 2.3–8.3, P<0.001). The OR for Kaposi's sarcoma increased with increasing antilatent KSHV antibody titre (χ21 for trend=32.2, P<0.001). Lytic antibodies against KSHV were detectable among 33% (61 out of 187) of Kaposi's sarcoma cases and 19% (36 out of 187) of their controls (OR=2.0, 95% CI 1.2–3.4, P=0.003) and the OR for Kaposi's sarcoma increased with increasing antilytic KSHV antibody titre (χ21 for trend=6.2, P=0.02). Virtually, all cases and controls had anti-EBV antibodies detected and the OR for non-Hodgkin's lymphoma associated with a doubling of the anti-EBV antibody titre was estimated to increase by a multiplicative factor of 1.3 (95% CI 0.9–1.7, P=0.1). Kaposi's sarcoma was not associated with antibody levels against EBV (P=0.4) and non-Hodgkin's lymphoma was not associated with antibodies against KSHV (latent P=0.3; lytic P=0.5). Adjustment for CD4 count at the time of sample collection made no material difference to any of the results. In conclusion, among human immunodeficiency virus infected people, high levels of antibodies against KSHV latent and lytic antigens are strongly associated with subsequent risk of Kaposi's sarcoma but not non-Hodgkin's lymphoma. Antibody titre to EBV does not appear to be strongly associated with subsequent risk of Kaposi's sarcoma or non-Hodgkin's lymphoma in HIV infected people.
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Affiliation(s)
- R Newton
- Epidemiology and Genetics Unit, Department of Health Sciences, Area 3, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK.
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Ascoli V, Facchinelli L, Valerio L, Zucchetto A, Dal Maso L, Coluzzi M. Distribution of mosquito species in areas with high and low incidence of classic Kaposi's sarcoma and seroprevalence for HHV-8. MEDICAL AND VETERINARY ENTOMOLOGY 2006; 20:198-208. [PMID: 16871701 DOI: 10.1111/j.1365-2915.2006.00624.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The 'promoter-arthropod' hypothesis, which postulates that exposure to the bites of certain species of haematophagous arthropods is an environmental risk cofactor linked to human herpes virus 8 (HHV-8) and Kaposi's sarcoma, was investigated in the Po River valley, northern Italy. The presence and density of adult female mosquitoes (Diptera: Culicidae) was determined by CDC light trap catches in two adjacent districts, at variance with respect to Kaposi's sarcoma incidence and HHV-8 seroprevalence. A total of 3910 specimens belonging to 11 species was collected in 34 rural sites (six municipalities) representative of the two districts. Five of these species are considered to be possible 'promoters' because of the irritation their bites cause humans: Aedes vexans (Meigen) and Ae. caspius (Pallas) (87% of sampled promoters), Culex modestus Ficalbi, Culiseta annulata (Schrank) and Coquillettidia richiardii (Ficalbi). Six are probable 'non-promoters': Cx. pipiens s.l., Cx. martinii Medschid, Anopheles claviger (Meigen), An. maculipennis s.l., An. plumbeus Stephens and Uranotaenia unguiculata Edwards. The density of promoters by site was correlated with the incidence rates of Kaposi's sarcoma at the district level (Pearson's r = 0.33, P = 0.06) and at the municipal level (r = 0.50, P< 0.01). Similar correlations emerged for non-promoters (r = 0.48, P< 0.01 and r = 0.42, P = 0.01, respectively). The density of promoters was higher than that of non-promoters in sites with livestock (odds ratio, OR = 2.8, 95% CI 2.2-3.6) and in municipalities with Kaposi's sarcoma cases (OR = 2.5, 95% CI 1.7-3.5). The study provides additional evidence of the association between the density of some mosquito species and Kaposi's sarcoma.
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Affiliation(s)
- V Ascoli
- Dipartimento di Medicina Sperimentale e Patologia, Rome, Italy.
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Mbulaiteye SM, Biggar RJ, Pfeiffer RM, Bakaki PM, Gamache C, Owor AM, Katongole-Mbidde E, Ndugwa CM, Goedert JJ, Whitby D, Engels EA. Water, socioeconomic factors, and human herpesvirus 8 infection in Ugandan children and their mothers. J Acquir Immune Defic Syndr 2005; 38:474-9. [PMID: 15764964 DOI: 10.1097/01.qai.0000132495.89162.c0] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Human herpesvirus 8 (HHV-8) infection is common in sub-Saharan Africa, but its distribution is uneven. Transmission occurs during childhood within families by unclear routes. METHODS We evaluated 600 Ugandan children with sickle cell disease and their mothers for factors associated with HHV-8 seropositivity in a cross-sectional study. HHV-8 serostatus was determined using an HHV-8 K8.1 glycoprotein enzyme immunoassay. Odds ratios for seropositivity were estimated using logistic regression, and factor analysis was used to identify clustering among socioeconomic variables. RESULTS One hundred seventeen (21%) of 561 children and 166 (34%) of 485 mothers with definite HHV-8 serostatus were seropositive. For children, seropositivity was associated with age, mother's HHV-8 serostatus (especially for children aged 6 years or younger), lower maternal education level, mother's income, and low-status father's occupation (P < 0.05 for all). Using communal standpipe or using surface water sources were both associated with seropositivity (OR 2.70, 95% CI 0.80-9.06 and 4.02, 95% CI 1.18-13.7, respectively) as compared to using private tap water. These associations remained, albeit attenuated, after adjusting for maternal education and child's age (P = 0.08). In factor analysis, low scores on environmental and family factors, which captured household and parental characteristics, respectively, were positively associated with seropositivity (P(trend) < 0.05 for both). For mothers, HHV-8 seropositivity was significantly associated with water source and maternal income. CONCLUSIONS HHV-8 infection in Ugandan children was associated with lower socioeconomic status and using surface water. Households with limited access to water may have less hygienic practices that increase risk for HHV-8 infection.
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Affiliation(s)
- Sam M Mbulaiteye
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Rockville, MD 20852, USA.
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Abstract
PURPOSE OF REVIEW With the emergence of the highly active antiretroviral therapy era, it is apparent that the incidence of Kaposi sarcoma, in particular, and lymphoma in patients with AIDS is declining, especially in regions of the world where these regimens are routinely available. The burden of HIV infection and AIDS is greatest in the developing world, and no doubt neoplastic complications are increasingly encountered. The purpose of this review is to highlight recent developments of this aspect of the AIDS epidemic in the developing world. RECENT FINDINGS It was readily apparent that the incidence of Kaposi sarcoma sharply increased after the onset of the AIDS epidemic in developing countries. By the end of the second decade of the epidemic, non-Hodgkin lymphoma is increasing in incidence and the natural history of Burkitt lymphoma is evolving in the backdrop of HIV infection as well. Cervical cancer is the most common cancer in women in many developing countries, yet the true impact of HIV infection on the development of this neoplasm is not fully understood. Squamous cell carcinoma of the conjunctiva appears to be a unique AIDS-associated neoplasm that is encountered in sub-Saharan Africa as well. Finally, although the epidemiologic and clinicopathologic features for many AIDS-associated neoplasms are well characterized in developing regions of the world, there is a paucity of data on the therapeutic approach to these tumors in this setting. SUMMARY It is apparent that as the AIDS pandemic proceeds, the burden of neoplastic diseases is increasing in developing nations. Current therapeutic approaches are not well documented. Pragmatic prevention and therapeutic interventions suitable for the resource-constrained setting are clearly needed.
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Affiliation(s)
- Jackson Orem
- Uganda Cancer Institute, Mulago Hospital and the Makerere University School of Medicine, Kampala, Uganda
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Simonart T. Iron: a target for the management of Kaposi's sarcoma? BMC Cancer 2004; 4:1. [PMID: 14725718 PMCID: PMC317471 DOI: 10.1186/1471-2407-4-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2003] [Accepted: 01/15/2004] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Kaposi's sarcoma (KS) is a mesenchymal tumour associated with human herpesvirus-8 infection. However, the incidence of human herpesvirus-8 infection is far higher than the prevalence of KS, suggesting that viral infection per se is not sufficient for the development of malignancy and that one or more additional cofactors are required. DISCUSSION Epidemiological data suggest that iron may be one of the cofactors involved in the pathogenesis of KS. Iron is a well-known carcinogen and may favour KS growth through several pathways. Based on the apoptotic and antiproliferative effect of iron chelation on KS cells, it is suggested that iron withdrawal strategies could be developed for the management of KS. Studies using potent iron chelators in suitable KS animal models are critical to evaluate whether iron deprivation may be a useful anti-KS strategy. SUMMARY It is suggested that iron may be one of non-viral co-factors involved of KS pathogenesis and that iron withdrawal strategies might interfere with tumour growth in patients with KS.
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Affiliation(s)
- Thierry Simonart
- Department of Dermatology, Erasme University Hospital, Route de Lennik 808, B-1070 Brussels, Belgium.
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Wojcicki JM, Newton R, Urban MI, Stein L, Hale M, Patel M, Ruff P, Sur R, Bourboulia D, Sitas F. Risk factors for high anti-HHV-8 antibody titers (> or =1:51,200) in black, HIV-1 negative South African cancer patients: a case control study. BMC Infect Dis 2003; 3:21. [PMID: 12971827 PMCID: PMC222909 DOI: 10.1186/1471-2334-3-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2003] [Accepted: 09/12/2003] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Infection with human herpesvirus 8 (HHV-8), also known as Kaposi's sarcoma-associated herpesvirus (KSHV), is the necessary causal agent in the development of Kaposi's sarcoma (KS). Infection with HIV-1, male gender and older age all increase risk for KS. However, the geographic distribution of HHV-8 and KS both prior to the HIV/AIDS epidemic and with HIV/AIDS suggest the presence of an additional co-factor in the development of KS. METHODS Between January 1994 and October 1997, we interviewed 2576 black in-patients with cancer in Johannesburg and Soweto, South Africa. Blood was tested for antibodies against HIV-1 and HHV-8 and the study was restricted to 2191 HIV-1 negative patients. Antibodies against the latent nuclear antigen of HHV-8 encoded by orf73 were detected with an indirect immunofluorescence assay. We examined the relationship between high anti-HHV-8 antibody titers (> or =1:51,200) and sociodemographic and behavioral factors using unconditional logistic regression models. Variables that were significant at p = 0.10 were included in multivariate analysis. RESULTS Of the 2191 HIV-1 negative patients who did not have Kaposi's sarcoma, 854 (39.0%) were positive for antibodies against HHV-8 according to the immunofluorescent assay. Among those seropositive for HHV-8, 530 (62.1%) had low titers (1:200), 227 (26.6%) had medium titers (1:51,200) and 97 (11.4%) had highest titers (1:204,800). Among the 2191 HIV-1 negative patients, the prevalence of high anti-HHV-8 antibody titers (> or =1:51,200) was independently associated with increasing age (p-trend = 0.04), having a marital status of separated or divorced (p = 0.003), using wood, coal or charcoal as fuel for cooking 20 years ago instead of electricity (p = 0.02) and consuming traditional maize beer more than one time a week (p = 0.02; p-trend for increasing consumption = 0.05) although this may be due to chance given the large number of predictors considered in this analysis. CONCLUSIONS Among HIV-negative subjects, patients with high anti-HHV-8 antibody titers are characterized by older age. Other associations that may be factors in the development of high anti-HHV-8 titers include exposure to poverty or a low socioeconomic status environment and consumption of traditional maize beer. The relationship between these variables and high anti-HHV-8 titers requires further, prospective study.
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Affiliation(s)
- Janet M Wojcicki
- Center for AIDS Prevention Studies, University of California, San Francisco, United States
| | - Rob Newton
- Cancer Epidemiology Unit, the Radcliffe Infirmary, Oxford University, United Kingdom
| | - Margaret I Urban
- The South African Cancer Epidemiology Research Group, South Africa
| | - Lara Stein
- The South African Cancer Epidemiology Research Group, South Africa
| | - Martin Hale
- Department of Anatomical Pathology, the National Health Laboratory Service and the University of the Witwatersrand, South Africa
| | - Moosa Patel
- Division of Medical Oncology, Department of Medicine, University of Witwatersrand, Faculty of Health Sciences,, South Africa
- The Haematology/Oncology Division, Department of Medicine at Chris Hani Baragwanath Hospital, South Africa
| | - Paul Ruff
- Division of Medical Oncology, Department of Medicine, University of Witwatersrand, Faculty of Health Sciences,, South Africa
- Johannesburg Hospital, Johannesburg, South Africa
| | - Ranjan Sur
- Division of Medical Oncology, Department of Medicine, University of Witwatersrand, Faculty of Health Sciences,, South Africa
- McMaster University Hamilton Regional Cancer Centre, Department of Radiation Oncology, Hamilton, Ontario, Canada
| | - Dimitra Bourboulia
- Cancer Research UK, Viral Oncology Group, Wolfeon Institute for Biomedical Research, University College London, UK
| | - Freddy Sitas
- The South African Cancer Epidemiology Research Group, South Africa
- The New South Wales Cancer Council, Woolloomooloo, Australia
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40
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Newton R, Ziegler J, Bourboulia D, Casabonne D, Beral V, Mbidde E, Carpenter L, Parkin DM, Wabinga H, Mbulaiteye S, Jaffe H, Weiss R, Boshoff C. Infection with Kaposi's sarcoma-associated herpesvirus (KSHV) and human immunodeficiency virus (HIV) in relation to the risk and clinical presentation of Kaposi's sarcoma in Uganda. Br J Cancer 2003; 89:502-4. [PMID: 12888820 PMCID: PMC2394369 DOI: 10.1038/sj.bjc.6601113] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A case-control study from Uganda found that the risk of Kaposi's sarcoma increased with increasing titre of antibodies against Kaposi's sarcoma-associated herpesvirus (KSHV) latent nuclear antigens, independently of HIV infection. Clinically, widespread Kaposi's sarcoma was more frequent among patients with HIV infection than in those without, but was not related to anti-KSHV antibody titres.
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Affiliation(s)
- R Newton
- Cancer Research UK, Epidemiology Unit, Gibson Building, Radcliffe Infirmary, Oxford OX2 6HE, UK
- Cancer Research UK, Epidemiology Unit, Gibson Building, Radcliffe Infirmary, Oxford OX2 6HE, UK. E-mail:
| | - J Ziegler
- Uganda Cancer Institute and Makerere University Medical School, Kampala, Uganda
| | - D Bourboulia
- Cancer Research UK, Viral Oncology Group, Wolfson Institute of Medical Sciences, Cruciform Building, Gower Street, London WC1E 6BT, UK
| | - D Casabonne
- Cancer Research UK, Epidemiology Unit, Gibson Building, Radcliffe Infirmary, Oxford OX2 6HE, UK
| | - V Beral
- Cancer Research UK, Epidemiology Unit, Gibson Building, Radcliffe Infirmary, Oxford OX2 6HE, UK
| | - E Mbidde
- Uganda Cancer Institute and Makerere University Medical School, Kampala, Uganda
| | - L Carpenter
- MRC Programme on AIDS, Uganda Virus Research Institute, PO Box 49, Entebbe, Uganda
| | - D M Parkin
- International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon, France
| | - H Wabinga
- Uganda Cancer Institute and Makerere University Medical School, Kampala, Uganda
| | - S Mbulaiteye
- Uganda Cancer Institute and Makerere University Medical School, Kampala, Uganda
| | - H Jaffe
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia, 30333, USA
| | - R Weiss
- Windeyer Institute, University College London, 46 Cleveland Street, London, UK
| | - C Boshoff
- Cancer Research UK, Viral Oncology Group, Wolfson Institute of Medical Sciences, Cruciform Building, Gower Street, London WC1E 6BT, UK
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Newton R, Ziegler J, Bourboulia D, Casabonne D, Beral V, Mbidde E, Carpenter L, Reeves G, Parkin DM, Wabinga H, Mbulaiteye S, Jaffe H, Weiss R, Boshoff C. The sero-epidemiology of Kaposi's sarcoma-associated herpesvirus (KSHV/HHV-8) in adults with cancer in Uganda. Int J Cancer 2003; 103:226-32. [PMID: 12455037 DOI: 10.1002/ijc.10817] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The association between the prevalence of antibodies against Kaposi's sarcoma-associated herpesvirus (KSHV or human herpesvirus 8 [HHV-8]) and sociodemographic, sexual, reproductive and lifestyle factors was investigated in a study of adults presenting with cancer at hospitals in Kampala, Uganda. Patients were interviewed and tested for antibodies against KSHV (using an indirect immunofluorescent assay). Data are presented for 607 patients who were not infected with the human immunodeficiency virus-1 (HIV) and who did not have Kaposi's sarcoma (these included people with cancers of the uterine cervix [140], breast [58], liver [41], oesophagus [36], lymphoma [47], other cancers [285] and benign tumours [63]). The prevalence of anti-KSHV antibodies was 50% overall (302/607) and did not differ significantly by cancer site (p = 0.4) or sex (p = 0.2), but increased linearly with age from 35% in those under 25 years to 55% in those 45 years and over (chi(2) trend [1 df] = 9.1; p < 0.001). After adjusting for age and sex, anti-KSHV antibodies were more common in tribal groups other than the Baganda tribe (54% vs. 45% among Baganda; p = 0.02), but there was no significant (p > 0.05) variation in seroprevalence by district of birth, region of residence prior to becoming ill or various measures of wealth. The prevalence of anti-KSHV antibodies decreased with increasing number of older siblings, although this may be due to chance (p = 0.05) and was higher among people who had ever been married (p = 0.03). There was no significant association (p > 0.05) between the presence of antibodies against KSHV and other sexual and reproductive factors. Among the 302 patients with anti-KSHV antibodies, the proportion with high titres increased linearly with increasing age (p = 0.03) and was higher among those reporting having had a blood transfusion (p = 0.03). In conclusion, in this population in Uganda, where KSHV is relatively common, the prevalence of anti-KSHV antibodies increased with age but showed little association with nearly 50 other factors studied.
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Affiliation(s)
- Robert Newton
- Cancer Research UK, Epidemiology Unit, Radcliffe Infirmary, Oxford, United Kingdom.
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