Transplantation-associated Kaposi's sarcoma: herpesvirus 8 transmission through renal allografts

Fifty percent tissue culture infective dose assay for determining the titer of infectious human herpesvirus 8

We have developed a human herpesvirus 8 (HHV-8) 50% tissue culture infective dose (TCID50) assay using the T1H6-DC-SIGN cell line. Infection of T1H6-DC-SIGN cells with HHV-8 induces expression of β-galactosidase, which was used to determine TCID50 levels. Validation of TCID50 values was performed by immunofluorescence assay of HHV-8 infection of immature dendritic cells at various TCID50 doses.

[Donor-transmitted infections]

The defence response to infectious agents is compromised in solid organ recipients because of their immunosuppressive treatment. Transmission of infection from a donor organ can result in dysfunction or loss of the allograft, and may lead to death of the recipient if adequate preventive measures are not taken. This potential risk should be thoroughly assessed, particularly in the case of organs from infected donors, in order to optimize organ use without increasing the incidence of graft dysfunction and recipient morbidity and mortality. This article reviews the current knowledge regarding screening for infection in potential donors and discusses risk-benefit considerations related to the use of organs from infected donors.

Regression of post-transplant Kaposi's sarcoma using sirolimus

Kaposi's sarcoma (KS) is a recognised complication following kidney transplantation, but the incidence varies according to the geographical area. Although it is a rare tumour, its incidence increases dramatically after solid-organ transplantation. The immunosuppressive medications reactivate human herpes virus 8, which has been proposed as the offending agent. The usual treatment of KS is to reduce immunosuppression, chemotherapy and radiotherapy. Nevertheless, the mortality still remains considerably high and has been reported between 8 and 14%. Sirolimus (SRL) has properties which may be useful in the management of some posttransplant tumours such as KS. We report a renal transplant patient with KS, who had multiple relapses after radiotherapy but responded well to the change of immunosuppression from cyclosporine to SRL.

Human herpesvirus 8, Kaposi's sarcoma, and associated conditions

HHV-8 is a recently identified human herpes virus that can produce tumors, most often in immune compromised hosts. The virus is most closely associated with Kaposi's sarcoma, but is also clearly associated with primary effusion lymphomas and multicentric Castleman's disease. The prevalence of HHV-8 infection varies considerably, but is highest among men who have sex with men and others with histories of sexually transmitted diseases and high numbers of lifetime sexual partners. HHV-8 is shed in saliva, and less commonly in genital secretions. Treatment of HHV-8 associated diseases includes reversal of immune compromise either via discontinuation of immunosuppressives or immune reconstitution via antiretroviral regimens. Specific antiviral drug inhibit HHV-8 replication, and can result in responses in certain HHV-8-associated conditions.

Seroprevalence of Kaposi's sarcoma-associated herpesvirus infection among blood donors from Texas

PURPOSE

Kaposi's sarcoma-associated herpesvirus (KSHV), a gammaherpesvirus recently discovered among AIDS patients with Kaposi's sarcoma, is a potential candidate for screening in blood and plasma donors. While a number of studies have assessed KSHV infection among U.S. blood donors, larger-scale population-based studies would be necessary to develop more refined estimates of the magnitude and variation of KSHV infection across different geographic regions of the U.S. blood supply. The goal of the present study, therefore, was to determine the seroprevalence of KSHV infection and to assess demographic correlates of KSHV infection among south Texas blood donors.

METHODS

KSHV infection was determined using specific serologic assays that measure antibodies to KSHV latent and lytic antigens.

RESULTS

The overall seroprevalence of KSHV in Texas blood donors (15.0%) is substantially higher than previously reported among blood donor and general population samples in the United States. This high rate of KSHV infection persisted across most of the sociodemographic subgroups under study but was particularly elevated among participants with less than a high school education. The infection rate also increased linearly with age.

CONCLUSIONS

The elevated infection rate reported in the present study suggests that screening methods to detect KSHV infection in blood donors should be considered. In view of the etiologic role of KSHV for several malignancies, it would be important for future studies to directly assess the risk of KSHV transmission via blood transfusion.

Hot-spot variations of Kaposi's sarcoma-associated herpesvirus latent nuclear antigen and application in genotyping by PCR-RFLP

Kaposi's sarcoma-associated herpesvirus (KSHV, human herpesvirus-8) is aetiologically associated with Kaposi's sarcoma and several other lymphoproliferative disorders. The latent nuclear antigen (LNA) encoded by KSHV ORF73 has important functions in virus latent infection and shows molecular polymorphism. Sequence variations were identified in the internal repeat domain (IRD) of ORF73. DNA sequencing of ORF73 from one KSHV-infected cell line, PK-1, revealed that there were 558 bp (30.2%) deletions and 66 (3.6%) point mutations located mainly in repeat region 2, the glutamine-rich region of ORF73 IRD, compared with ORF73 of BC-1 KSHV. Similar sequence variations of ORF73 were also identified in two other isolates. None of the sequence variations caused any translational frame-shift in these four KSHV isolates examined, suggesting that LNA has a conservative function in virus latent infection. The frequent sequence variations in repeat region 2 of ORF73 IRD were also identified by PCR-RFLP genotyping in 26 KSHV isolates, suggesting that this region is a 'hot-spot' for genetic variations. Each Kaposi's sarcoma lesion sample contained one virus genotype with a unique RFLP pattern, indicating that in vivo KSHV infection was established with single predominate genotypes, which was further supported by the presence of invariable genotypes in multifocal lesions from individual KS patients. Four KSHV subtypes were classified based on the RFLP patterns that represent the patterns of DNA sequence variations in the ORF73 IRD. PCR-RFLP genotyping is capable of identifying LNA genetic variations and differentiating individual KSHV isolates, and thus may be useful for KSHV molecular epidemiology studies.

Human Herpesvirus 8 Infections

Human herpesvirus 8 (HHV-8) or Kaposi's sarcoma (KS)-associated herpesvirus is a recently identified virus that is associated with KS, multicentric Castleman's disease, and body cavity-based lymphomas. KS is the most common kind of cancer in AIDS patients and the initial AIDS-defining condition in over 20% of patients. HHV-8 DNA has now been detected in over 95% of KS tissue samples supporting the concept that HHV-8 has a causal role in KS. The discovery has opened new avenues for understanding the epidemiology, pathogenesis, and treatment of KS and related conditions.