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THE SEROPREVALENCE OF HHV8 IN THE HAART NAVE HIVPATIENTS AT KENYATTA NATIONAL HOSPITAL
COMPREHENSIVE CARE CLINIC
Einstein M. Tsuma,
Omu Anzala,
Erastus O. Amayo,
Gladwell K. Kiarie,
Marybeth C. Maritim and Peter Wanzala
a Dissertation to be Submitted in Partial Fulfillment to the Award of the Degree ofMasters in Medicine in Internal Medicine, University of Nairobi
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1.HHV8 causes KS HHV8 is the causative agent for KS1
LANA
Viral G
IL6
Viral flip
KS is the 2nd most frequent tumor in HIV patients worldwide.2
Most common cancer in HIV in sub Saharan Africa.
Synergy HIV and HHV8
Seroconversion to HHV8 seropositivity associated with
development of KS.3,4
1. Chang, Y. et al. Science 19942. Martellotta, F.et al Curr HIV Res. 20093. Edelman, D et al. Virology Journal20054. QIN, D., LU, C. Virologica sinica.2008
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Immunological status and HHV8
Low CD4 counts faster progression to
KS.1,2
Low CD4 counts associated withincreased risk for HHV8 seropositivity.3
1. Guiguet, M et al. Lancet oncology. 2009
2. Jacobson et al. J Infect Dis. 2000
3. Guadalupe M., et al .J Acquir Immune Defic Syndr. 2011
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2.HHV8 is a common infection
Seroprevalence of HHV8 >40 %
sub-Saharan Africa.1,2
Kenya-HHV8 prevalence is about43-44%.3,4
No studies in the HIV population.
1. Ahmadpoor, P. Iranian Journal of Kidney Diseases.2009
2. Dukers, et al.Am J EpidemiolVol. 2000
3. Baeten, J. M. et al.AIDS. 2002
4. Lavreys, L, et al. The Journal of Infectious Diseases. 2003
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What are the association to HHV8seropositivity?
HHV8 transmitted thro various mechanisms.1 Sexual( heterosexual, homosexual)
Horizontal
Parenteral2
Seropositivity has been associated3,4
Age
STI
Circumcision
Condom use
Smoking
Low socioeconomic status
1. Sullivan, R. J. et al. Clinical Infectious Diseases 20082. Hladik, Wet al . N Engl J Med. 20063. Baeten, J. M. et al.AIDS. 2002
4. Campbell, T.B. et al. Clin Infect Dis. 2009
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3.Treatment of HHV8 infection is available
Antiviral agents1,2
Foscarnet and ganciclovir
Valganciclovir
HAART 3,4
Decreased KS incidence since HAART in
1996
1. Casper, C. Rev. Med. Virol. 2008
2. Casper, C. et al.Jour Inf. Dis.2008
3. Bourboulia, D. et al.AIDS 2004
4. Appleby, P. et al. J Natl Cancer Inst. 2000
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Incidence rates (99% confidence intervals [CIs]) for Kaposi'ssarcoma. Rates are adjusted for study, age at seroconversion, time
since seroconversion, sex, and HIV transmission group.1
71.Appleby, P. et al. J Natl Cancer Inst.2000 92(22):1823-30
Figure 2
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Study Objectives
To determine the seroprevalenceof HHV8
Cross sectional descriptive studydesign
Site - KNH CCC.
HAART naive HIV patients
Consecutively recruited.
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METHODS
Patients recruited from December2010 to April 2011
Ethical approval was obtained fromERC/KNH
Pretested questionnaire
Blood drawn for analysis.HHV8serology and CD4 counts
Data analyze SPSS version 179
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Results
Baseline characteristics HHV8 seroprevalence
200(54.4%) of the
population tested
positive for HHV8.
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Demographic characteristicsand HHV8 seropositivity
HHV8 status
n Positive
% P value
Gender Male 120 (78) 65.0% 0.005
Female 247 (122) 49.4%
Marital status Divorced 29 (14) 48.3% 0.956
Married 206 (115) 55.8%
Separated 6 (3) 50.0%
Single 85 (46) 54.1%
Widowed 38 (21) 55.3%
Education level College 87 (47) 54.0% 0.647
None 8 (5) 62.5%
Primary 121 (71) 58.7%
Secondary 148 (76) 51.4%
Religion Christian 355 (195) 54.9%
Muslim 9 (4) 44.4%
Employment status Govt 44 (22) 50.0% 0.372
Non-Govt 86 (53) 61.6%
Self-employed
144
(73)
50.7%
Unemployed 90 (51) 56.7%11
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CD4 counts and HHV8seropositivity
HHV8 status
n Positive
Row N %P value
CD4 Count grouped 0-49 14 (4) 28.6% =500 133 (49) 36.8%
Age groups 40 years 121 (73) 60.3%
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Multivariate analysis
The male gender was an independentpredictor of HHV8 seropositivity. oddsratio 2.77(1.75-4.38) [95%CI]
Lower CD4 counts was also anindependent predictor of HHV8
seropositivity. odds ratio 1.881 (1.18-2.99)[95% CI]
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Discussion of results.
Seroprevalence of HHV8 is 54.4%
Male gender is an independent risk
factor for HHV8 seropositivity.
low CD4(
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Study limitations
Lack of gold standard diagnostic tests.
Because the study was conducted in a
hospital during a specific period, thereis potential for confounding by regional
or temporal differences in HHV-8
seroprevalence.
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