Transmission of HHV-8

HHV-8 is spread sexually, through mother-to-child contact, and via organ transplant. A growing body of research suggests that the relatively high levels of HHV-8 in saliva may also contribute to HHV-8 transmission.

HHV-8 was originally thought to be transmitted through anal sex and rimming (oral-anal sex) because of its high prevalence among gay men. Certainly there is considerable evidence to suggest that HHV-8 is spread through sexual contact between men, although the actual mechanism remains elusive. A study of 259 HIV-positive men followed between 1982 and 1999 found that receptive anal intercourse, insertive rimming, and insertive fisting were significant risk factors for HHV-8 seropositivity.1 Other studies have supported the link between anal sex and rimming and HHV-8 transmission.2,3 Most recently, new HHV-8 infection among gay men has been associated with an HIV-positive partner, rather than any specific sexual practice, and use of amyl nitrate.4

However, very little HHV-8 has been found in the sexual fluid of people infected with the virus. For example, HHV-8 was detected in only one sample from six HHV-8 / HIV-positive men and in the cervico-vaginal secretions of only one of 13 women infected with both HHV-8 and HIV-1.5 Another study found 30% of tissue samples taken from the mouths and throats of 30 HHV-8 / HIV co-infected men contained HHV-8 compared with 1% of anal and genital samples. In addition, HHV-8 viral load in the mouth and throat was much higher than viral in other tissues.6,7 Similar results have been reported among women: HHV-8 DNA was found in a third of salivary samples taken from 34 HHV-8-infected women but in no cervical samples.

These findings suggest that HHV-8 in saliva may play an important role in HHV-8 transmission. This theory accords with the high prevalence of HHV-8 in Africa, where HHV-8 is thought to be acquired during infancy or early childhood. It has been suggested that HHV-8 is transmitted to children through maternal saliva when women pre-chew their infants' food.8,9 Social factors such as poor nutrition, poverty, poor hygiene and crowded living conditions may also contribute to the transmission of HHV-8 in Africa,10 while HIV infection is known to increase the risk of childhood acquisition of HHV-8.11

References

  1. O'Brien TR et al. Evidence for concurrent epidemics of human herpesvirus 8 and human immunodeficiency virus type 1 in US homosexual men: rates, risk factors and relationship to Kaposi's sarcoma. Journal of Infectious Diseases 180(4): 1010-1017, 1999
  2. Diamond C et al. Seroepidemiology of human herpesvirus 8 among young men who have sex with men. Sex Transm Dis 28: 176-183, 2001
  3. Grulich A et al. Route of transmission of Kaposi's sarcoma associated herpes virus. J Acquir Immune Defic Syndr 14: A16, 1997
  4. Casper C et al. Correlates of prevalent and incident Kaposi's sarcoma-associated herpesvirus infection in men who have sex with men. J Infect Dis 185: 990-993, 2002
  5. Calabro ML et al. Detection of Human Herpesvirus 8 in cervicovaginal secretions and seroprevalence in human immunodeficiency virus type 1-seropositive and -seronegative women. J Infect Dis 179: 1534-1537, 1999
  6. Pauk J et al. Mucosal shedding of human herpesvirus 8 in men. N Engl J Med 343: 1369-1377, 2000
  7. Casper C et al. Differential reduction of human herpesvirus 8 oropharyngeal shedding rats with specific antiretroviral agents. Eleventh Conference on Retroviruses and Opportunisitic Infections, San Francisco, abstract 780, 2004
  8. Hladik W et al. Human herpesvirus 8 infection among voluntary blood donors in Uganda. Thirteenth International AIDS Conference, Durban, abstract A475, 2000
  9. Vaithilingum M et al. Prevalence and patterns of antibody response to human herpes virus 8 (HHV-8) in mother-baby pairs in KwaZulu Natal, South Africa. Thirteenth International AIDS Conference, Durban, abstract A471, 2000
  10. Moore PS et al. Detection of herpesvirus-like DNA sequences in Kaposi's sarcoma in patients with and those without HIV infection. New England Journal of Medicine 332(18): 1181-1185, 1995
  11. Phiri S et al. Human herpesvirus type 8/Kaposi's sarcoma-associated herpesvirus infection in Zambian children: correlation with HIV-1 status. Eleventh Conference on Retroviruses and Opportunisitic Infections, San Francisco, abstract 781, 2004
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