The Discovery of HHV-8

• Kaposi’s sarcoma was one of the original clinical syndromes that led to the discovery of HIV

• Thought for many years that the cause was infectious

• The virus was discovered in 1994 by Yuan Chang and colleagues at Columbia University

• Belongs to a family of viruses which cause cancer known as the gammaherpesvirus family

How is HHV-8 Transmitted ? Sexual Transmission

HHV-8 infection has been linked to a history of various Sexually Transmitted Diseases

No specific sexual behavior that results in infection has been identified

Mother to Child In Africa, infections are rare before age two, but the number of

infections in puberty is identical to adult prevalence. This suggests that children may get HHV-8 from their family

Transmission through Blood Transmission through Saliva

High seroprevalence of antibodies to HHV-8 in Egyptian children: evidence of

non-sexual transmission

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20

30

40

50

60

70

8090

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<1 1-3 4-6 7-9 10-12 >12

EBV

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20

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CMV

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20

30

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HHV-6

Years

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20

30

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HHV-8

YearsAndreoni. J nat cancer Inst. 1999

The clinical disease that is classically associated with HHV-8 infection is KS and less commonly Castleman’s disease and primary effusion lymphoma (PEL). These HHV-8-associated diseases occur most commonly among immunocompromised patients, such as HIV-infected patients, those with end-stage renal disease, and transplant recipients. In the United States, the incidence of transplant associated KS is 10 to 20 times higher than the general population

The natural history of human herpesvirus 8 infection: clinical stages and determinants of progression.

Progression to KS stratified by HHV8 Progression to KS stratified by HHV8 antibody titersantibody titers

HHV8 negativeHHV8 negative

0.00.0

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HHV8 antibodyHHV8 antibody

titers (1:125)titers (1:125)

HHV8 antibodyHHV8 antibody

titers (1:5 to 1:25)titers (1:5 to 1:25)

years from seroconversionyears from seroconversion

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Manifestazioni cliniche dell’infezione primaria di HHV8

nell’immunocompromesso• Febbre, artralgia, linfoadenopatia (iperplasia angiolinfoide),

splenomegalia e citopenia. HIV+ (Oksehendler NEJM 1998)

• Febbre, splenomegalia, pancitopenia. 2 trapiantati rene HHV-8 negativi. (Luppi NEJM 2000)

• Multiorgan failure. Bambina di un mese con S. Di George (Sanchez-Velasco, JID 2001)

• Febbre, sudorazioni, linfoadenopatia, epatite (Marcelin AIDS, 2000)

• Diarrea, linfoadenopatia rash. 5 omosessuali HIV negativi (Wang, Blood 2001)

• Esantema maculopapulare e artrite. Donna con artrite reumatoide (Herpesvirus infections, Parigi 2001)