HIV and human herpesvirus 8 co‐infection across the globe: Systematic review and meta‐analysis

• Published in: International journal of cancer Vol. 138; no. 1; pp. 45 - 54
• Main Authors: Rohner, Eliane, Wyss, Natascha, Heg, Zina, Faralli, Zully, Mbulaiteye, Sam M., Novak, Urban, Zwahlen, Marcel, Egger, Matthias, Bohlius, Julia
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.01.2016
• Subjects: Behavior; Cancer; Coinfection; Confidence intervals; co‐infection; Global Health; Health risk assessment; Herpesviridae Infections - complications; Herpesviridae Infections - epidemiology; Herpesvirus 8, Human; HIV; HIV Infections - complications; HIV Infections - epidemiology; Human herpesvirus 8; Human immunodeficiency virus; Humans; Infections; Medical research; meta‐analysis; Seroepidemiologic Studies; meta-analysis; HIV; co-infection; human herpesvirus 8
• ISSN: 0020-7136; 1097-0215; 1097-0215
• DOI: 10.1002/ijc.29687

HIV‐infection is an important risk factor for developing Kaposi sarcoma (KS), but it is unclear whether HIV‐positive persons are also at increased risk of co‐infection with human herpesvirus 8 (HHV‐8), the infectious cause of KS. We systematically searched literature up to December 2012 and included studies reporting HHV‐8 seroprevalence for HIV‐positive and HIV‐negative persons. We used random‐effects meta‐analysis to combine odds ratios (ORs) of the association between HIV and HHV‐8 seropositivity and conducted random‐effects meta‐regression to identify sources of heterogeneity. We included 93 studies with 58,357 participants from 32 countries in sub‐Saharan Africa, North and South America, Europe, Asia, and Australia. Overall, HIV‐positive persons were more likely to be HHV‐8 seropositive than HIV‐negative persons (OR 1.99, 95% confidence interval [CI] 1.70–2.34) with considerable heterogeneity among studies (I2 84%). The association was strongest in men who have sex with men (MSM, OR 3.95, 95% CI 2.92–5.35), patients with hemophilia (OR 3.11, 95% CI 1.19–8.11), and children (OR 2.45, 95% CI 1.58–3.81), but weaker in heterosexuals who engage in low‐risk (OR 1.42, 95% CI 1.16–1.74) or high‐risk sexual behavior (OR 1.66, 95% CI 1.27–2.17), persons who inject drugs (OR 1.66, 95% CI 1.28–2.14), and pregnant women (OR 1.68, 95% CI 1.15–2.47), p value for interaction <0.001. In conclusion, HIV‐infection was associated with an increased HHV‐8 seroprevalence in all population groups examined. A better understanding of HHV‐8 transmission in different age and behavioral groups is needed to develop strategies to prevent HHV‐8 transmission. What's new? Immunodeficiency sets the stage for human herpesvirus 8 (HHV‐8) infection, which can lead to Kaposi sarcoma. Compared with the general population, HHV‐8 infection is common in HIV‐positive individuals and in men who have sex with men (MSM). Those associations are corroborated by the present meta‐analysis, which also shows that HHV‐8 seroprevalence is highest in MSM and in children. Sexual transmission of HIV and HHV‐8 is likely in MSM. In children, who typically acquire HHV‐8 via nonsexual transmission, infection may occur as a result of HHV‐8 shedding from HIV‐positive family members. Further studies are needed to clarify HHV‐8 transmission routes.