European Journal of Epidemiology

, Volume 17, Issue 9, pp 871–876

A seroprevalence study of human herpesvirus type 8 (HHV8) in eastern and Central Africa and in the Mediterranean area

  • Diego Serraino
  • Luigi Toma
  • Massimo Andreoni
  • Stefano Buttò
  • Odile Tchangmena
  • Loredana Sarmati
  • Paolo Monini
  • Silvia Franceschi
  • Barbara Ensoli
  • Giovanni Rezza


Human herpes virus type 8 (HHV8) is the major determinant of Kaposi's sarcoma (KS), a neoplasm with wide geographic variations in incidence rates. To assess the prevalence of HHV8 infection among populations with differing rates of KS, we used sera from 1402 persons (Central Africa: Cameroon, n = 293, age range: 5–40; eastern Africa: Uganda, n = 315, age range: 1–64: Mediterranean area: Egypt, n = 236, age range: 13–19: Italy, blood donors n = 134, age range: 20–67: Italy. HIV seroconverters n = 424, age range: 16–65). Serum samples were tested for antibodies to lytic and latent antigens of HHV8 using two immunofluorescence assays. HHV8 prevalence was evaluated according to geographic area, gender and age groups. Overall, the highest prevalence of HHV8 lytic antigens (47.5%) was recorded among children and adults in Africa. Approximately 40% of children and adolescents from Egypt and of Italian HIV-positive persons (39.9%) were HHV8 seropositive. In eastern and Central Africa and in Egypt, no differences emerged between males and females for both types of HHV8 antibodies. Conversely, Italian females were at lower HHV8 risk than their male counterparts. Moreover the prevalence of HHV8 infection tended to increase with age. This investigation partially confirms that HHV8 infection mirrors incidence rates of KS. The high prevalence of HHV8 infection in newborns, children and adolescents in Egypt, in eastern and in Central Africa strongly suggests the existence of transmission modes other than sexual.

Africa Antibodies Epidemiology HHV8 Italy Kaposi's sarcoma 


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  1. 1.
    Chang Y, Cesarman EC, Pessin MS, et al. Identification of herpesvirus-like DNA sequences in AIDSassociated Kaposi's sarcoma. Science 1994; 266: 1865–1869.Google Scholar
  2. 2.
    Ambroziak JA, Blackbourn DJ, Herndier BG, et al. Herpes-like sequences in HIV-infected and uninfected Kaposi's sarcoma patients. Science 1995; 268: 582–583.Google Scholar
  3. 3.
    Huang YQ, Li JJ, Kaplan MH, et al. Human herpesvirus-like nucleic acid in various forms of Kaposi's sarcoma. Lancet 1995; 345: 759–761.Google Scholar
  4. 4.
    Moore PS, Chang Y. Detection of herpesvirus-like DNA sequences in Kaposi's sarcoma in patients with and without HIV infection. N Engl J Med 1995; 332: 1181–1185.Google Scholar
  5. 5.
    Schalling M, Ekman M, Kaaya EE, Linde A, Biberfeld P. A role for a new herpes virus (KSHV) in different forms of Kaposi's sarcoma. Nat Med 1995; 1: 707–708.Google Scholar
  6. 6.
    Chang Y, Ziegler J, Wabinga H, et al. Kaposi's sarcoma-associated herpesvirus and Kaposi's sarcoma in Africa. Uganda Kaposi's Sarcoma Study Group. Arch Intern Med 1996; 156: 202–204.Google Scholar
  7. 7.
    Cesarman E, Chang Y, Moore PS, Said JW, Knowles DM. Kaposi's sarcoma-associated herpesvirus-like DNA sequences in AIDS-related body-cavity-based lymphomas. N Engl J Med 1995; 332: 1186–1191.Google Scholar
  8. 8.
    Soulier J, Grollet L, Oksenhendler E, et al. Kaposi's sarcoma-associated herpesvirus-like DNA sequences in multicentric Castleman's disease. Blood 1995; 86: 1276–1280.Google Scholar
  9. 9.
    Marcelin AG, Dupin N, Bouscary D, et al. HHV8 and multiple myeloma in France. Lancet 1997; 350: 1144.Google Scholar
  10. 10.
    MacKenzie J, Sheldon J, Morgan G, Cook G, Schulz TF, Jarrett RF. HHV8 and multiple myeloma in UK. Lancet 1997; 350: 1144–1145.Google Scholar
  11. 11.
    Gao SJ, Alsina M, Deng JH, et al. Antibodies to Kaposi's sarcoma-associated herpesvirus (human herpesvirus 8) in patients with multiple myeloma. J Infect Dis 1998; 178: 846–849.Google Scholar
  12. 12.
    Kedes DH, Operskalski E, Busch M, Kohn R, Flood J, Ganem D. The seroepidemiology of human herpesvirus 8 (Kaposi's sarcoma-associated herpesvirus): Distribution of infection in KS risk groups and evidence for sexual transmission. Nat Med 1996; 2: 918–924.Google Scholar
  13. 13.
    Lennette ET, Blackbourn DJ, Levy JA. Antibodies to human herpesvirus type 8 in the general population and in Kaposi's sarcoma patients. Lancet 1996; 348: 858–861.Google Scholar
  14. 14.
    Simpson GR, Schulz TF, Whitby D, et al. Prevalence of Kaposi's sarcoma associated herpesvirus infection measured by antibodies to recombinant capsid protein and latent immunofluorescence antigen. Lancet 1996; 346: 1133–1138.Google Scholar
  15. 15.
    Whitby D, Howard MR, Tenant-Flowers M, et al. Detection of Kaposi sarcoma associated herpesvirus in peripheral blood of HIV-infected individuals and progression to Kaposi's sarcoma. Lancet 1995; 346: 799–802.Google Scholar
  16. 16.
    Moore PS, Kingsley LA, Holmberg SD, et al. Kaposi's sarcoma-associated herpesvirus infection prior to onset of Kaposi's sarcoma. AIDS 1996; 10: 175–180.Google Scholar
  17. 17.
    Gao SJ, Kingsley LA, Hoover DR, et al. Seroconversion to antibodies against Kaposi's sarcoma-associated herpesvirus-related latent nuclear antigens before the development of Kaposi's sarcoma. N Engl J Med 1996; 335: 233–241.Google Scholar
  18. 18.
    Boshoff C, Schulz TF, Kennedy MM, et al. Kaposi's sarcoma-associated herpesvirus infects endothelial and spindle cells. Nat Med 1995; 1: 1274–1278.Google Scholar
  19. 19.
    Gao SJ, Kingsley LA, Li M, et al. KSHV antibodies among Americans, Italians and Ugandans with and without Kaposi's sarcoma. Nat Med 1996; 2: 925–928.Google Scholar
  20. 20.
    International Agency for Research on Cancer. Infections with Epstein-Barr virus and human herpesviruses, Vol. 70, IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Lyon, 1997.Google Scholar
  21. 21.
    Schmid DS. Role of HHV8 in Kaposi Sarcoma. JAMA 1998; 280: 570–571.Google Scholar
  22. 22.
    Ensoli B, Sturzl M. Kaposi's sarcoma: A results of the interplay among inflammatory cytokines, angiogenic factors and viral agents. In: Sporn M, Vilcek JT (eds), Cytokine and Growth Factor Review, Vol 9, 1998; 63–83.Google Scholar
  23. 23.
    Rabkin CS, Schulz TF, Whitby D, et al. Interassay correlation of human herpesvirus 8 serologic tests. HHV8 Interlaboratory Collaborative Group. J Infect Dis 1998; 178: 304–309.Google Scholar
  24. 24.
    Sharp D. Current assays for HHV8 seropositivity unreliable. Lancet 1998; 352: 965.Google Scholar
  25. 25.
    Kedes DH, Ganem D, Ameli N, Bacchetti P, Greenblatt R. The prevalence of serum antibody to human herpes virus 8 (Kaposi's sarcoma-associated virus) among HIV-seropositive and high-risk HIV-seronegative women. JAMA 1997; 277: 478–481.Google Scholar
  26. 26.
    Lin JC, Lin SC, Mar EC, et al. Is Kaposi's sarcomaassociated herpesvirus detectable in semen of HIV-infected homosexual men? Lancet 1995; 346: 1601–1602.Google Scholar
  27. 27.
    Monini P, de Lellis LD, Fabris M, Rigolin F, Cassai E. Kaposi's sarcoma-associated herpesvirus DNA sequences in prostate tissue and human semen. N Engl J Med 1996; 334: 1168–1172.Google Scholar
  28. 28.
    Olsen SJ, Chang Y, Moore PS, Biggar RJ, Melbye M. Increasing Kaposi's sarcoma associated herpesvirus seroprevalence with age in a highly Kaposi's sarcoma endemic region, Zambia in 1985. AIDS 1998; 12: 1921–1925.Google Scholar
  29. 29.
    Mayama S, Cuevas LE, Sheldon J, et al. Prevalence and transmission of Kaposi's sarcoma-associated herpesvirus (Human Herpesvirus 8) in Ugandan children and adolescents. Int J Cancer 1998; 77: 817–820.Google Scholar
  30. 30.
    Andreoni M, El-Sawaf G, Rezza G, et al. High seroprevalence of antibodies to human herpesvirus-8 in Egyptian children: Evidence of non-sexual transmission. J Natl Cancer Inst 1999; 91: 465–469.Google Scholar
  31. 31.
    Gessain A, Mauclere P, van Beveren M, et al. Human herpesvirus 8 primary infection occurs during childood in Cameroon, Central Africa. Int J Cancer 1999 81: 189–192.Google Scholar
  32. 32.
    Rezza G, Andreoni M, Dorrucci M, et al. Human herpesvirus 8 seropositivity and risk of Kaposi's sarcoma and other acquired immunodeficiency syndromerelated diseases. J Natl Cancer Inst 1999; 91: 1468–1474.Google Scholar
  33. 33.
    Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective stiudies of disease. J Natl Cancer Inst 1959; 22: 719–748.Google Scholar
  34. 34.
    Rezza G, Tchangmena OB, Andreoni M, et al. Prevalence and risk factors for human herpesvirus 8 infection in northern Cameroon. Sexually Transmitted Diseases 2000; 27: 159–164.Google Scholar
  35. 35.
    Parkin DM, Pisani P, Ferlay J. Global cancer statistics. CA Cancer J Clin 1999; 49: 33–64.Google Scholar
  36. 36.
    Bestetti G, Renon G, Mauclere P, et al. High seroprevalence of human herpesvirus-8 in pregnant women and prostitutes from Cameroon. AIDS 1998; 12: 541–543.Google Scholar
  37. 37.
    de-The G, Bestetti G, van Beveren M, Gessain A. Prevalence of human herpesvirus 8 infection before the acquired immunodeficiency disease-syndrome-related epidemic of Kaposi's sarcoma in East Africa. J Natl Cancer Inst 1999; 91: 1888–1889.Google Scholar
  38. 38.
    Perna AM, Bonura F, Vitale F, et al. Antibodies to human herpes virus type 8 (HHV8) in general population and in individuals at risk for sexually transmitted diseases in Western Sicily. Int J Epidemiol 2000; 29: 175–179.Google Scholar
  39. 39.
    Davidovici B, Karakis I, Bourboulia D, et al. Seroepidemiology and molecular epidemiology of Kaposi's sarcoma-associated herpesvirus among Jewish population groups in Israel. J Natl Cancer Inst 2001; 93: 194–203.Google Scholar
  40. 40.
    Plancoulaine S, Abel L, van Beveren M, et al. Human herpesvirus 8 transmission from mother to child and between siblings in an endemic population. Lancet 2000; 356: 1062–1065.Google Scholar
  41. 41.
    Geddes M, Franceschi S, Balzi D, Arniani S, Gafa L, Zanetti R. Birthplace and classic Kaposi's sarcoma in Italy. J Natl Cancer Inst 1995; 87: 1015–1017.Google Scholar
  42. 42.
    Franceschi S, Geddes M. Epidemiology of classic Kaposi's sarcoma, with special reference to Mediterranean population. Tumori 1995; 81: 308–314.Google Scholar
  43. 43.
    Beral V. Epidemiology of Kaposi's sarcoma. Cancer Surveys 1991; 10: 5–22.Google Scholar
  44. 44.
    Fife K, Bower M. Recent insights into the pathogenesis of Kaposi's sarcoma. Br J Cancer 1996; 73: 1317–1322.Google Scholar

Copyright information

© Kluwer Academic Publishers 2001

Authors and Affiliations

  • Diego Serraino
    • 1
  • Luigi Toma
    • 2
  • Massimo Andreoni
    • 3
  • Stefano Buttò
    • 4
  • Odile Tchangmena
    • 2
  • Loredana Sarmati
    • 3
  • Paolo Monini
    • 4
  • Silvia Franceschi
    • 5
  • Barbara Ensoli
    • 4
  • Giovanni Rezza
    • 2
  1. 1.Dipartimento di EpidemiologiaIstituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, IRCCSItaly
  2. 2.Centro Operativo AIDSIstituto Superiore di SanitàItaly
  3. 3.Infectious Disease InstituteTor Vergata UniversityItaly
  4. 4.Laboratorio di VirologiaIstituto Superiore di SanitàRomeItaly
  5. 5.Field and Intervention Studies UnitIARCLyonFrance

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