Engels Eric A, Biggar Robert J, Marshall Vickie A, Walters Michael A, Gamache Christine J, Whitby Denise, Goedert James J
Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland 20892, USA.
AIDS. 2003 Aug 15;17(12):1847-51. doi: 10.1097/00002030-200308150-00015.
To identify immunologic and virologic predictors of AIDS-associated Kaposi's sarcoma (KS).
Nested case-control analysis of KS risk in a cohort of 132 HIV-infected homosexual men in New York and Washington, DC, USA.
For each KS case, we selected two HIV-infected controls, matched for CD4 cell count and Kaposi's sarcoma-associated herpesvirus (human herpesvirus 8; KSHV) serostatus (enzyme immunoassay for antibody to KSHV protein K8.1). Cell-associated KSHV and Epstein-Barr virus (EBV) viral loads were measured with quantitative real-time PCR assays on samples collected 1 year (median) before KS diagnosis.
Thirty-one men developed AIDS-associated KS (incidence 3.1 per 100 person years). Among HIV-infected men, KS incidence was higher among those with K8.1 seropositivity (5.0 versus 1.4 per 100 person years; P = 0.004), low CD4 cell count [hazard ratio (HR), 1.49; 95% confidence interval (CI), 1.24-1.79 per 100 x 10(6) cells/l decline), or high HIV RNA level (HR, 3.96; 95% CI, 2.19-7.16 per log(10)). In the case-control analysis, nine of 70 evaluated subjects had KSHV viremia, generally low level (median viral load 180 copies per 1 x 10(6) cells). KSHV viremia was associated with increased KS risk (unadjusted odds ratio, 9.1; 95% CI, 1.7-48; odds ratio, 11.7; 95% CI, 1.8-76 after adjustment for K8.1 serostatus, CD4 cell count, and HIV RNA). Among K8.1-seropositive subjects, KS incidence was tenfold higher in those with KSHV viremia (30.3 per 100 person years versus 3.4 per 100 person years in those without viremia). Also, EBV viral loads were higher in cases than in controls (P = 0.07).
Among individuals with HIV-KSHV coinfection, KSHV viremia identifies a subgroup with extremely high risk for developing KS.
确定艾滋病相关卡波西肉瘤（KS）的免疫和病毒学预测指标。
对美国纽约和华盛顿特区132名感染HIV的同性恋男性队列中的KS风险进行巢式病例对照分析。
对于每例KS患者，我们选择两名感染HIV的对照，根据CD4细胞计数和卡波西肉瘤相关疱疹病毒（人类疱疹病毒8型；KSHV）血清学状态（KSHV蛋白K8.1抗体的酶免疫测定）进行匹配。在KS诊断前1年（中位数）采集的样本上，采用定量实时PCR测定法测量细胞相关的KSHV和爱泼斯坦-巴尔病毒（EBV）病毒载量。
31名男性发生了艾滋病相关KS（发病率为每100人年3.1例）。在感染HIV的男性中，K8.1血清阳性者的KS发病率较高（每100人年5.0例对1.4例；P = 0.004），CD4细胞计数低[风险比（HR），1.49；95%置信区间（CI），每100×10⁶个细胞/升下降1.24 - 1.79]，或HIV RNA水平高（HR，3.96；95% CI，每log₁₀为2.19 - 7.16）。在病例对照分析中,70名评估对象中有9名存在KSHV病毒血症，一般水平较低（病毒载量中位数为每1×10⁶个细胞180拷贝）。KSHV病毒血症与KS风险增加相关（未调整优势比，9.1；95% CI，1.7 - 48；调整K8.1血清学状态、CD4细胞计数和HIV RNA后优势比为11.7；95% CI，1.8 - 76）。在K8.1血清阳性的对象中，有KSHV病毒血症者的KS发病率比无病毒血症者高10倍（每100人年30.3例对3.4例）。此外，病例组的EBV病毒载量高于对照组（P = 0.07）。
在HIV - KSHV合并感染的个体中，KSHV病毒血症可识别出发生KS风险极高的一个亚组。
