Martró Elisa, Esteve Anna, Schulz Thomas F, Sheldon Julie, Gambús Gemma, Muñoz Rafael, Whitby Denise, Casabona Jordi
Centre d'Estudis Epidemiològics sobre l'HIV/SIDA de Catalunya, Departament de Salut, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Int J Cancer. 2007 Mar 1;120(5):1129-35. doi: 10.1002/ijc.22281.
We aimed to identify risk factors for Kaposi's sarcoma (KS) among HIV-positive patients and behaviors associated with human Herpesvirus 8 (HHV-8) infection, as well as to assess KS incidence and mortality rates longitudinally. To fulfill the first objective, a European case-control study was designed in the early 1990s (each KS case was matched to 2 controls with another AIDS indicative disease). After the discovery of HHV-8, serology testing enabled us to assess risk factors for KS development among HHV-8 and HIV-1 coinfected men who have sex with men (MSM), as well as risk factors for HHV-8 infection. HHV-8 seroprevalence was determined using a latent immunofluorescence assay. Relevant information was obtained by means of a questionnaire and medical charts review. Assessment of risk factors for KS development and HHV-8 infection was performed using conditional and unconditional logistic regression models, respectively. A low CD4 count was the only significant risk factor for KS. HHV-8 infection was most strongly linked to the number of life-time sex partners, and multiple body fluids such as saliva and semen are quite likely involved in sexual transmission. Longitudinal follow up showed a significant protective role for highly-active antiretroviral therapy (HAART) both on KS development and mortality of KS patients. Although more conclusive data from cohort studies are needed to better define specific transmission mechanisms for HHV-8, our results contribute to explain why KS incidence is higher among MSM, and the decreasing KS incidence trend observed in countries with universal access to HAART.
我们旨在确定HIV阳性患者中卡波西肉瘤（KS）的危险因素以及与人类疱疹病毒8型（HHV-8）感染相关的行为，并纵向评估KS的发病率和死亡率。为实现第一个目标，在20世纪90年代初设计了一项欧洲病例对照研究（每例KS病例与2例患有另一种艾滋病指示性疾病的对照相匹配）。在发现HHV-8后，血清学检测使我们能够评估HHV-8和HIV-1合并感染的男男性行为者（MSM）中KS发生的危险因素以及HHV-8感染的危险因素。使用间接免疫荧光测定法确定HHV-8血清阳性率。通过问卷调查和病历审查获取相关信息。分别使用条件和无条件逻辑回归模型评估KS发生和HHV-8感染的危险因素。低CD4计数是KS唯一显著的危险因素。HHV-8感染与终身性伴侣数量的关联最为密切，唾液和精液等多种体液很可能参与性传播。纵向随访显示，高效抗逆转录病毒疗法（HAART）对KS的发生和KS患者的死亡率均具有显著的保护作用。尽管需要队列研究提供更确凿的数据来更好地确定HHV-8的具体传播机制，但我们的结果有助于解释为什么MSM中KS的发病率较高，以及在普遍可获得HAART的国家中观察到的KS发病率下降趋势。
