National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa.
Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
Int J Cancer. 2023 May 15;152(10):2081-2089. doi: 10.1002/ijc.34454. Epub 2023 Feb 15.
Kaposi sarcoma-associated herpesvirus (KSHV) causes Kaposi sarcoma (KS). The risk of KS is amplified in HIV-immunosuppressed individuals and antiretroviral therapy (ART) reduces KS incidence. Reliable data on the relationship between these factors are lacking in Africa. We used questionnaires and serum from 7886 black South Africans (18-74 years) with incident cancer, recruited between 1995 and 2016. ART rollout started in 2004. We measured associations between KS, HIV-1 and KSHV before and after ART rollout. We measured seropositivity to HIV-1, KSHV latency-associated nuclear antigen (LANA) and glycoprotein (K8.1) and calculated case-control-adjusted odds ratios (OR ) and 95% confidence intervals (CI) in relation to KS and KSHV infection, before (1995-2004), early (2005-2009) and late (2010-2016) ART rollout periods. KSHV seropositivity among 1237 KS cases was 98%. Among 6649 controls, KSHV seropositivity was higher in males (OR = 1.4 [95%CI 1.23-1.52]), in persons with HIV, (OR = 4.2 [95%CI 3.74-4.73]) and lower in high school leavers (OR = 0.7 [95%CI 0.59-0.83]). KSHV seropositivity declined over the three ART rollout periods (37%, 28% and 28%, P < .001) coinciding with increases in high school leavers over the same periods (46%, 58% and 67%, P < .001). HIV-1 seroprevalence increased from 10% in the pre-ART period to 22% in the late ART period (P < .001). Compared to HIV-1 and KSHV seronegatives, KSHV seropositives yielded an OR for KS of 26 (95%CI 11-62) in HIV-1 seronegative participants and an OR of 2501 (95%CI 1083-5776) in HIV-1 seropositive participants. HIV-1 increases the risk of KS in those infected with KSHV by 100-fold. Declines in KSHV seroprevalence coincide with ART rollout and with improvements in educational standards and general hygiene.
卡波西肉瘤相关疱疹病毒（KSHV）会导致卡波西肉瘤（KS）。HIV 免疫抑制个体的 KS 风险会增加，而抗逆转录病毒疗法（ART）会降低 KS 的发病率。在非洲，缺乏这些因素之间关系的可靠数据。我们使用问卷和血清，对 1995 年至 2016 年间新确诊癌症的 7886 名南非黑人（18-74 岁）进行了研究。ART 于 2004 年开始推广。我们在 ART 推广前后测量了 KS、HIV-1 和 KSHV 之间的关联。我们测量了 HIV-1、KSHV 潜伏相关核抗原（LANA）和糖蛋白（K8.1）的血清阳性率，并计算了 KS 和 KSHV 感染的病例对照调整比值比（OR）和 95%置信区间（CI），与 KS 和 KSHV 感染有关，分为 ART 推广前（1995-2004 年）、早期（2005-2009 年）和晚期（2010-2016 年）。1237 例 KS 病例中，KSHV 血清阳性率为 98%。在 6649 名对照者中，男性 KSHV 血清阳性率（OR=1.4[95%CI 1.23-1.52]）较高，HIV 感染者（OR=4.2[95%CI 3.74-4.73]）较高，高中及以上学历者（OR=0.7[95%CI 0.59-0.83]）较低。KSHV 血清阳性率在三个 ART 推广期间呈下降趋势（37%、28%和 28%，P<0.001），同期高中及以上学历者呈上升趋势（46%、58%和 67%，P<0.001）。HIV-1 血清阳性率从 ART 前的 10%增加到晚期的 22%（P<0.001）。与 HIV-1 和 KSHV 血清阴性者相比，KSHV 血清阳性者在 HIV-1 血清阴性者中 KS 的 OR 为 26（95%CI 11-62），在 HIV-1 血清阳性者中 OR 为 2501（95%CI 1083-5776）。HIV-1 使感染 KSHV 的人患 KS 的风险增加 100 倍。KSHV 血清阳性率的下降与 ART 的推广以及教育水平和一般卫生条件的改善相吻合。
