Kaposi Sarcoma-Associated Herpes Virus and Response to Antiretroviral Therapy: A Prospective Study of HIV-Infected Adults

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 63; no. 4; pp. 442 - 448
• Main Authors: Maskew, Mhairi, MacPhail, A Patrick, Whitby, Denise, Egger, Matthias, Fox, Matthew P
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-08-2013; Lippincott Williams & Wilkins; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adult; Adults; Anti-Retroviral Agents - therapeutic use; Antigens; Antigens, Nuclear - immunology; Antiretroviral drugs; Biological and medical sciences; CD4 Lymphocyte Count; Coinfection; Female; Fundamental and applied biological sciences. Psychology; Glycoproteins - immunology; Herpes viruses; Herpesviridae Infections - complications; Herpesviridae Infections - immunology; Herpesvirus; Herpesvirus 8, Human - immunology; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - immunology; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Kaposi's sarcoma-associated herpesvirus; Linear Models; Male; Medical sciences; Microbiology; Middle Aged; Miscellaneous; Mycobacterium; Prospective Studies; Regression analysis; Risk assessment; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral Load; Viral Proteins - immunology; Virology; South Africa; Gammaherpesvirinae; Immunopathology; Skin disease; Antiretroviral agent; resource-poor setting; Herpesviridae; Suppression; antiretroviral therapy; Kaposi sarcoma herpes virus; AIDS; Malignant tumor; Immune deficiency; Infection; Virus; Kaposi sarcoma; Human herpesvirus 8; Treatment; Viral disease; virologic suppression; Antiviral; Cancer
• ISSN: 1525-4135; 1944-7884
• DOI: 10.1097/QAI.0b013e3182969cc1

BACKGROUND:The possible impact of coinfection with the Kaposi sarcoma–associated herpes virus (KSHV) on the response to antiretroviral therapy (ART) is unknown. Prospective studies are rare, particularly in Africa.
METHODS:We enrolled a prospective cohort of HIV-infected adults initiating ART in Johannesburg, South Africa. The subjects were defined as seropositive to KSHV if they were reactive to either KSHV lytic K8.1 or latent Orf73 antigen or to both. The subjects were followed from ART initiation until 18 months of treatment. HIV viral load and CD4 counts were tested 6 monthly. Linear generalized estimating and log-binomial regression models were used to estimate the effect of KSHV infection on immunologic recovery and response and HIV viral load suppression within 18 months after ART initiation.
RESULTS:Three hundred eighty-five subjects initiating ART from November 2008 to March 2009 were considered to be eligible including 184 (48%) KSHV+. The KSHV+ group was similar to the KSHV− in terms of age, gender, initiating CD4 count, body mass index, tuberculosis, and hemoglobin levels. The KSHV+ group gained a similar number of cells at 6 [difference of 10 cells per cubic millimeter, 95% confidence interval (CI)−11 to 31], 12 (3 cells per cubic millimeter, 95% CI−19 to 25), and 18 months (24 cells per cubic millimeter, 95% CI−13 to 61) compared with that gained by the KSHV− group. Adjusted relative risk of failure to suppress viral load to <400 copies per milliliter (1.03; 95% CI0.90 to 1.17) were similar for KSHV+ and KSHV− by 6 months on treatment.
CONCLUSIONS:In a population with a high KSHV prevalence, HIV-positive adults coinfected with KSHV achieved similar immunologic and virologic responses to ART early after treatment initiation compared with those with KSHV−.