Substantial regional differences in human herpesvirus 8 seroprevalence in sub‐Saharan Africa: Insights on the origin of the “Kaposi's sarcoma belt”

• Published in: International journal of cancer Vol. 127; no. 10; pp. 2395 - 2401
• Main Authors: Dollard, Sheila C., Butler, Lisa M., Jones, Alison M. Graves, Mermin, Jonathan H., Chidzonga, Midion, Chipato, Tsungai, Shiboski, Caroline H., Brander, Christian, Mosam, Anisa, Kiepiela, Photini, Hladik, Wolfgang, Martin, Jeffrey N.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 15-11-2010; Wiley-Blackwell
• Subjects: Adolescent; Adult; adults; Africa; Africa South of the Sahara - epidemiology; Biological and medical sciences; Child; Child, Preschool; Cross-Sectional Studies; Dermatology; Female; Herpesviridae Infections - epidemiology; Herpesvirus 8, Human - isolation & purification; HHV‐8; Humans; Incidence; Infant; Infant, Newborn; KSHV; Male; Medical sciences; Middle Aged; Sarcoma, Kaposi - epidemiology; Sarcoma, Kaposi - virology; Seroepidemiologic Studies; Tropical medicine; Tumors; Tumors of the skin and soft tissue. Premalignant lesions; Young Adult; Uganda; Sub-Saharan Africa; Africa; Africa South of the Sahara; Gammaherpesvirinae; Human; Skin disease; Prevalence; Herpesviridae; Africa; adults; Serology; Malignant tumor; Epidemiology; Incidence; Infection; Virus; Kaposi sarcoma; Human herpesvirus 8; Cancerology; KSHV; Viral disease; Adult; HHV-8; Public health; Geographical variation; Cancer
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.25235

Equatorial Africa has among the highest incidences of Kaposi's sarcoma (KS) in the world, thus earning the name “KS Belt.” This was the case even before the HIV epidemic. To date, there is no clear evidence that HHV‐8 seroprevalence is higher in this region but interpretation of the available literature is tempered by differences in serologic assays used across studies. We examined representatively sampled ambulatory adults in Uganda, which is in the “KS Belt,” and in Zimbabwe and South Africa which are outside the Belt, for HHV‐8 antibodies. All serologic assays were uniformly performed in the same reference laboratory by the same personnel. In the base‐case serologic algorithm, seropositivity was defined by reactivity in an immunofluorescence assay or in 2 enzyme immunoassays. A total of 2,375 participants were examined. In Uganda, HHV‐8 seroprevalence was high early in adulthood (35.5% by age 21) without significant change thereafter. In contrast, HHV‐8 seroprevalence early in adulthood was lower in Zimbabwe and South Africa (13.7 and 10.8%, respectively) but increased with age. After age adjustment, Ugandans had 3.24‐fold greater odds of being HHV‐8 infected than South Africans (p < 0.001) and 2.22‐fold greater odds than Zimbabweans (p < 0.001). Inferences were unchanged using all other serologic algorithms evaluated. In conclusion, HHV‐8 infection is substantially more common in Uganda than in Zimbabwe and South Africa. These findings help to explain the high KS incidence in the “KS Belt” and underscore the importance of a uniform approach to HHV‐8 antibody testing.