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Human Herpesvirus 8 Shed in Saliva

Human herpesvirus 8 (HHV-8) has been linked to the development of Kaposi's sarcoma in HIV-positive men who have sex with men (MSM). While it has been thought to be transmitted through sexual activity, the precise mode of transmission has been unknown (see JWID May 1998, p. 30, accession number 980501017, and N Engl J Med 1998; 338:948). Seattle investigators have now provided strong evidence that the virus is shed in saliva and spread by kissing.

Mucosal samples collected from 2 cohorts of MSM were tested for HHV-8 using quantitative PCR and in situ assays. Among HHV-8 seropositive men, HHV-8 DNA was identified most frequently and abundantly in oropharyngeal samples, compared with peripheral blood mononuclear cell, semen, anal, and prostatic fluid samples. Overall, HHV-8 DNA was found in 30 percent of oropharyngeal samples, but in just 1 percent of anal and genital samples (P<0.001). Shedding of the virus in oral secretions, although episodic, was approximately 2.5 logs higher than in other samples. In situ assays identified HHV-8 DNA in buccal epithelial cells. In multivariate analysis of risk factors for HHV-8 infection in these cohorts, 3 factors independently predicted HHV-8 seropositivity: a history of deep kissing with an HIV-positive partner, having a sexual partner with Kaposi's sarcoma, and using inhaled nitrites ("poppers") in association with sexual activity.

Comment: This study provides important but perplexing new information about HHV-8 disease. If HHV-8 is transmitted by the common behavior of kissing, it is unclear why in the U.S. this infection has remained relatively restricted to MSM. It is likely that the virus is not readily transmitted, but more information is needed.

— R Ellison

Published in Journal Watch Infectious Diseases December 7, 2000

Citation(s):

Pauk J et al. Mucosal shedding of human herpesvirus 8 in men. N Engl J Med 2000 Nov 9 343 1369-1377.

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• Medline abstract (Free)

Moore PS. The emergence of Kaposi's sarcoma-associated herpesvirus (human herpesvirus 8). N Engl J Med 2000 Nov 9 343 1411-1413.

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• Medline abstract (Free)