Human herpesvirus-8 infection in hemodialysis patients from northern Italy

Human herpesvirus-8 infection in hemodialysis patients from northern Italy To the Editor: Early epidemiologic studies showed that the incidence of Kaposis’s sarcoma (KS) in renal transplant patients is 400 to 500 times more frequent than in a control population of the same ethnic origin [1]. Recent molecular and serological studies have suggested a pathogenetic involvement of human herpesvirus-8 (HHV-8) infection in all forms of KS, including post-transplant KS [2]. Relevant to this, antibodies to HHV-8 have been detected in the sera of most renal transplant recipients before immunesuppressive treatment, suggesting that KS is mainly due to virus reactivation, although occurrence of HHV-8 transmission by donor’s allograft has been documented [3]. We tested the hypothesis that either the uremic state or hemodialysis, both of which are known to be associated with a high susceptibility to viral infections, may confer an increased risk of developing KS by increasing the risk of exposure to HHV-8 infection. The prevalence of antibodies against the HHV-8 latent nuclear antigen (LNA-1) was investigated with an immunofluorescence assay in 97 hemodialysis patients and in 71 blood donors from the lower Po valley of northern Italy, an area with one of the highest incidence rates of classic KS in the world (Table 1). Sera were tested blindly at a dilution of 1:100 as we previously described [4]. The prevalence of antibodies against HHV-8 LNA-1 in hemodialysis patients is 9.2%, which is comparable to that documented in the blood donors from the same area (12.7%) (Table 1) [4]. Our data indicate that the immunosuppressive state associated with uremia and the hemodialysis procedure are not associated with an increased frequency of HHV-8 primary infection or reactivation, even in a geographic area with  1999 by the International Society of Nephrology

Table 1. Prevalence of antibodies against HHV-8 in Italian hemodialysis patients No. of patients Median age years (range) Median dialysis time years (range) Male/female ratio HHV-8 positivea Hepatitis C virus (HCV) positive

97 69 (26.8–89.7) 5.9 (0.3–22.7) 53/44 9 (9.2%) 13 (22.8%)

a The HHV-8 positive patients were 7 female and 2 male, with a median age of 74.2 years (28.5 to 80.5 years), and with a median dialysis time of 8.0 years (1.9 to 15.6 years). Two were also HCV positive.

a relatively high prevalence of HHV-8 infection in “the healthy population.” Mario Luppi, Lorenza Vandelli, Denise Whitby, Anna Maria Savazzi, Patrizia Barozzi, Giuseppe Medici, Alberto Albertazzi, and Giuseppe Torelli Department of Medical Sciences, Section of Hematology, and Nephrology Unit, Modena, Italy; and Institute of Cancer Research, Chester Beatty Laboratories, London, England, United Kingdom

NOTE ADDED IN PROOF Recently, it has been reported that HHV-8 is transmitted through renal allografts and is a risk factor transplantationassociated KS [Regamey N, Tamm N, Wernli M, Witschi A, Thiel G, Cathomas G, Erb P: Transmission of human herpesvirus 8 infection from renal-transplant donors to recipients. New Engl J Med 339:1358–1363, 1998]. REFERENCES 1. Penn I: Kaposi’s sarcoma in transplant recipients. Transplantation 65:669–673, 1997 2. Ganem D: KSHV and Kaposi’s sarcoma: The end of the beginning? Cell 91:157–160, 1997 3. Parravicini C, Olsen SJ, Capra M, Poli F, Sirchia G, Gao S-J, Berti E, Nocera A, Rossi E, Bestetti G, Pizzuto M, Galli M, Moroni M, Moore PS, Corbellino M: Risk of Kaposi’s sarcoma associated herpes virus transmission from donor allografts among Italian posttransplant Kaposi’s sarcoma patients. Blood 90:2826– 2829, 1997 4. Whitby D, Luppi M, Barozzi P, Boshoff C, Weiss R, Torelli G: Human herpesvirus-8 seroprevalence in blood donors and lymphoma patients from different regions of Italy. J Natl Cancer Inst 90:395–397, 1998

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