Bay Area Reporter - November 16, 2000
Bob Roehr

The research findings appeared in the November 9 edition of the New England Journal of Medicine. "Mucosal Shedding of Human Herpesvirus 8 in Men," was based upon work by John Pauk and others at the University of Washington in Seattle. Much of the research was presented at an AIDS malignancies conference in May at the National Institutes of Health, when this reporter first wrote on the subject.

"One of the reasons people started looking in the mouth is because Kaposi's sarcoma often shows up first as lesions in the mouth," said Pauk.

It also made sense because Epstein-Barr virus, which causes mono, is another member of the herpes virus family whose oral transmission is well established.

About 20 percent of the 112 gay men tested positive for HHV-8 in Seattle.

The rate was double for those infected with HIV. At the May conference, research leader Dr. Lawrence Corey spoke of a detailed sub-study of 27 gay men who carried HHV-8, 11 also were HIV-positive. They took tissue and fluid samples once a week for four weeks.

They found that more than half of the men shed virus in their saliva at some point during the study. That was significantly higher than shedding found at any other body site. And the amount of virus being shed was 2.5 logs higher in saliva than in the next most active site. Each log increase is 10 times greater than the previous.

A third group of gay men was asked to collect separate daily swabs from the genital, anal/rectal, and oral areas for 47 consecutive days. Corey and his colleagues were able to isolate HHV-8 DNA from 33.7 percent of the samples of saliva, but from only 1.3 percent of the anal samples and 0.3 percent of the urethral samples.

This pattern of HHV-8 virus actively replicating in the mouth but with little evidence of replication in semen or in the rectum, mirrors what is found with the related Epstein-Barr virus.

Those who shed HHV-8 seemed to do so rather consistently. Men coinfected with HIV seemed more likely to shed HHV-8, but the study was too small to reach a definitive conclusion.

The NEJM paper listed three independent risk factors for infection with HHV-8. One is a history of sex with someone who has KS. Another is a history of deep kissing with an HIV-positive partner. The final risk factor was use of amyl nitrite, or "poppers," though the reason for this was unclear. It may be that poppers affect a biological mechanism that makes one more vulnerable or it may be that men who use poppers engage in activities that put them more at risk.

Hold the paranoia

These research findings are scientifically interesting, but there is no reason to become paranoid about one's daily life, researchers said. "In most people [HHV-8] seems to be a very benign virus like mono," said

Douglas Ward, an AIDS doctor in Washington, D.C. "You can't say, have zero concern, but it isn't something you should be changing your life for."

"Look at HSV-1," the herpes simplex virus, said Ward, "85 percent of people carry it and don't have problems. The same thing is true with KS. A lot of people carry the virus who don't have KS." A healthy immune system keeps most of the herpes family viruses under control most of the time.

Problems tend to emerge as the immune response becomes severely compromised with advanced age or disease.

The Centers for Disease Control (CDC) has said that there is insufficient data for them to issue guidelines on the risk of acquiring HHV-8 through deep kissing.

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