United Press International - November 8, 2000

Researchers say the virus, called HHV-8, appears to promote Kaposi's sarcoma, the skin cancer that is associated with HIV and which was one of the first symptoms identified with AIDS.

The term "herpes" refers to a large family of viral infections including the common cold sore, genital warts, and the Epstein-Barr virus, often linked to chronic fatigue syndrome. In the United States HHV-8 is most common among homosexual men.

Dr. John Pauk of the University of Washington, Seattle, said that he and his colleagues have discovered that HHV-8 is "is present in oral mucosal tissue and is probably shed or transmitted from these oral surfaces and spread through infected saliva." He said, "deep kissing with an HIV-positive partner was an independent risk factor for HHV-8 infection." Other HHV-8 risk factors were sex with a partner who had Kaposi's sarcoma and uses of amyl nitrite capsules, called poppers, Pauk said.

In an interview with United Press International Pauk said, "we can't offer any suggestions for prophylaxis because we think the transmission is oral-to-oral."

Dr. Edward Chapnick, director of infectious diseases at Maimonides Medical Center in Brooklyn, said, "there really isn't anything [we can recommend to prevent transmission] short of putting people in a bubble." Chapnick was not involved in the study.

Pauk and his colleagues studied oral samples as well as genital and anal swabs taken from 112 men who have sex with men. They also collected blood, urine, semen, and prostatic secretion samples for analysis. Twenty of the men had HIV infection confirmed by blood test and 39 had HHV-8 confirmed by blood test. Eleven men were co-infected with HIV and HHV-8. They report their findings in the November 9 issue of The New England Journal of Medicine.

Pauk said that HHV-8 has been a challenge for the infectious disease community since it was identified less than 10 years ago. He says the infection has few if any symptoms but it is highly associated with Kaposi's sarcoma in men who are co-infected with HIV.

Chapnick said, "mucosal shedding has been suspected for a long time, so this is not a surprise. The fortunate part for clinicians and patients is that the overwhelming majority of people who are infected with HHV-8 have no symptoms at all and the other good news is that with the retroviral therapy we are now using there has been a big decline in the cases of Kaposi's sarcoma, because the degree of immune compromise is lessened."

Chapnick said it appears that the powerful anti-viral drugs now used in HIV patients protect the immune system from attack by HHV-8 and with HHV-8 held at bay, Kaposi's sarcoma does not have the opportunity to develop.

In the United States, Pauk estimated that about "10 percent to 20 percent of men who have sex with men who are HIV negative have HHV-8. Among homosexual men who are HIV positive, probably 30 percent to 50 percent are co-infected with HHV-8." He says that in the general population the "infection rate is very low, probably zero to 5 percent."

But in Africa and Italy, HHV-8 infection is seen in heterosexuals and is appears to be "present beginning in childhood," he says.

Pauk said his "goal was simply to try to learn more about the way the virus is transmitted. But we still need to learn if there is some co-factor that influences shedding, or transmission. Why are we seeing the infection in these populations? That is an area for additional research."

Dr. Nell S. Lurain, an immunologist at Rush-Presbyterian-St. Luke's Medical Center Chicago, said HHV-8 "does appear to follow certain populations and that suggests that it is probably not that highly infectious. What we think happens is that an index case is a certain population-such as men who have sex with men-is infected and because the person stays within that population, the infection also stays." Lurain was not involved in Pauk's study.

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