Sex and geographic patterns of human herpesvirus 8 infection in a nationally representative population‐based sample in Uganda

Abstract

Background: Human herpesvirus 8 (HHV8), the infectious cause of Kaposi sarcoma, varies dramatically across Africa, suggesting that cofactors correlated with large-area geographic or environmental characteristics may influence risk of infection. Variation in HHV8 seropositivity across small-area regions within countries in Africa is unknown. We investigated this issue in Uganda, where Kaposi sarcoma distribution is uneven and well described.

Methods: Archival samples from individuals aged 15-59 years randomly selected from a nationally representative 2004-2005 human immunodeficiency virus-AIDS serobehavioral survey were tested for HHV8 seropositivity with use of enzyme immunoassays based on synthetic peptides from the K8.1 and orf65 viral genes. Adjusted odds ratios and 95% confidence intervals (CIs) of association of HHV8 seropositivity with demographic risk factors were estimated.

Results: Among 2681 individuals tested, HHV8 seropositivity was 55.4%. HHV8 seropositivity was lower in female than in male persons (adjusted odds ratio, 0.82 [95% CI, 0.69-0.97]) and increased 2.2% (95% CI, 1.0%-3.6%) in female persons and 1.2% (95% CI, 1.0%-2.3%) in male persons per year of age. HHV8 seropositivity was inversely associated with education ( P = .01, for trend) and was elevated in the West Nile region, compared with the Central region (adjusted odds ratio, 1.49 [95% CI, 1.02-2.18]) but not with other regions.

Conclusions: Our findings suggest that HHV8 seropositivity in Uganda may be influenced by cofactors correlated with small-area geography, age, sex, and education.

Figure 1

Percent HHV8 seropositivity among males and females aged 15–59 years selected from the Uganda HIV/AIDS serobehavioral Survey 2004/05. Note. HHV88 seropositivity for men and women crosses over at about 40 years of age (P = 0.034 for interaction between HHV8 seropositivity, age group (<40 years versus ≥40 years), and gender.)

Figure 2

Map of Uganda showing the standardized morbidity ratio (SMR) for Kaposi sarcoma for 17 regions in Uganda during 1964 to 1968 based on published data in reference [9] (left panel) and HHV8 seropositivity for 9 regions based on HHV8 serological testing in a sample from the Uganda HIV/AIDS Serobehavioral survey 2004/05 (right panel).