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    Original Articles -- NEJM 2001; 344: 637-643 NEJM Home | Search | Log On to Full Text ... Table of Contents | Previous Article | Next Article ... The full text
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      Original Articles -- NEJM 2001; 344: 637-643
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      The New England Journal of Medicine -- March 1, 2001 -- Vol. 344, No. 9


      Blood-Borne and Sexual Transmission of Human Herpesvirus 8 in Women with or at Risk for Human Immunodeficiency Virus Infection
      Michael J. Cannon, Sheila C. Dollard, Dawn K. Smith, Robert S. Klein, Paula Schuman, Josiah D. Rich, David Vlahov, Philip E. Pellett, for the HIV Epidemiology Research Study Group
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      Abstract
      Background. Human herpesvirus 8 (HHV-8), the causal agent of Kaposi's sarcoma, is transmitted sexually among homosexual men, but little is known of its transmission among women. Although HHV-8 has been detected in blood, there has been no clear evidence of blood-borne transmission.

      Methods. We identified risk factors for HHV-8 infection in 1295 women in Baltimore, Detroit, New York, and Providence, Rhode Island, who reported high-risk sexual behavior or drug use. HHV-8 serologic studies were performed with two enzyme-linked immunosorbent assays.

      Results. In univariate analyses, HHV-8 was associated with black race, Hispanic ethnic background, a lower level of education, and infection with syphilis, the human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV). The risk of seropositivity for HHV-8 increased with the frequency of injection-drug use (P<0.001); HHV-8 seroprevalence among the women who used drugs daily was three times that among women who never injected drugs. Among the women with a low risk of sexual transmission, HHV-8 seroprevalence was 0 percent in those who had never injected drugs and 36 percent in those who had injected drugs (P<0.001). However, injection-drug use was linked less strongly to HHV-8 infection than to infection with HBV or HCV. In a multivariate analysis, independent predictors of HHV-8 seropositivity included HIV infection (odds ratio, 1.6; 95 percent confidence interval, 1.1 to 2.2), syphilis infection (odds ratio, 1.8; 95 percent confidence interval, 1.1 to 2.8), and daily injection-drug use (odds ratio, 3.2; 95 percent confidence interval, 1.4 to 7.6).

      Conclusions. Both injection-drug use and correlates of sexual activity were risk factors for HHV-8 infection in the women studied. The independent association of HHV-8 infection with injection-drug use suggests that HHV-8 is transmitted through needle sharing, albeit less efficiently than HBV, HCV, or HIV. (N Engl J Med 2001;344:637-43.)


      Source Information
      From the Centers for Disease Control and Prevention, Atlanta (M.J.C., S.C.D., D.K.S., P.E.P.); Rollins School of Public Health, Emory University, Atlanta (M.J.C.); the Division of Infectious Diseases, Department of Medicine, and the Department of Epidemiology and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, N.Y. (R.S.K.); the Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit (P.S.); Brown University, Providence, R.I. (J.D.R.); and the Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, and the New York Academy of Medicine, New York (D.V.). Address reprint requests to Dr. Pellett at the Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop G18, Atlanta, GA 30333, or at ppellett@....

      Other members of the HIV Epidemiology Research Study Group are listed in the Appendix.


      Appendix
      In addition to the authors, members of the HIV Epidemiology Research Study Group include R. Klein, E. Schoenbaum, J. Arnsten, R. Burk, C. Chang, P. Demas, and A. Howard (Montefiore Medical Center, Albert Einstein College of Medicine); P. Schuman and J. Sobel (Wayne State University School of Medicine); A. Rompalo, D. Vlahov, and D. Celentano (Johns Hopkins University School of Medicine); C. Carpenter, K. Mayer, S. Cu-Uvin, T. Flanigan, J. Hogan, V. Stone, K. Tashima, and J. Rich (Brown University School of Medicine); A. Duerr, L. Gardner, S. Holmberg, D. Jamieson, J. Moore, R. Phelps, D. Smith, and D. Warren (Centers for Disease Control and Prevention); and K. Davenny (National Institute of Drug Abuse).


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      Copyright � 2001 by the Massachusetts Medical Society. All rights reserved.


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