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1996 87: 3521-3522
Human immunodeficiency virus-1 infection, homosexuality, and
Kaposi- associated herpes-like DNA in peripheral blood mononuclear
cells [letter]
A De Milito, M Catucci, G Venturi, L Romano, PE Valensin, M Zazzi and P Almi
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3521
CORRESPONDENCE
Human Immunodeficiency Virus-I Infection, Homosexuality, and Kaposi-Associated Herpes-Like DNA in
Peripheral Blood Mononuclear Cells
To the Editor:
A novel herpesvirus-like DNA sequence has recently been identified
in acquired immunodeficiency syndrome (AIDS>associated and nonassociated Kaposi's sarcoma (KS),'-5 in human immunodeficiency virus-I
(HIV-1)-infected and uninfected subjects with multicentric Castleman's
disease:'
and in HIV-I-related body-cavity-based lymphomas? These
findings have raised the possibility that a new herpesvirus-related infectious agent is involved in the pathogenesis of KS and some lymphoproliferative disorders. However, the presence of the KS herpesvirus-like (KSHV) sequence in peripheral blood mononuclear cells
(PBMCs) has been poorly investigated, making it difficult to define the pattern of transmission of the putative new herpesvirus.
To this end, we analyzed blood samples from 155 subjects for
the presence of the KSHV sequence by using polymerase chain
reaction (PCR) with the primer pair specific for the KS330zss
region of KSHV DNA.'
The population analyzed included six different groups from central
Italy: 24 HIV-1 -infected homosexual men, 5 HIV-1 -uninfected
homosexual men, 17 HIV-I -infected heterosexual men, 42 HIV-I uninfected heterosexual men, 25 HIV-I -infected women, and 42
HIV-1-uninfected women. Results are shown in Table 1. Three of
the HIV-I -infected homosexual males developed KS. KSHV DNA
was detected in the single sample tested from the first patient 2 years
before development of KS. The second patient was shown to harbor
the KSHV DNA only in the fourth of 6 PBMC samples analyzed,
concomitant with the appearance of KS. The third patient did not
harbor the KSHV sequence in any of the 4 samples tested, with KS
Table 1. Detection of KSHV DNA in PBMC's From HIV-1-Infected
and Uninfected Subiects
KSHV-Positive PatientdPatients Tested (%)
Group
HIV-1Infected
HIV-1Uninfected
Total
Homosexual men
Heterosexual men
Women
Total
8/24 (33.3)
2/17 (11.8)
0/25 (0.0)
10/66 (14.5)
1.5 (20.0)
0/42 (0.0)
0/42 (0.0)
1/89 (1.2)
9/29 (31.0)
2/59 (3.4)
0/67 (0.0)
11/155 (7.1)
oral lesions being detected only at the time of the first sampling.
Also, the KS330233sequence was not detected in any of the 11 paired
plasma specimens obtained from the 3 KS patients. Serial blood
samples were also obtained from 2 HIV-infected homosexual men
without KS (7 and 8 samples, respectively). In both cases there was
a temporal shift from KS330233 PCR-positive to PCR-negative in
PBMC samples, whereas the KSHV DNA sequence was not detected
in any of the paired plasma samples. The failure to detect KSHV
DNA in plasma samples of subjects whose PBMC are KSHV-positive is consistent with PBMC being latently infected by the putative
new herpesvirus, as is well known for other human lymphotropic
herpesviruses.
Overall, the presence of KSHV DNA in PBMC appeared to be
associated with homosexuality in the male population examined (P
= ,006,Fisher exact test). The significantly higher prevalence of
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3522
CORRESPONDENCE
KSHV DNA in the male compared with the female population and
in HIV-I -infected compared with uninfected subjects clearly derived from such an association. Because few HIV-1 -uninfected homosexual men were investigated, it remains to be established
whether HIV-I infection poses an additional risk over male homosexuality. The only 2 heterosexual subjects found to be KSHVpositive were intravenous drug abusers. Because a total of 39 drug
abusers (20 men and 19 women) were included in the study population, this low prevalence (5.1%) does not appear to indicate a very
efficient transmission of the putative herpes-like agent by sharing
needles. The higher prevalence in the homosexual male population
is consistent with the suggested association between the KSHV DNA
sequence and KS, because KS is found predominantly in homosexual
men. However, the presence of the KSHV DNA sequence in PBMCs
does not appear to be sufficient for development of KS. Accordingly,
a role for the related gamma herpesviruses (Epstein-Barr and herpesvirus saimiri) as cofactors in neoplastic processes is well established.
Further epidemiologic studies and biologic and molecular characterization of the KS-associated herpes-like agent are essential to define
the significance of the presence of KSHV DNA in PBMCs.
ACKNOWLEDGMENT
Supported by Grant No. 9302-10 from Progetto AIDS, Istituto
Superiore di Sanith, Minister0 della Saniti, Rome, Italy.
Angelo De Milito
Marinunzia Catucci
Giulietta Venturi
Laura Romano
Pier Egisto Valensin
Maurizio Zazzi
Sezivne di Microbiologia
Dipartimento di Biologia Molecolare
Universita di Siena
Siena, Italy
Paolo Almi
Divisione di Malattie Infettivc I
Azienda Ospedaliera Senese
Siena. Italy
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