Seroconversion to Antibodies against Kaposi's Sarcoma-Associated Herpesvirus-Related Latent Nuclear Antigens before the Development of Kaposi's Sarcoma

doi:10.1056/NEJM199607253350403

Volume 335:233-241		July 25, 1996		Number 4

Seroconversion to Antibodies against Kaposi's Sarcoma–Associated Herpesvirus–Related Latent Nuclear Antigens before the Development of Kaposi's Sarcoma

Shou-Jiang Gao, Ph.D., Lawrence Kingsley, Dr.P.H., Donald R. Hoover, Ph.D., Thomas J. Spira, M.D., Charles R. Rinaldo, Ph.D., Alfred Saah, M.D., John Phair, M.D., Roger Detels, M.D., M.S., Preston Parry, B.A., Yuan Chang, M.D., and Patrick S. Moore, M.D., M.P.H.

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ABSTRACT

Background If Kaposi's sarcoma–associated herpesvirus(KSHV) is the cause of Kaposi's sarcoma, serologic evidenceof infection should be present in patients before the diseasedevelops.

Methods Using an immunoblot assay for two latent nuclear antigensof KSHV, we tested serum samples from homosexual male patientswith the acquired immunodeficiency syndrome (AIDS) with andwithout Kaposi's sarcoma, HIV-infected men with hemophilia,HIV-seronegative blood donors, and HIV-seronegative patientswith high titers of antibodies against Epstein–Barr virus(EBV). Serial serum samples obtained from patients with Kaposi'ssarcoma before the diagnosis of the disease were tested forevidence of seroconversion.

Results Of 40 patients with Kaposi's sarcoma, 32 (80 percent)were positive for antibodies against KSHV antigens by the immunoblotassay, as compared with only 7 of 40 homosexual men (18 percent)without Kaposi's sarcoma immediately before the onset of AIDS.Of 122 blood donors, 22 EBV-infected patients, and 20 HIV-infectedmen with hemophilia, none were seropositive. When studied bythe immunoblot assay over a period of 13 to 103 months, 21 ofthe 40 patients with Kaposi's sarcoma (52 percent) seroconverted6 to 75 months before the clinical appearance of Kaposi's sarcoma.The median duration of antibody seropositivity for KSHV-relatedlatent nuclear antigens before the diagnosis of Kaposi's sarcomawas 33 months.

Conclusions In most patients with Kaposi's sarcoma and AIDS,seroconversion to positivity for antibodies against KSHV-relatednuclear antigens occurs before the clinical appearance of Kaposi'ssarcoma. This supports the hypothesis that Kaposi's sarcomaresults from infection with KSHV.

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From the Division of Epidemiology, School of Public Health (S.-J.G., P.P., P.S.M.), and the Department of Pathology, College of Physicians and Surgeons (Y.C.), Columbia University, New York; the Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh (L.K., C.R.R.); the Division of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore (D.R.H., A.S.); the Division of AIDS, Sexually Transmitted Diseases, and Tuberculosis Laboratory Research, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta (T.J.S.); the Comprehensive AIDS Center, Northwestern University Medical School, Chicago (J.P.); and the Department of Epidemiology, University of California, Los Angeles, School of Public Health, Los Angeles (R.D.).

Address reprint requests to Dr. Gao at the Division of Epidemiology, School of Public Health, Columbia University, P&S 14-442, 630 W. 168th St., New York, NY 10032.

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