Effects of Antiretroviral Therapy on Kaposi’s Sarcoma–Associated Herpesvirus (KSHV) Transmission Among HIV-Infected Zambian Children

Authors

Landon Olp, University of Nebraska-LincolnFollow
Veenu Minhas, University of Nebraska-LincolnFollow
Clement Gondwe, University of Zambia Teaching Hospital, Lusaka, Zambia
Chipepo Kankasa, University of Zambia Teaching Hospital, Lusaka, Zambia
Janet M. Wojcicki, University of California - San FranciscoFollow
Charles Mitchell, University of Miami School of MedicineFollow
John T. West, University of Nebraska-LincolnFollow
Charles Wood, University of Nebraska-LincolnFollow

Document Type

Article

Date of this Version

7-2015

Citation

Published in JCNI Journal of the National Cancer Institute 107:10 (2015), djv189, 8 pp.; doi: 10.1093/jnci/djv189

Comments

Copyright © 2015 Landon N. Olp, Veenu Minhas, Clement Gondwe, Chipepo Kankasa, Janet Wojcicki, Charles Mitchell, John T. West, and Charles Wood. Published by Oxford University Press. Used by permission

Abstract

Background: The risk of Kaposi’s sarcoma–associated herpesvirus (KSHV) acquisition among children is increased by HIV infection. Antiretroviral therapy (ART) was recently made widely available to HIV-infected children in Zambia. However, the impact of early ART on KSHV transmission to HIV-infected children is unknown.

Methods: We enrolled and followed a cohort of 287 HIV-exposed, KSHV-negative children under 12 months of age from Lusaka, Zambia, to identify KSHV seroconversion events. Potential factors associated with KSHV infection—with an emphasis on HIV, ART, and immunological measures—were assessed through structured questionnaires and blood analyses. Incidence rate, Kaplan- Meier, and multivariable Cox regression models were used to assess differences in time to event (KSHV seroconversion) between groups. All statistical tests were two-sided.

Results: During follow-up, 151 (52.6%) children underwent KSHV seroconversion. Based on 3552 months of follow-up, we observed similar KSHV incidence rates between HIV-infected and uninfected children. Among HIV-infected children, ARTnaive children had statistically significantly increased risk of KSHV acquisition (adjusted hazard ratio [AHR] = 5.04, 95% confidence interval [CI] = 2.36 to 10.80, P < .001). Time-updated CD4+ T-cell percentage was also statistically significantly associated with risk of KSHV acquisition (AHR = 0.82, 95% CI = 0.74 to 0.92, P < .001), such that each 5% increase of CD4+ T-cells represented an 18% decrease in risk of acquiring KSHV.

Conclusions: Our data suggest that early ART and prevention of immune suppression reduce the risk of KSHV acquisition among HIV-infected children in an area where both viruses are highly endemic. This study highlights the importance of programs in Africa to provide children with ART immediately after HIV infection is diagnosed.

Includes supplementary materials.