JOURNAL OF CLINICAL MICROBIOLOGY, Feb. 2005, p. 1008
2
0095-1137/05/$08.00⫹0 doi:10.1128/JCM.43.2.1008.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.
Confirming Shedding of Human Herpesvirus 8 in Urine from Infected Patients
in Brazil
Since the discovery of Kaposi’s sarcoma-associated herpes-
virus, also known as human herpesvirus 8 (HHV-8), several
studies have been conducted to identify the body fluids into
which the virus is shed, with consequent potential virus trans-
mission (7, 10). Although saliva has been pointed out as the
main route of virus transmission, mostly in populations in areas
where the virus is endemic, semen, blood, urine, and stool have
also been suggested as vehicles of virus transmission-acquisi-
tion in populations at risk of infection, such as homosexual
males and human immunodeficiency virus (HIV)-AIDS pa-
tients (4, 5, 11). Unfortunately, all specimens analyzed up to
now have yielded controversial results except saliva, which
tested positive for HHV-8 DNA for several asymptomatic car-
riers and for Kaposi’s sarcoma (KS) patients (3, 4, 9, 11, 12).
In the last years, a group of researchers published interesting
studies conducted on Malawian people. First, they investigated
the molecular epidemiology of HHV-8 and the routes of virus
transmission (1, 8). Then, using PCR, sequencing, and other
molecular approaches, they evaluated blood and several oral
samples from KS patients and their relatives and identified the
HHV-8 subtypes named B1, A2, and A5 that circulate in Malawi.
They also detected infection with multiple HHV-8 subtypes in
a single individual and mixed patterns of HHV-8 transmission
(sexual and nonsexual transmission via intra- and extrafamilial
routes), confirming HHV-8 shedding in oral fluids (1, 8). In
recent issues of the Journal of Clinical Microbiology, Beyari et
al. presented the results obtained for urine and oral rinse from
the same Malawian people. Using PCR and sequencing of
open reading frame (ORF) 26 and K1/V1, they detected
HHV-8 DNA in 6.4% of urine samples (5 of 78 samples),
identified monotypic virus in urine and multitypic virus in sa-
liva, and pointed out urine as another site of virus shedding (2).
To add some information concerning this matter, we present
the results obtained with a group of KS patients and HIV-
infected patients in São Paulo, Brazil, whose urine was ana-
lyzed for the presence of HHV-8 DNA by PCR of ORF 26 and
K1/V1, as previously described (1). The results obtained re-
vealed HHV-8 DNA positivity in 6 out of 55 (11%) KS patients
and in 5 out of 18 (28%) HIV-1-infected patients without
clinical evidence of KS. Interestingly, the group without KS
presented the higher prevalence rate of HHV-8 infection. On
the basis of clinical and epidemiological data, we may specu-
late that these patients were recently infected with HHV-8 or
had KS at sites not yet identified. In agreement with this
hypothesis, two out of five HHV-8-infected patients were
found to be HHV-8 seropositive in immunofluorescence assays
(6). In contrast, the relatively low rate of HHV-8 infection
detected in the urine of KS patients may be the result of highly
active antiretroviral therapy and/or ABV treatment to which
these patients were submitted, which can contribute to virus
clearance in blood and urine.
We do not know the exact significance of HHV-8 DNA in
urine, but we can hypothesize that when virions are present in
urine, this specimen could be of importance for virus transmis-
sion-acquisition, mainly in populations of countries with poor
socioeconomic and sanitary conditions where the virus is endemic
1008
Vol. 43, No.
and also in individuals with promiscuous behaviors. Additional
investigations, including the determination of viral load using
real-time PCR and primers for different regions of the HHV-8
genome, are needed to solve this question. If urine is confirmed to
be another vehicle of virus transmission, it will be necessary to
formulate recommendations to block the spread of the virus.
Downloaded from http://jcm.asm.org/ on March 19, 2015 by UCSF Library & CKM
REFERENCES
1. Beyari, M. M., T. A. Hodgson, R. D. Cook, W. Kondowe, E. M. Molynex, C.
M Scully, C. G. Teo, and S. R. Porter. 2003. Multiple human herpesvirus-8
infection. J. Infect. Dis. 188:678–689.
2. Beyari, M. M., T. A. Hodgson, W., Kondowe, E. M. Molynex, C. M Scully,
S. R. Porter, and C. G. Teo. 2004. Genotypic profile of human herpesvirus 8
(Kaposi’s sarcoma-associated herpesvirus) in urine. J. Clin. Microbiol. 42:
3313–3316.
3. Biggar, R. J., D. Whitby, V. Marshall, A. C. Linhares, and F. Black. 2000.
Human herpesvirus 8 in Brazilian Amerindians: a hyperendemic population
with a new subtype. J. Infect. Dis. 181:1562–1568.
4. Cannon, M. J., S. C. Dollard, J. B. Black, B. R. Edlin, C. Hannah, S. E.
Hogan, M. M. Patel, H. W. Jaffe, M. K. Offermann, T. J. Spira, P. E. Pellet,
and C. J. Gunthel. 2003. Risk factors for Kaposi’s sarcoma in men seropos-
itive for both human herpesvirus 8 and human immunodeficiency virus.
AIDS 17:215–222.
5. Casper, C., M. Redman, M.-L. Huang, J. Pauk, T. M. Lampinen, S. E.
Hawes, C. W. Critchlow, R. A. Morrow, L. Corey, N. Kivial, and A. Wald.
2004. HIV infection and human herpesvirus-8 oral shedding among men who
have sex with men. J. Acquir. Immune Defic. Syndr. 35:233–238.
6. Caterino-de-Araujo, A., E. Santos-Fortuna, P. H. L. Carbone, S. E. L. Ci-
bella, and A. A. Moreira. 2003. Human herpesvirus 8 (HHV-8) antibodies
among women from São Paulo, Brazil. Association with behavioral factors
and Kaposi’s sarcoma. Braz. J. Infect. Dis. 7:395–401.
7. Cattani, P., M. Capuano, F. Cerimele, I. L. Parola, R. Santangelo, C. Masini,
D. Cerimele, and G. Fadda. 1999. Human herpesvirus 8 seroprevalence and
evaluation of nonsexual transmission routes by detection of DNA in clinical
specimens from human immunodeficiency virus-seronegative patients from
Central and Southern Italy, with and without Kaposi’s sarcoma. J. Clin.
Microbiol. 37:1150–1153.
8. Cook, R. D., T. A. Hodgson, A. C. W. Waugh, E. M. Molyneux, E. Borgstein,
A. Sherry, C. G. Teo, and S. R. Porter. 2002. Mixed patterns of transmission
of human herpesvirus-8 (Kaposi’s sarcoma-associated herpesvirus) in
Malawian families. J. Gen. Virol. 83:1613–1619.
9. Dedicoat, M., R. Newton, K. R. Alkharsah, J. Sheldon, I. Szabados, B.
Ndlovu, T. Page, D. Casabonne, C. F. Gilks, S. A. Cassol, D. Whitby, and
T. F. Schulz. 2004. Mother-to-child transmission of human herpesvirus-8 in
South Africa. J. Infect. Dis. 190:1068–1075.
10. LaDuca, J. R., J. L. Love, L. Z. Abbott, S. Dube, A. E. Freidman-Kien, and
B. J. Poiesz. 1998. Detection of human herpesvirus 8 DNA sequences in
tissues and bodily fluids. J. Infect. Dis. 178:1610–1615.
11. Pauk, J., M-L, Huang, S. J. Brodie, A. Wald, D. M. Koelle, T. Schacker, C.
Celum, S. Selke, and L. Corey. 2000. Mucosal shedding of human herpesvi-
rus 8 in men. N. Engl. J. Med. 343:1369–1377.
12. Taylor, M. M., B. Chohan, L. Lavreys, W. Hassan, M.-L. Huang, L. Corey,
R. A. Morrow, B. A. Richardson, K. Mandaliya, J. Ndinya-Achola, J. Bwayo,
and J. Kreiss. 2004. Shedding of human herpesvirus 8 in oral and genital
secretions from HIV-1-seropositive and -seronegative Kenyan women. J. In-
fect. Dis. 190:484–488.
Elizabeth Santos-Fortuna*
Adele Caterino-de-Araujo
Immunology Department
Instituto Adolfo Lutz
Av. Dr. Arnaldo 355. 11 andar
São Paulo 01246902
Brazil
*Phone: 55 11 30682898
Fax: 55 11 30682898
E-mail: efortuna@ial.sp.gov.br