DETECTION OF KAPOSI-SARCOMA ASSOCIATED HERPESVIRUS IN PERIPHERAL-BLOOD OF HIV-INFECTED INDIVIDUALS AND PROGRESSION TO KAPOSIS-SARCOMA

Kaposi sarcoma-associated herpesvirus (KSHV) is consistently found in biopsy samples from patients with AIDS-related and ''classical'' Kapos i's sarcoma.(KS). Although highly suggestive of a causal role of KSHV in the pathogenesis of KS, this observation does not exclude the possi bility that KSHV, like other herpesviruses, is widely distributed and is a mere ''passenger'' in these lesions. Here we report that KSHV was detectable in peripheral blood mononuclear cells of 24/46 (52%) of KS patients, but in none of 134 blood donors or 26 HIV-uninfected hospit al controls. KSHV detection increased with immunosuppression, as shown by a correlation with a reduced number of CD4-positive T-cells. Moreo ver, KSHV detection in peripheral blood cells of HIV-infected individu als without KS predicted the subsequent appearance of KS lesions. 143 patients who did not have KS at the time of their first (or only) bloo d sample were followed up for a median of 30 months. Of the 11 who had been KSHV positive 6 developed KS compared with only 12 out of 132 wh o were KSHV negative. These findings are compatible with a causative r ole of KSHV in KS. KSHV was rarely detected in sputum and throat swabs of HIV-infected patients, providing a potential explanation for the a pparently limited spread of this virus.