Prospective study of human herpesvirus 8 oral shedding, viremia, and serological status among human immunodeficiency virus seropositive and seronegative individuals in Sao Paulo, Brazil

Figures & data

Table 1. Participants’ characteristics and HHV-8 antibody and DNA detection among HIV-positive and HIV-negative patients in Sao Paulo, Brazil.

	Male HIV negative, N = 47	Male HIV positive, N = 44	Female HIV positive, N = 32	p-Value
Characteristics
Age (years), median (interquartile range)	30 (26–37)	40 (35–45)	42 (39–52)	<0.01^a
Proportion with CD4+ >500 cells/mm^3 (%)	n/a	30 (68.1)	24 (75.0)	0.52
Proportion with undetectable HIV PVL (%)^b	n/a	35 (79.5)	27 (84.3)	0.59
HHV-8 serology positivity
ELISA (%)	18 (38.3)	24 (54.6)	6 (18.8)	<0.01^c
IFA-LANA (%)	14 (29.8)	13 (29.6)	6 (18.8)	0.49
IFA-lytic (%)	8 (17.0)	10 (22.7)	4 (12.5)	0.51
Any assay (%)	24 (51.0)	28 (63.6)	12 (37.5)	0.08
HHV-8 DNA detection among all patients	N = 47	N = 44	N = 32
Serum^d	0	0	0	—
Plasma^d	0	0	0	—
Saliva (per person analysis)
Positive person/tested (%)	7/47 (14.9)	11/44 (25.0)	0	0.23^e
Saliva (per sample analysis)^d
Positive sample/tested (%)	40/5,640 (0.7)	70/5,280 (1.3)	0	<0.01^e
HHV-8 DNA saliva detection among HHV-8-seropositive patients only	N = 24	N = 28	N = 12
Per person analysis
Positive individual/tested (%)	7/24 (29.2)	11/28 (39.3)	0	0.71^e
Per sample analysis^d
Positive sample/tested (%)	40/2,880 (1.4)	70/3,360 (2.1)	0	0.04^e
Positive samples among shedders samples (%)	40/840 (4.8)	70/1,320 (5.3)	0	0.58^e
HHV-8 DNA log10 copies/mL	2.8 (2.4–3.2)	3.7 (3.3–4.5)	0	<0.01^e

Continuous variables are presented as medians and interquartile ranges; P-values are presented for comparison across three groups

^aMale HIV-negative group was significantly different from male HIV-positive and female HIV-positive groups in pairwise comparison; difference between male HIV positive-and female HIV-positive groups was not significant.

^bThreshold for detection 50 copies/mL.

^cIn pairwise comparison, ELISA positivity was significantly different between male HIV-positive and female HIV-positive groups only.

^dPer sample analysis: six serum, six plasma, and 120 saliva samples per patient.

^ePairwise comparison for male HIV-negative and male HIV-positive groups.

HHV-8, human herpesvirus 8; HIV, human immunodeficiency virus; PVL, plasma viral load; ELISA, enzyme-linked immunosorbent assay; IFA, immunofluorescence assays.

Table 2. Intra-assay concordance for six serum samples obtained from 123 patients patients in Sao Paulo, Brazil.

Assay	Overall concordance, % (n/N)	Concordance among positive results, % (n/N)	Concordance among negative results, % (n/N)	Kappa (95% CI) for overall	p-Value
ELISA	100% (738/738)	100% (288/288)	100% (450/450)	100%	<0.0001
IF-LANA	99.2% (732/738)	96.9% (192/198)	100% (540/540)	96%	<0.0001
IF-lytic	98.9% (730/738)	94.2% (130/138)	100% (600/600)	94%	<0.0001

Table 3. Performance of serological assays for the detection of salivary HHV-8 DNA shedders among 91 men (47 HIV-seropositive and 44 HIV-seronegative MSM).

Serologic assay	Positivity, n (%)	Sensitivity % (95% CI)	Specificity % (95% CI)	Positive predictive value % (95% CI)	Negative predictive value % (95% CI)
ELISA	18 (100.0)	100.0 (81.5–100.0)	67.1 (55.1–77.7)	42.9 (27.7–59.0)	100.0 (92.7–100.0)
IFA LANA	15 (83.3)	83.3 (58.6–96.4)	83.6 (73.0–91.2)	55.6 (35.3–74.5)	95.3 (86.9–99.0)
IFA-lytic	6 (33.3)	33.3 (13.3–59.0)	83.6 (73.0–91.2)	33.3 (13.3–59.0)	83.6 (73.0–91.2)
ELISA + IFA-LANA	15 (83.3)	83.3 (58.6–96.4)	91.8 (83.0–96.9)	71.4 (47.8–88.7)	95.7 (88.0–99.1)
ELISA + IFA-lytic	6 (33.3)	33.3 (13.3–59.0)	93.2 (84.7–97.7)	54.5 (23.4–83.3)	85.0 (75.3–92.0)
ELISA + IFA-LANA + IFA-lytic	6 (33.3)	33.3 (13.3–59.0)	98.6 (92.6–100.0)	85.7 (42.1–99.6)	85.7 (76.4–92.4)
IFA-LANA + IFA-lytic	6 (33.3)	33.3 (13.3–59.0)	94.5 (86.6–98.5)	60.0 (26.2–87.8)	85.2 (75.6–92.1)