Diagnosis and antiviral therapy of human herpesvirus 8 infection
- Corey Casper, MD, MPH
Corey Casper, MD, MPH
- Professor of Medicine
- University of Washington and Fred Hutchinson Cancer Research Center
The first disease associated with human herpesvirus 8 (HHV-8) infection was Kaposi sarcoma (KS). Subsequently, several other conditions, such as primary effusion lymphoma (PEL, also known as body cavity based lymphoma) and Castleman's disease (CD), were also linked to this virus. A severe inflammatory syndrome attributed to interleukin-6 production has also been described among HHV-8 infected individuals and is known as the Kaposi sarcoma-associated herpesvirus inflammatory cytokine syndrome (KICS) . Host factors and other related issues influence disease expression, since HHV-8 infection is relatively common. The onset of disease typically occurs several years after acquisition of infection. HHV-8 can also induce a primary infection characterized by fever and a maculopapular rash in children and more marked manifestations in immunocompromised individuals.
The diagnosis of HHV-8 infection and the possible role of antiviral therapy will be reviewed here. The epidemiology, mode of transmission, and disease associations of HHV-8 infection are discussed separately. (See "Virology, epidemiology, and transmission of human herpesvirus 8 infection" and "Disease associations of human herpesvirus 8 infection".)
The development of diagnostic testing for human herpesvirus 8 (HHV-8) has been hampered by the lack of a cell line that can serve as a culture system for isolating the virus from tissue or mucosal sites. The identification of HHV-8 positive immortalized lymphoma cell lines (eg, BCBL-1, KS-1) has been an important step in maintaining virus for study and in the development of serologic testing. These cell lines contain latent virus in an episomal form that can be stimulated by phorbol esters or butyrate into active replication with production of intact virions .
Polymerase chain reaction — Several different polymerase chain reaction (PCR) assays employing primers unique for HHV-8 have been described. HHV-8 DNA can be identified using PCR in virtually all biopsies of Kaposi sarcoma (KS), including AIDS-associated KS, classic KS, and endemic KS [3-9].
PCR techniques for investigation of disease associations and molecular epidemiology have proven to be of enormous value, but the following caveats must be kept in mind:
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