Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Virology, epidemiology, and transmission of human herpesvirus 8 infection

Corey Casper, MD, MPH
Section Editor
Martin S Hirsch, MD
Deputy Editor
Allyson Bloom, MD


Kaposi's sarcoma, an unusual skin tumor localized in the lower extremities of elderly Mediterranean or Ashkenazi Jewish men, was first described in 1872 by the pathologist Moritz Kaposi [1]. This malignancy was relatively rare until the early 1980s when, with the onset of the HIV epidemic, it was described in several homosexual men in North America [2,3].

The epidemiology of Kaposi's sarcoma (KS) suggested a link between the development of disease and a transmissible agent. In 1994, a novel gamma herpesvirus was subsequently identified in KS biopsies [4]. After sequence analysis of the genome and characterization of the viral replication cycle, this virus was subsequently named human herpesvirus 8 (HHV-8) or Kaposi's sarcoma-associated herpesvirus (KSHV).

There are four epidemiologic forms of KS:

Classic — Classic KS is an indolent cutaneous proliferative disease, mainly affecting the lower extremities of elderly men of Mediterranean and Jewish origin [5,6].

Endemic or African — The endemic or African form of KS found in all parts of equatorial Africa, particularly in sub-Saharan Africa. It is not typically associated with immune deficiency [7,8].


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Apr 21, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Braun M. Classics in Oncology. Idiopathic multiple pigmented sarcoma of the skin by Kaposi. CA Cancer J Clin 1982; 32:340.
  2. Hymes KB, Cheung T, Greene JB, et al. Kaposi's sarcoma in homosexual men-a report of eight cases. Lancet 1981; 2:598.
  3. Centers for Disease Control (CDC). Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men--New York City and California. MMWR Morb Mortal Wkly Rep 1981; 30:305.
  4. Chang Y, Cesarman E, Pessin MS, et al. Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi's sarcoma. Science 1994; 266:1865.
  5. Iscovich J, Boffetta P, Winkelmann R, et al. Classic Kaposi's sarcoma in Jews living in Israel, 1961-1989: a population-based incidence study. AIDS 1998; 12:2067.
  6. Fenig E, Brenner B, Rakowsky E, et al. Classic Kaposi sarcoma: experience at Rabin Medical Center in Israel. Am J Clin Oncol 1998; 21:498.
  7. Cook-Mozaffari P, Newton R, Beral V, Burkitt DP. The geographical distribution of Kaposi's sarcoma and of lymphomas in Africa before the AIDS epidemic. Br J Cancer 1998; 78:1521.
  8. Olsen SJ, Chang Y, Moore PS, et al. Increasing Kaposi's sarcoma-associated herpesvirus seroprevalence with age in a highly Kaposi's sarcoma endemic region, Zambia in 1985. AIDS 1998; 12:1921.
  9. Beral V, Peterman TA, Berkelman RL, Jaffe HW. Kaposi's sarcoma among persons with AIDS: a sexually transmitted infection? Lancet 1990; 335:123.
  10. Antman K, Chang Y. Kaposi's sarcoma. N Engl J Med 2000; 342:1027.
  11. Akula SM, Pramod NP, Wang FZ, Chandran B. Integrin alpha3beta1 (CD 49c/29) is a cellular receptor for Kaposi's sarcoma-associated herpesvirus (KSHV/HHV-8) entry into the target cells. Cell 2002; 108:407.
  12. Hassman LM, Ellison TJ, Kedes DH. KSHV infects a subset of human tonsillar B cells, driving proliferation and plasmablast differentiation. J Clin Invest 2011; 121:752.
  13. Birkmann A, Mahr K, Ensser A, et al. Cell surface heparan sulfate is a receptor for human herpesvirus 8 and interacts with envelope glycoprotein K8.1. J Virol 2001; 75:11583.
  14. Akula SM, Pramod NP, Wang FZ, Chandran B. Human herpesvirus 8 envelope-associated glycoprotein B interacts with heparan sulfate-like moieties. Virology 2001; 284:235.
  15. Rappocciolo G, Jenkins FJ, Hensler HR, et al. DC-SIGN is a receptor for human herpesvirus 8 on dendritic cells and macrophages. J Immunol 2006; 176:1741.
  16. Kaleeba JA, Berger EA. Kaposi's sarcoma-associated herpesvirus fusion-entry receptor: cystine transporter xCT. Science 2006; 311:1921.
  17. Dutta D, Chakraborty S, Bandyopadhyay C, et al. EphrinA2 regulates clathrin mediated KSHV endocytosis in fibroblast cells by coordinating integrin-associated signaling and c-Cbl directed polyubiquitination. PLoS Pathog 2013; 9:e1003510.
  18. Paulose-Murphy M, Ha NK, Xiang C, et al. Transcription program of human herpesvirus 8 (kaposi's sarcoma-associated herpesvirus). J Virol 2001; 75:4843.
  19. Cesarman E, Moore PS, Rao PH, et al. In vitro establishment and characterization of two acquired immunodeficiency syndrome-related lymphoma cell lines (BC-1 and BC-2) containing Kaposi's sarcoma-associated herpesvirus-like (KSHV) DNA sequences. Blood 1995; 86:2708.
  20. Sun R, Lin SF, Gradoville L, et al. A viral gene that activates lytic cycle expression of Kaposi's sarcoma-associated herpesvirus. Proc Natl Acad Sci U S A 1998; 95:10866.
  21. Mercader M, Taddeo B, Panella JR, et al. Induction of HHV-8 lytic cycle replication by inflammatory cytokines produced by HIV-1-infected T cells. Am J Pathol 2000; 156:1961.
  22. Chang J, Renne R, Dittmer D, Ganem D. Inflammatory cytokines and the reactivation of Kaposi's sarcoma-associated herpesvirus lytic replication. Virology 2000; 266:17.
  23. Davis DA, Rinderknecht AS, Zoeteweij JP, et al. Hypoxia induces lytic replication of Kaposi sarcoma-associated herpesvirus. Blood 2001; 97:3244.
  24. Balistreri G, Viiliäinen J, Turunen M, et al. Oncogenic Herpesvirus Utilizes Stress-Induced Cell Cycle Checkpoints for Efficient Lytic Replication. PLoS Pathog 2016; 12:e1005424.
  25. Zhu FX, King SM, Smith EJ, et al. A Kaposi's sarcoma-associated herpesviral protein inhibits virus-mediated induction of type I interferon by blocking IRF-7 phosphorylation and nuclear accumulation. Proc Natl Acad Sci U S A 2002; 99:5573.
  26. Bellare P, Ganem D. Regulation of KSHV lytic switch protein expression by a virus-encoded microRNA: an evolutionary adaptation that fine-tunes lytic reactivation. Cell Host Microbe 2009; 6:570.
  27. Lei X, Bai Z, Ye F, et al. Regulation of NF-kappaB inhibitor IkappaBalpha and viral replication by a KSHV microRNA. Nat Cell Biol 2010; 12:193.
  28. Günther T, Grundhoff A. The epigenetic landscape of latent Kaposi sarcoma-associated herpesvirus genomes. PLoS Pathog 2010; 6:e1000935.
  29. Toth Z, Maglinte DT, Lee SH, et al. Epigenetic analysis of KSHV latent and lytic genomes. PLoS Pathog 2010; 6:e1001013.
  30. Gregory SM, West JA, Dillon PJ, et al. Toll-like receptor signaling controls reactivation of KSHV from latency. Proc Natl Acad Sci U S A 2009; 106:11725.
  31. Beral V. The epidemiology of cancer in AIDS patients. AIDS 1991; 5 Suppl 2:S99.
  32. Wijnveen AC, Persson H, Björck S, Blohmé I. Disseminated Kaposi's sarcoma--full regression after withdrawal of immunosuppressive therapy: report of a case. Transplant Proc 1987; 19:3735.
  33. Nagy S, Gyulai R, Kemeny L, et al. Iatrogenic Kaposi's sarcoma: HHV8 positivity persists but the tumors regress almost completely without immunosuppressive therapy. Transplantation 2000; 69:2230.
  34. Cattelan AM, Calabrò ML, Gasperini P, et al. Acquired immunodeficiency syndrome-related Kaposi's sarcoma regression after highly active antiretroviral therapy: biologic correlates of clinical outcome. J Natl Cancer Inst Monogr 2001; :44.
  35. Paparizos VA, Kyriakis KP, Papastamopoulos V, et al. Response of AIDS-associated Kaposi sarcoma to highly active antiretroviral therapy alone. J Acquir Immune Defic Syndr 2002; 30:257.
  36. Guihot A, Dupin N, Marcelin AG, et al. Low T cell responses to human herpesvirus 8 in patients with AIDS-related and classic Kaposi sarcoma. J Infect Dis 2006; 194:1078.
  37. Wilkinson J, Cope A, Gill J, et al. Identification of Kaposi's sarcoma-associated herpesvirus (KSHV)-specific cytotoxic T-lymphocyte epitopes and evaluation of reconstitution of KSHV-specific responses in human immunodeficiency virus type 1-Infected patients receiving highly active antiretroviral therapy. J Virol 2002; 76:2634.
  38. Lambert M, Gannagé M, Karras A, et al. Differences in the frequency and function of HHV8-specific CD8 T cells between asymptomatic HHV8 infection and Kaposi sarcoma. Blood 2006; 108:3871.
  39. Bihl F, Mosam A, Henry LN, et al. Kaposi's sarcoma-associated herpesvirus-specific immune reconstitution and antiviral effect of combined HAART/chemotherapy in HIV clade C-infected individuals with Kaposi's sarcoma. AIDS 2007; 21:1245.
  40. Bihl F, Berger C, Chisholm JV 3rd, et al. Cellular immune responses and disease control in acute AIDS-associated Kaposi's sarcoma. AIDS 2009; 23:1918.
  41. Biggar RJ, Chaturvedi AK, Goedert JJ, et al. AIDS-related cancer and severity of immunosuppression in persons with AIDS. J Natl Cancer Inst 2007; 99:962.
  42. Sirianni MC, Vincenzi L, Topino S, et al. NK cell activity controls human herpesvirus 8 latent infection and is restored upon highly active antiretroviral therapy in AIDS patients with regressing Kaposi's sarcoma. Eur J Immunol 2002; 32:2711.
  43. Kimball LE, Casper C, Koelle DM, et al. Reduced levels of neutralizing antibodies to Kaposi sarcoma-associated herpesvirus in persons with a history of Kaposi sarcoma. J Infect Dis 2004; 189:2016.
  44. Lagos D, Vart RJ, Gratrix F, et al. Toll-like receptor 4 mediates innate immunity to Kaposi sarcoma herpesvirus. Cell Host Microbe 2008; 4:470.
  45. West J, Damania B. Upregulation of the TLR3 pathway by Kaposi's sarcoma-associated herpesvirus during primary infection. J Virol 2008; 82:5440.
  46. Weber KS, Gröne HJ, Röcken M, et al. Selective recruitment of Th2-type cells and evasion from a cytotoxic immune response mediated by viral macrophage inhibitory protein-II. Eur J Immunol 2001; 31:2458.
  47. Brander C, Suscovich T, Lee Y, et al. Impaired CTL recognition of cells latently infected with Kaposi's sarcoma-associated herpes virus. J Immunol 2000; 165:2077.
  48. Ishido S, Wang C, Lee BS, et al. Downregulation of major histocompatibility complex class I molecules by Kaposi's sarcoma-associated herpesvirus K3 and K5 proteins. J Virol 2000; 74:5300.
  49. Coscoy L, Ganem D. A viral protein that selectively downregulates ICAM-1 and B7-2 and modulates T cell costimulation. J Clin Invest 2001; 107:1599.
  50. Irmler M, Thome M, Hahne M, et al. Inhibition of death receptor signals by cellular FLIP. Nature 1997; 388:190.
  51. Bertin J, Armstrong RC, Ottilie S, et al. Death effector domain-containing herpesvirus and poxvirus proteins inhibit both Fas- and TNFR1-induced apoptosis. Proc Natl Acad Sci U S A 1997; 94:1172.
  52. Djerbi M, Screpanti V, Catrina AI, et al. The inhibitor of death receptor signaling, FLICE-inhibitory protein defines a new class of tumor progression factors. J Exp Med 1999; 190:1025.
  53. Flore O, Rafii S, Ely S, et al. Transformation of primary human endothelial cells by Kaposi's sarcoma-associated herpesvirus. Nature 1998; 394:588.
  54. Radkov SA, Kellam P, Boshoff C. The latent nuclear antigen of Kaposi sarcoma-associated herpesvirus targets the retinoblastoma-E2F pathway and with the oncogene Hras transforms primary rat cells. Nat Med 2000; 6:1121.
  55. Lundquist A, Barré B, Bienvenu F, et al. Kaposi sarcoma-associated viral cyclin K overrides cell growth inhibition mediated by oncostatin M through STAT3 inhibition. Blood 2003; 101:4070.
  56. Seo T, Park J, Lee D, et al. Viral interferon regulatory factor 1 of Kaposi's sarcoma-associated herpesvirus binds to p53 and represses p53-dependent transcription and apoptosis. J Virol 2001; 75:6193.
  57. Nakamura H, Li M, Zarycki J, Jung JU. Inhibition of p53 tumor suppressor by viral interferon regulatory factor. J Virol 2001; 75:7572.
  58. Chatterjee M, Osborne J, Bestetti G, et al. Viral IL-6-induced cell proliferation and immune evasion of interferon activity. Science 2002; 298:1432.
  59. Pati S, Cavrois M, Guo HG, et al. Activation of NF-kappaB by the human herpesvirus 8 chemokine receptor ORF74: evidence for a paracrine model of Kaposi's sarcoma pathogenesis. J Virol 2001; 75:8660.
  60. Schwarz M, Murphy PM. Kaposi's sarcoma-associated herpesvirus G protein-coupled receptor constitutively activates NF-kappa B and induces proinflammatory cytokine and chemokine production via a C-terminal signaling determinant. J Immunol 2001; 167:505.
  61. Bais C, Santomasso B, Coso O, et al. G-protein-coupled receptor of Kaposi's sarcoma-associated herpesvirus is a viral oncogene and angiogenesis activator. Nature 1998; 391:86.
  62. Hong YK, Foreman K, Shin JW, et al. Lymphatic reprogramming of blood vascular endothelium by Kaposi sarcoma-associated herpesvirus. Nat Genet 2004; 36:683.
  63. Wang HW, Trotter MW, Lagos D, et al. Kaposi sarcoma herpesvirus-induced cellular reprogramming contributes to the lymphatic endothelial gene expression in Kaposi sarcoma. Nat Genet 2004; 36:687.
  64. Renne R, Lagunoff M, Zhong W, Ganem D. The size and conformation of Kaposi's sarcoma-associated herpesvirus (human herpesvirus 8) DNA in infected cells and virions. J Virol 1996; 70:8151.
  65. Ballestas ME, Chatis PA, Kaye KM. Efficient persistence of extrachromosomal KSHV DNA mediated by latency-associated nuclear antigen. Science 1999; 284:641.
  66. Simpson GR, Schulz TF, Whitby D, et al. Prevalence of Kaposi's sarcoma associated herpesvirus infection measured by antibodies to recombinant capsid protein and latent immunofluorescence antigen. Lancet 1996; 348:1133.
  67. Martin JN, Ganem DE, Osmond DH, et al. Sexual transmission and the natural history of human herpesvirus 8 infection. N Engl J Med 1998; 338:948.
  68. Kedes DH, Operskalski E, Busch M, et al. The seroepidemiology of human herpesvirus 8 (Kaposi's sarcoma-associated herpesvirus): distribution of infection in KS risk groups and evidence for sexual transmission. Nat Med 1996; 2:918.
  69. Pollack MS, Safai B, Myskowski PL, et al. Frequencies of HLA and Gm immunogenetic markers in Kaposi's sarcoma. Tissue Antigens 1983; 21:1.
  70. Contu L, Cerimele D, Pintus A, et al. HLA and Kaposi's sarcoma in Sardinia. Tissue Antigens 1984; 23:240.
  71. Kaloterakis A, Papasteriades C, Filiotou A, et al. HLA in familial and nonfamilial Mediterranean Kaposi's sarcoma in Greece. Tissue Antigens 1995; 45:117.
  72. Ioannidis JP, Skolnik PR, Chalmers TC, Lau J. Human leukocyte antigen associations of epidemic Kaposi's sarcoma. AIDS 1995; 9:649.
  73. Tzfoni EE, Scherman L, Battat S, Brautbar H. No HLA antigen is significant in classic Kaposi's sarcoma. J Am Acad Dermatol 1993; 28:118.
  74. Strichman-Almashanu L, Weltfriend S, Gideoni O, et al. No significant association between HLA antigens and classic Kaposi sarcoma: molecular analysis of 49 Jewish patients. J Clin Immunol 1995; 15:205.
  75. Melbye M, Kestens L, Biggar RJ, et al. HLA studies of endemic African Kaposi's sarcoma patients and matched controls: no association with HLA-DR5. Int J Cancer 1987; 39:182.
  76. Marmor M, Winchester R, Zeleniuch-Jacquotte A, et al. Evidence for an effect of human leukocyte antigens on susceptibility to Kaposi's sarcoma related to charge and peptide-binding properties of class I molecules. AIDS 1995; 9:1194.
  77. Gayà A, Esteve A, Casabona J, et al. Amino acid residue at position 13 in HLA-DR beta chain plays a critical role in the development of Kaposi's sarcoma in AIDS patients. AIDS 2004; 18:199.
  78. Aoki Y, Jones KD, Tosato G. Kaposi's sarcoma-associated herpesvirus-encoded interleukin-6. J Hematother Stem Cell Res 2000; 9:137.
  79. Fishman D, Faulds G, Jeffery R, et al. The effect of novel polymorphisms in the interleukin-6 (IL-6) gene on IL-6 transcription and plasma IL-6 levels, and an association with systemic-onset juvenile chronic arthritis. J Clin Invest 1998; 102:1369.
  80. Foster CB, Lehrnbecher T, Samuels S, et al. An IL6 promoter polymorphism is associated with a lifetime risk of development of Kaposi sarcoma in men infected with human immunodeficiency virus. Blood 2000; 96:2562.
  81. Gazouli M, Zavos G, Papaconstantinou I, et al. The interleukin-6-174 promoter polymorphism is associated with a risk of development of Kaposi's sarcoma in renal transplant recipients. Anticancer Res 2004; 24:1311.
  82. Guttman-Yassky E, Cohen A, Kra-Oz Z, et al. Familial clustering of classic Kaposi sarcoma. J Infect Dis 2004; 189:2023.
  83. Brown EE, Fallin D, Ruczinski I, et al. Associations of classic Kaposi sarcoma with common variants in genes that modulate host immunity. Cancer Epidemiol Biomarkers Prev 2006; 15:926.
  84. Mocroft A, Youle M, Gazzard B, et al. Anti-herpesvirus treatment and risk of Kaposi's sarcoma in HIV infection. Royal Free/Chelsea and Westminster Hospitals Collaborative Group. AIDS 1996; 10:1101.
  85. Martin DF, Kuppermann BD, Wolitz RA, et al. Oral ganciclovir for patients with cytomegalovirus retinitis treated with a ganciclovir implant. Roche Ganciclovir Study Group. N Engl J Med 1999; 340:1063.
  86. Whitby D, Howard MR, Tenant-Flowers M, et al. Detection of Kaposi sarcoma associated herpesvirus in peripheral blood of HIV-infected individuals and progression to Kaposi's sarcoma. Lancet 1995; 346:799.
  87. Campbell TB, Borok M, Gwanzura L, et al. Relationship of human herpesvirus 8 peripheral blood virus load and Kaposi's sarcoma clinical stage. AIDS 2000; 14:2109.
  88. Broccolo F, Bossolasco S, Careddu AM, et al. Detection of DNA of lymphotropic herpesviruses in plasma of human immunodeficiency virus-infected patients: frequency and clinical significance. Clin Diagn Lab Immunol 2002; 9:1222.
  89. Gill J, Bourboulia D, Wilkinson J, et al. Prospective study of the effects of antiretroviral therapy on Kaposi sarcoma--associated herpesvirus infection in patients with and without Kaposi sarcoma. J Acquir Immune Defic Syndr 2002; 31:384.
  90. Lorenzen T, Albrecht D, Paech V, et al. HHV-8 DNA in blood and the development of HIV-associated Kaposi's sarcoma in the era of HAART--a prospective evaluation. Eur J Med Res 2002; 7:283.
  91. Cannon MJ, Dollard SC, Black JB, et al. Risk factors for Kaposi's sarcoma in men seropositive for both human herpesvirus 8 and human immunodeficiency virus. AIDS 2003; 17:215.
  92. Grundhoff A, Ganem D. Inefficient establishment of KSHV latency suggests an additional role for continued lytic replication in Kaposi sarcoma pathogenesis. J Clin Invest 2004; 113:124.
  93. Sarmati L. Serological testing for human herpesvirus 8. Herpes 2001; 8:76.
  94. Engels EA, Atkinson JO, Graubard BI, et al. Risk factors for human herpesvirus 8 infection among adults in the United States and evidence for sexual transmission. J Infect Dis 2007; 196:199.
  95. Verbeek W, Frankel M, Miles S, et al. Seroprevalence of HHV-8 antibodies in HIV-positive homosexual men without Kaposi's sarcoma and their clinical follow-up. Am J Clin Pathol 1998; 109:778.
  96. Regamey N, Cathomas G, Schwager M, et al. High human herpesvirus 8 seroprevalence in the homosexual population in Switzerland. J Clin Microbiol 1998; 36:1784.
  97. Casper C, Redman M, Huang ML, et al. HIV infection and human herpesvirus-8 oral shedding among men who have sex with men. J Acquir Immune Defic Syndr 2004; 35:233.
  98. Gao SJ, Kingsley L, Li M, et al. KSHV antibodies among Americans, Italians and Ugandans with and without Kaposi's sarcoma. Nat Med 1996; 2:925.
  99. Marcelin AG, Dupin N, Bossi P, Calvez V. Seroprevalence of human herpesvirus-8 in healthy subjects and patients with AIDS-associated and classical Kaposi's sarcoma in France. AIDS 1998; 12:539.
  100. Rabkin CS, Schulz TF, Whitby D, et al. Interassay correlation of human herpesvirus 8 serologic tests. HHV-8 Interlaboratory Collaborative Group. J Infect Dis 1998; 178:304.
  101. Kedes DH, Ganem D, Ameli N, et al. The prevalence of serum antibody to human herpesvirus 8 (Kaposi sarcoma-associated herpesvirus) among HIV-seropositive and high-risk HIV-seronegative women. JAMA 1997; 277:478.
  102. Cannon MJ, Dollard SC, Smith DK, et al. Blood-borne and sexual transmission of human herpesvirus 8 in women with or at risk for human immunodeficiency virus infection. N Engl J Med 2001; 344:637.
  103. Casper C, Meier AS, Wald A, et al. Human herpesvirus 8 infection among adolescents in the REACH cohort. Arch Pediatr Adolesc Med 2006; 160:937.
  104. Luppi M, Borozzi P, Morabitio F, et al. HHV-8 Infection in blood donors and patients with malignant and reactive lymphoproliferations from different regions of Italy. Haematologica 1998; 83:468.
  105. Angeloni A, Heston L, Uccini S, et al. High prevalence of antibodies to human herpesvirus 8 in relatives of patients with classic Kaposi's sarcoma from Sardinia. J Infect Dis 1998; 177:1715.
  106. Guttman-Yassky E, Kra-Oz Z, Dubnov J, et al. Infection with Kaposi's sarcoma-associated herpesvirus among families of patients with classic Kaposi's sarcoma. Arch Dermatol 2005; 141:1429.
  107. Ziegler JL, Templeton AC, Vogel CL. Kaposi's sarcoma: a comparison of classical, endemic, and epidemic forms. Semin Oncol 1984; 11:47.
  108. Bestetti G, Renon G, Mauclére P, et al. High seroprevalence of human herpesvirus-8 in pregnant women and prostitutes from Cameroon. AIDS 1998; 12:541.
  109. Mayama S, Cuevas LE, Sheldon J, et al. Prevalence and transmission of Kaposi's sarcoma-associated herpesvirus (human herpesvirus 8) in Ugandan children and adolescents. Int J Cancer 1998; 77:817.
  110. Plancoulaine S, Abel L, van Beveren M, et al. Human herpesvirus 8 transmission from mother to child and between siblings in an endemic population. Lancet 2000; 356:1062.
  111. Lennette ET, Blackbourn DJ, Levy JA. Antibodies to human herpesvirus type 8 in the general population and in Kaposi's sarcoma patients. Lancet 1996; 348:858.
  112. Dollard SC, Butler LM, Jones AM, et al. Substantial regional differences in human herpesvirus 8 seroprevalence in sub-Saharan Africa: insights on the origin of the "Kaposi's sarcoma belt". Int J Cancer 2010; 127:2395.
  113. Butler LM, Were WA, Balinandi S, et al. Human herpesvirus 8 infection in children and adults in a population-based study in rural Uganda. J Infect Dis 2011; 203:625.
  114. Biryahwaho B, Dollard SC, Pfeiffer RM, et al. Sex and geographic patterns of human herpesvirus 8 infection in a nationally representative population‐based sample in Uganda. J Infect Dis 2010; 202:1347.
  115. Johnston C, Orem J, Okuku F, et al. Impact of HIV infection and Kaposi sarcoma on human herpesvirus-8 mucosal replication and dissemination in Uganda. PLoS One 2009; 4:e4222.
  116. Hladik W, Dollard SC, Mermin J, et al. Transmission of human herpesvirus 8 by blood transfusion. N Engl J Med 2006; 355:1331.
  117. Gantt S, Orem J, Krantz EM, et al. Prospective Characterization of the Risk Factors for Transmission and Symptoms of Primary Human Herpesvirus Infections Among Ugandan Infants. J Infect Dis 2016; 214:36.
  118. Minhas V, Crabtree KL, Chao A, et al. Early childhood infection by human herpesvirus 8 in Zambia and the role of human immunodeficiency virus type 1 coinfection in a highly endemic area. Am J Epidemiol 2008; 168:311.
  119. Olp LN, Minhas V, Gondwe C, et al. Effects of Antiretroviral Therapy on Kaposi's Sarcoma-Associated Herpesvirus (KSHV) Transmission Among HIV-Infected Zambian Children. J Natl Cancer Inst 2015; 107.
  120. Sivayathorn A, Srihra B, Leesanguankul W. Prevalence of skin disease in patients infected with human immunodeficiency virus in Bangkok, Thailand. Ann Acad Med Singapore 1995; 24:528.
  121. Wang YF, Lee SB, Cheng LC, et al. Detection of serum antibodies to three different recombinant antigens of human herpesvirus 8 by immunoblotting: seroprevalence studies in Taiwan. Clin Chim Acta 2002; 320:37.
  122. Chen N, Nelson KE, Jenkins FJ, et al. Seroprevalence of human herpesvirus 8 infection in Northern Thailand. Clin Infect Dis 2004; 39:1052.
  123. Xie Y, Ruan B, Chen Y, et al. Kaposi's sarcoma-associated herpesvirus infection in Chinese patients with chronic hepatitis B. J Med Virol 2011; 83:879.
  124. Freitas RB, Freitas MR, Linhares AC. Prevalence of human herpesvirus 8 antibodies in the population of Belém, Pará, Brazil. Rev Inst Med Trop Sao Paulo 2002; 44:309.
  125. Guanira JV, Casper C, Lama JR, et al. Prevalence and correlates of human herpesvirus 8 infection among Peruvian men who have sex with men. J Acquir Immune Defic Syndr 2008; 49:557.
  126. Biggar RJ, Whitby D, Marshall V, et al. Human herpesvirus 8 in Brazilian Amerindians: a hyperendemic population with a new subtype. J Infect Dis 2000; 181:1562.
  127. Martro E, Bulterys M, Stewart JA, et al. Comparison of human herpesvirus 8 and Epstein-Barr virus seropositivity among children in areas endemic and non-endemic for Kaposi's sarcoma. J Med Virol 2004; 72:126.
  128. Baillargeon J, Leach CT, Deng JH, et al. High prevalence of human herpesvirus 8 (HHV-8) infection in south Texas children. J Med Virol 2002; 67:542.
  129. Casper C, Wald A, Pauk J, et al. Correlates of prevalent and incident Kaposi's sarcoma-associated herpesvirus infection in men who have sex with men. J Infect Dis 2002; 185:990.
  130. Lavreys L, Chohan B, Ashley R, et al. Human herpesvirus 8: seroprevalence and correlates in prostitutes in Mombasa, Kenya. J Infect Dis 2003; 187:359.
  131. Eltom MA, Mbulaiteye SM, Dada AJ, et al. Transmission of human herpesvirus 8 by sexual activity among adults in Lagos, Nigeria. AIDS 2002; 16:2473.
  132. Blauvelt A, Sei S, Cook PM, et al. Human herpesvirus 8 infection occurs following adolescence in the United States. J Infect Dis 1997; 176:771.
  133. Borges JD, Souza VA, Giambartolomei C, et al. Transmission of human herpesvirus type 8 infection within families in american indigenous populations from the Brazilian Amazon. J Infect Dis 2012; 205:1869.
  134. Pauk J, Huang ML, Brodie SJ, et al. Mucosal shedding of human herpesvirus 8 in men. N Engl J Med 2000; 343:1369.
  135. Sosa C, Benetucci J, Hanna C, et al. Human herpesvirus 8 can be transmitted through blood in drug addicts. Medicina (B Aires) 2001; 61:291.
  136. Hladik W, Pellett PE, Hancock J, et al. Association between transfusion with human herpesvirus 8 antibody-positive blood and subsequent mortality. J Infect Dis 2012; 206:1497.
  137. Cannon MJ, Operskalski EA, Mosley JW, et al. Lack of evidence for human herpesvirus-8 transmission via blood transfusion in a historical US cohort. J Infect Dis 2009; 199:1592.
  138. Schennach H, Schönitzer D, Wachter H, Fuchs D. Blood donations and viruses. Lancet 1997; 349:1327.
  139. Regamey N, Tamm M, Wernli M, et al. Transmission of human herpesvirus 8 infection from renal-transplant donors to recipients. N Engl J Med 1998; 339:1358.
  140. Nocera A, Corbellino M, Valente U, et al. Posttransplant human herpes virus 8 infection and seroconversion in a Kaposi's sarcoma affected kidney recipient transplanted from a human herpes virus 8 positive living related donor. Transplant Proc 1998; 30:2095.
  141. Luppi M, Barozzi P, Schulz TF, et al. Bone marrow failure associated with human herpesvirus 8 infection after transplantation. N Engl J Med 2000; 343:1378.
  142. Barozzi P, Luppi M, Facchetti F, et al. Post-transplant Kaposi sarcoma originates from the seeding of donor-derived progenitors. Nat Med 2003; 9:554.
  143. Parravicini C, Scalamogna C, Calattini S, et al. KSHV reactivation in post-transplant Kaposi sarcoma. Nat Med 2003; 9:986; author reply 986.
  144. Parravicini C, Olsen SJ, Capra M, et al. Risk of Kaposi's sarcoma-associated herpes virus transmission from donor allografts among Italian posttransplant Kaposi's sarcoma patients. Blood 1997; 90:2826.
  145. Farge D, Lebbé C, Marjanovic Z, et al. Human herpes virus-8 and other risk factors for Kaposi's sarcoma in kidney transplant recipients. Groupe Cooperatif de Transplantation d' Ile de France (GCIF). Transplantation 1999; 67:1236.
  146. Moore PS, Kingsley LA, Holmberg SD, et al. Kaposi's sarcoma-associated herpesvirus infection prior to onset of Kaposi's sarcoma. AIDS 1996; 10:175.
  147. Andreoni M, Sarmati L, Nicastri E, et al. Primary human herpesvirus 8 infection in immunocompetent children. JAMA 2002; 287:1295.
  148. Koelle DM, Huang ML, Chandran B, et al. Frequent detection of Kaposi's sarcoma-associated herpesvirus (human herpesvirus 8) DNA in saliva of human immunodeficiency virus-infected men: clinical and immunologic correlates. J Infect Dis 1997; 176:94.
  149. Vieira J, Huang ML, Koelle DM, Corey L. Transmissible Kaposi's sarcoma-associated herpesvirus (human herpesvirus 8) in saliva of men with a history of Kaposi's sarcoma. J Virol 1997; 71:7083.
  150. Blackbourn DJ, Lennette ET, Ambroziak J, et al. Human herpesvirus 8 detection in nasal secretions and saliva. J Infect Dis 1998; 177:213.
  151. LaDuca JR, Love JL, Abbott LZ, et al. Detection of human herpesvirus 8 DNA sequences in tissues and bodily fluids. J Infect Dis 1998; 178:1610.
  152. Dedicoat M, Newton R, Alkharsah KR, et al. Mother-to-child transmission of human herpesvirus-8 in South Africa. J Infect Dis 2004; 190:1068.
  153. Taylor MM, Chohan B, Lavreys L, et al. Shedding of human herpesvirus 8 in oral and genital secretions from HIV-1-seropositive and -seronegative Kenyan women. J Infect Dis 2004; 190:484.
  154. Mbulaiteye SM, Pfeiffer RM, Engels EA, et al. Detection of kaposi sarcoma-associated herpesvirus DNA in saliva and buffy-coat samples from children with sickle cell disease in Uganda. J Infect Dis 2004; 190:1382.
  155. de Souza VA, Sumita LM, Nascimento MC, et al. Human herpesvirus-8 infection and oral shedding in Amerindian and non-Amerindian populations in the Brazilian Amazon region. J Infect Dis 2007; 196:844.
  156. Casper C, Krantz E, Selke S, et al. Frequent and asymptomatic oropharyngeal shedding of human herpesvirus 8 among immunocompetent men. J Infect Dis 2007; 195:30.
  157. Monini P, de Lellis L, Fabris M, et al. Kaposi's sarcoma-associated herpesvirus DNA sequences in prostate tissue and human semen. N Engl J Med 1996; 334:1168.
  158. Pellett PE, Spira TJ, Bagasra O, et al. Multicenter comparison of PCR assays for detection of human herpesvirus 8 DNA in semen. J Clin Microbiol 1999; 37:1298.
  159. Ambroziak JA, Blackbourn DJ, Herndier BG, et al. Herpes-like sequences in HIV-infected and uninfected Kaposi's sarcoma patients. Science 1995; 268:582.
  160. Diamond C, Huang ML, Kedes DH, et al. Absence of detectable human herpesvirus 8 in the semen of human immunodeficiency virus-infected men without Kaposi's sarcoma. J Infect Dis 1997; 176:775.
  161. Tasaka T, Said JW, Morosetti R, et al. Is Kaposi's sarcoma--associated herpesvirus ubiquitous in urogenital and prostate tissues? Blood 1997; 89:1686.
  162. Huang YQ, Li JJ, Poiesz BJ, et al. Detection of the herpesvirus-like DNA sequences in matched specimens of semen and blood from patients with AIDS-related Kaposi's sarcoma by polymerase chain reaction in situ hybridization. Am J Pathol 1997; 150:147.
  163. Howard MR, Whitby D, Bahadur G, et al. Detection of human herpesvirus 8 DNA in semen from HIV-infected individuals but not healthy semen donors. AIDS 1997; 11:F15.
  164. Rubin MA, Parry JP, Singh B. Kaposi's sarcoma associated herpesvirus deoxyribonucleic acid sequences: lack of detection in prostatic tissue of human immunodeficiency virus-negative immunocompetent adults. J Urol 1998; 159:146.
  165. Lebbé C, Pellet C, Tatoud R, et al. Absence of human herpesvirus 8 sequences in prostate specimens. AIDS 1997; 11:270.
  166. Corbellino M, Poirel L, Bestetti G, et al. Restricted tissue distribution of extralesional Kaposi's sarcoma-associated herpesvirus-like DNA sequences in AIDS patients with Kaposi's sarcoma. AIDS Res Hum Retroviruses 1996; 12:651.
  167. Diamond C, Brodie SJ, Krieger JN, et al. Human herpesvirus 8 in the prostate glands of men with Kaposi's sarcoma. J Virol 1998; 72:6223.
  168. Calabrò ML, Fiore JR, Favero A, et al. Detection of human herpesvirus 8 in cervicovaginal secretions and seroprevalence in human immunodeficiency virus type 1-seropositive and -seronegative women. J Infect Dis 1999; 179:1534.
  169. Lampinen TM, Kulasingam S, Min J, et al. Detection of Kaposi's sarcoma-associated herpesvirus in oral and genital secretions of Zimbabwean women. J Infect Dis 2000; 181:1785.
  170. Brayfield BP, Phiri S, Kankasa C, et al. Postnatal human herpesvirus 8 and human immunodeficiency virus type 1 infection in mothers and infants from Zambia. J Infect Dis 2003; 187:559.