Human Herpesvirus 8 Seroprevalence, China

Na He

, Xiaodan Shao, Yue Chen, Tao Zhang, Veenu Minhas, Charles Wood, and Tiejun Zhang

Author affiliations: Fudan University, Shanghai, People’s Republic of China (T. Zhang, X. Shao, Tao Zhang, V. Minhas, C. Wood, N. He); University of Nebraska-Lincoln, Lincoln, Nebraska, USA (T. Zhang, V. Minhas, C. Wood); University of Ottawa, Ottawa, Ontario, Canada (Y. Chen)

Abstract

To summarize the seroprevalence of human herpesvirus 8 (HHV-8) in mainland China, we conducted a systematic review and meta-analysis based on available literature. Data show that differences in HHV-8 prevalence vary considerably among different ethnic groups and geographic regions. Blood-borne transmission could be a potential route for HHV-8 infection in China.

Human herpesvirus 8 (HHV-8) is the infectious etiologic agent associated with Kaposi sarcoma, primary effusion lymphoma, and multicentric Castleman disease. Worldwide seroprevalence of HHV-8 varies: generally low to moderate for populations in Western countries and Asia (1–4) but as high as 50% for the general population in sub-Saharan Africa and higher for HIV-positive populations (5–7). The transmission modes of HHV-8 may also differ in different geographic areas and subpopulations; sexual and nonsexual transmission have been described (8–10). Blood-borne transmission may exist, especially among intravenous drug users (IVDUs) and blood recipients (11).

The Ministry of Health of China, the United Nations Program on HIV/AIDS, and the World Health Organization estimate that ≈320,000 HIV/AIDS cases have been reported in China (12). However, the epidemiologic characteristics of HHV-8 infection, a severe HIV/AIDS opportunistic infection, have not been well described for China. Therefore, we conducted a systematic review and metaanalysis on the basis of available data for HHV-8 epidemiology from mainland China to have a better understanding of the prevalence, variation, and factors associated with its transmission.

The Study

A comprehensive literature search of published studies indexed in global and databases in China during 1995–2010 was conducted. Initially, 125 reports published in English and 223 in Chinese concerning the seroprevalence in mainland China were identified. Among them, 85 articles published in England and 178 articles published in China were excluded after title and abstract screening. After reading the full text, we excluded another 33 English and 26 Chinese articles. Finally, 26 publications were included in this systematic review and have been summarized in Technical Appendix Table 1

[PDF - 568 KB - 6 pages]. These studies were cross-sectional and were conducted in 8 of the 34 provinces. A substantial number (35.5%) of these studies were conducted in the Xinjiang Uygur Autonomous Region. Most samples tested were serum or plasma with few exceptions (1 whole blood, 1 peripheral blood mononuclear cells); sample sizes ranged from 37 to 4,461 (median 242, interquartile range 199–520). Overall, 18,547 participants were involved in the present analysis, and among them 15,913 were from the general population, 1,970 were
immunocompromised patients, and 664 were IVDUs. Laboratory methods for all included studies were reported (19 detected HHV-8 by ELISA, 3 by PCR, and 4 by immunofluorescent assay.

Figure

Figure. Regional distribution of pooled human herpesvirus 8 (HHV-8) prevalence in A) the general population and B) immunocompromised patients, China.

The prevalence of HHV-8 pooled from reviewed studies was 11.3% (95% CI 7.2–15.5) for the general population, 22.2% (95% CI 12.7–31.8) for immunocompromised patients, and 31.2% (95% CI 27.7–34.7) for IVDUs. The prevalence among the general population was found to be the lowest in Guangdong Province and the highest in Xinjiang Province. A similar regional variation was found for immunocompromised persons. Among IVDUs, the prevalence was 34.3% (95% CI 28.3–40.3) in Zhejiang and 29.6% (95% CI 25.3–33.9) in Xinjiang Uygur Autonomous Region (Technical Appendix Table 2

[PDF - 568 KB - 6 pages]; Figure).