Risk factors for Kaposi's sarcoma associated herpesvirus (KSHV) DNA in blood and in saliva in rural Uganda

INTRODUCTION: Detectable KSHV DNA in blood and increased antibody titres may indicate KSHV reactivation, while transmission of KSHV occurs via viral shedding in saliva. METHODS: We investigated risk factors for KSHV DNA detection by real-time PCR, in blood and viral shedding in saliva, in 878 people aged 3 to 89 years of both sexes in a rural Ugandan population cohort. Helminths were detected using microscopy and malaria parasitaemia was identified using rapid diagnostic tests. Regression modelling was used for statistical analysis. RESULTS: and discussion: KSHV viral load in blood did not correlate with viral load in saliva, suggesting separate immunological control within each compartment. The proportion of individuals with detectable virus in blood was 23% among children aged 3-5 years , 22% among 6-12 years old, thereafter reducing with increasing age. The proportion of individuals with detectable virus in saliva increased from 30% in 3-5 year old children to 45% in those aged 6-12 and decreasing subsequently with increasing age. Overall, 29% of males shed in saliva compared to 19% of females (p = 0.008). Together, these data suggest that young males may be responsible for much of the onward transmission of KSHV. Individuals with a current malaria infection had higher levels of viral DNA in blood (p = 0.031) compared to malaria uninfected individuals. This suggests that malaria may lead to KSHV reactivation, thereby increasing transmission and pathogenicity of the virus.