Highly heterogeneous human herpes virus-8 oral shedding kinetics among people with and without Kaposi sarcoma and HIV- co-infection

BackgroundAn improved understanding of oral human herpesvirus-8 (HHV-8) viral dynamics could provide insights into transmission risk and guide vaccine development. MethodsWe evaluated HHV-8 oral shedding dynamics in Ugandan adults stratified by Kaposi sarcoma (KS) and HIV status. Participants were followed for [≥]4 weeks, with daily home oral swab collection to quantify HHV-8 using Polymerase Chain Reaction. Shedding rates were defined by the number of days with HHV-8 detected divided by the total days with swabs and compared by group using hurdle models. Results295 participants were enrolled; median age was 35 years (range 18-71), 134 (45%) were male. HHV-8 was detected more frequently among participants with KS (HIV+/KS+ 56/76, 74%; HIV-/KS+ 9/18, 50%) than those without KS (HIV+/KS-36/125, 29%; HIV-/KS-16/76, 21%); odds of shedding did not differ significantly by HIV status. Among participants with HHV-8 detected, shedding rates did not differ significantly by group. Median per-participant viral loads among positive samples were lowest in HIV+/KS+ (3.1 log10 copies/mL) and HIV-/KS+ participants (3.3 log10 copies/mL) relative to HIV+/KS-(3.8 log10 copies/mL) and HIV-/KS-participants (4.0 log10 copies/mL). All groups had participants with low-viral load intermittent shedding and those with high-viral load persistent shedding. Within each group, individual HHV-8 shedding rate positively correlated with median HHV-8 log10 copies/mL, and episode duration positively correlated with peak viral load. ConclusionsOral HHV-8 shedding is highly heterogeneous across Ugandan adults with and without KS and HIV. Persistent shedding is associated with higher median viral loads regardless of HIV and KS status.