Relationship of human herpesvirus 8 peripheral blood virus load and Kaposi's sarcoma clinical stage.

OBJECTIVE: To determine the relationship between human herpesvirus 8 (HHV-8 or Kaposi's sarcoma-associated herpesvirus) peripheral blood virus load and Kaposi's sarcoma (KS) clinical stage. DESIGN: Blinded, cross-sectional analysis of peripheral blood HHV-8 DNA levels in persons with AIDS-related KS in Harare, Zimbabwe. METHODS: Subjects were stratified by KS clinical stage. The amount of HHV-8 DNA in plasma and peripheral blood mononuclear cells (PBMC) was determined by quantitative real-time PCR amplification of the HHV-8 open reading frame 26. RESULTS: Thirty-one HIV-1/HHV-8-coinfected persons were studied: 26 subjects had histologically confirmed KS (one stage II, 11 stage III and 14 stage IV) and five subjects had antibodies to HHV-8 but did not have KS. The age, CD4 lymphocyte count and plasma HIV-1 RNA levels were similar in all groups. HHV-8 DNA was detected in the plasma of all HHV-8-infected subjects (range < 2.4 to 5.2 log10 copies/ml), but plasma HHV-8 DNA levels were not associated with KS disease stage. In contrast, the amount of HHV-8 DNA in PBMC (range < 0.7 to 4.5 log10 copies/microg) was strongly associated with KS clinical stage (P = 0.005). Among stage IV KS cases, there was a linear relationship between plasma and PBMC HHV-8 DNA levels (r2 = 0.42; P = 0.01). CONCLUSION: The strong association observed between the extent of KS disease and the levels of HHV-8 DNA in PBMC provides further evidence for a relationship between HHV-8 virus load and KS pathogenesis.

Hepatitis C virus and HIV antibodies in patients with hepatocellular carcinoma in Zimbabwe: a pilot study.

To determine the role of hepatitis C virus (HCV) infection in the aetiology of hepatocellular carcinoma (HCC) in Zimbabwe, HCV antibodies (anti-HCV) were determined in sera from 63 HCC patients using a second generation enzyme immunoassay. Anti-HCV was found in 15 patients (23.8%), 12 of whom (80%) were males. The mean ages of anti-HCV positive and anti-HCV negative patients were 62.1 (SD = 10.6) and 44.3 (SD = 15.2) years, respectively (P < 0.001). HIV antibodies were found in 17/59 patients (28.8%), 12 of whom (70.6%) were males. The mean ages of HIV positive and HIV negative patients were 39.4 (SD = 15.2) and 51.0 (SD = 15.2) years (P = 0.011). Hepatitis B surface antigen (HBsAg) was detected in 26/61 patients (42.6%) with mean ages of HBsAg positive vs negative patients of 41.5 (SD = 15.4) years for HIV positive and 53.1 (SD = 15.1) years for HIV negative subjects (P = 0.005). Younger HCC patients had high prevalences of HBsAg and anti-HIV and a low prevalence of anti-HCV; while older patients had a high prevalence of anti-HCV and low prevalences of HBsAg and anti-HIV. This study suggested that HCV infection is probably an important aetiological agent of HCC in Zimbabwe; however, the role of HIV infection as a cause of HCC either singly or as a co-factor with hepatitis B virus infection remains speculative and warrants further study.

PIP: Several studies have reported a high prevalence of hepatitis C virus (HCV) antibodies (anti-HCV) in patients with hepatocellular carcinoma (HCC). In addition, HIV infection may be a causative factor for HCC. To determine the role of HCV infection in the etiology of HCC in Zimbabwe, the presence of anti-HCV was assessed in sera from 63 HCC patients using a second-generation enzyme immunoassay. Anti-HCV was isolated in 15 patients (23.8%), of whom 12 were male. The mean ages of anti-HCV-positive and anti-HCV-negative patients were 62.1 and 44.3 years, respectively. HIV antibodies were found in 17 (28.8%) of 59 patients, of whom 12 were male. The mean ages of HIV-positive and HIV-negative patients were 39.4 and 51.0 years, respectively. Hepatitis B surface antigen (HBsAg) was detected in 26 of 61 patients (42.6%), with the mean ages of HBsAg-positive versus HBsAg-negative patients of 41.5 years for HIV-positive and 53.1 years for HIV-negative subjects. Younger HCC patients had high prevalences of HBsAg and anti-HIV, and a low prevalence of anti-HCV, while older patients had a high prevalence of anti-HCV and low prevalences of HBsAg and anti-HIV. These findings suggest that HCV infection is probably an important etiological agent of HCC in Zimbabwe.

Fine needle aspiration cytology in the diagnosis of hepatocellular carcinoma.

Fine needle aspiration (FNA) of the liver without ultrasound guidance was performed on 110 patients with hepatocellular carcinoma (HCC). The median age was 52 years, with a range of 16 to 86 years. There were 90 males and 20 females (a male: female ratio of 4.5:1), with a median age of 51.5 years (range 16 to 86 years) and 55.5 years (range 17 to 72 years) respectively. FNA was reported as showing malignancy in 92 (84 pc, 95 pc CI 77 to 91 pc) patients; 80 (73 pc) were definite HCC, 12 (11 pc) were malignant unspecified, seven (6 pc) were suspicious of malignancy, seven (6 pc) had no malignant cells and four (4 pc) were non-diagnostic. The only complication observed was dizziness in one patient. We conclude that FNA of the liver for the diagnosis of HCC is a safe, simple and accurate procedure which can be undertaken in settings that would otherwise not be suitable for formal liver biopsy.