Download Age-and Sex-Specific Seroprevalence of Human Herpesvirus 8 in

would, by itself, potentially seriously
decrease the quality of their lives.
Although Dr. Gold suggests that
‘‘every single informed-consent, controlled clinical trial of hydrazine sulfate—
with the exception of the NCI-sponsored
studies . . .—has demonstrated efficacy
and safety,’’ this is simply not true. In
the study by Chlebowski et al. (5), the
overall treatment effect for hydrazine
was not statistically significant. Only
subset analysis revealed that patients
with favorable performance status
showed improvement in survival. However, the editorial (6) accompanying the
article by Chlebowski et al. (5) discussed the fact that the trial had too few
patients to be meaningful. This is why
the much larger trials were performed
that did not show any benefit. The Russian study (7) reported 740 patients who
had advanced cancer of various types
and had received hydrazine in a phase II
fashion. They noted objective responses
by standard definition in only 4% of patients with lung cancer but a ‘‘subjective
response’’ in 47%. Symptomatic improvement was poorly defined, and the
influence of hydrazine on weight loss,
nutritional status, and overall survival
was not evaluated. In other clinical trials
in which objective response rates were
used as criteria for benefit, none have
shown a significant response rate to hydrazine (8–10). Some uncontrolled trials
have shown subjective improvement in
65%–70% of patients (11,12). However,
as far as appetite improvement alone,
36%–55% of patients receiving placebos on two prospective double-blind
clinical trials noted improvement (3,13).
Thus, it should be no surprise that a
fairly high percentage of patients do report subjective improvement when taking hydrazine. Unless hydrazine-treated
patients are compared with a placebotreated group, no valid assessment can
be made of its true efficacy.
Proponents of alternative medical
therapies need to realize that benefit
from their treatment needs to be objectively determined in the same manner as
that from mainstream treatment. All of
us are looking for a magic bullet. However, stating that a treatment works
without data to back it up simply gives
false hope to cancer patients. Internet
websites are full of this type of ‘‘information.’’ Only careful clinical trials can
1102 CORRESPONDENCE
determine the true efficacy and ultimate
importance of new therapies. Although
cancer treatment today remains less than
optimal, hydrazine sulfate is not the answer.
BENTON M. WHEELER
trolled trial of cyproheptadine in cancer patients with anorexia and/or cachexia. Cancer
1990;65:2657–62.
Note
Correspondence to: Benton M. Wheeler, M.D.,
West Clinic, P.C., Memphis, TN 38117.
References
(1) Kosty MP, Fleishman SB, Herndon JE 2nd,
Coughlin K, Kornblith AB, Scalzo A, et al.
Cisplatin, vinblastine, and hydrazine sulfate
in advanced, non-small-cell lung cancer: a
randomized placebo-controlled, double-blind
phase III study of the Cancer and Leukemia Group B. J Clin Oncol 1994;12:1113–
20.
(2) Kosty MP, Herndon JE 2nd, Green MR,
McIntyre OR. Placebo-controlled randomized study of hydrazine sulfate in lung
cancer [letter]. J Clin Oncol 1995;13:1529–
30.
(3) Loprinzi CL, Kuross SA, O’Fallon JR,
Gesme DH Jr, Gerstner JB, Rospond RM, et
al. Randomized placebo-controlled evaluation of hydrazine sulfate in patients with advanced colorectal cancer. J Clin Oncol
1994;12:1121–5.
(4) Loprinzi CL, Goldberg RM, Su JQ, Mailliard
JA, Kuross SA, Maksymiuk AW, et al. Placebo-controlled trial of hydrazine sulfate
in patients with newly diagnosed non-smallcell lung cancer. J Clin Oncol 1994;12:
1126–9.
(5) Chlebowski RT, Bulcavage L, Grosvenor M,
Oktay E, Block JB, Chlebowski JS, et al.
Hydrazine sulfate influence on nutritional
status and survival in non-small-cell lung
cancer. J Clin Oncol 1990;8:9–15.
(6) Piantadosi S. Hazards of small clinical trials.
J Clin Oncol 1990;8:1–3.
(7) Filov VA, Gershanovich ML, Danova LA,
Ivin BA. Experience of the treatment with
Sehydrin (Hydrazine Sulfate, HS) in the advanced cancer patients. Invest New Drugs
1995;13:89–97.
(8) Lerner HJ, Regelson W. Clinical trial of hydrazine sulfate in solid tumors. Cancer Treat
Rep 1976;60:959–60.
(9) Ochoa M Jr, Wittes RE, Krakoff IH. Trial of
hydrazine sulfate (NSC-150014) in patients
with cancer. Cancer Chemother Rep 1975;
59:1151–4.
(10) Spremulli E, Wampler GL, Regelson W.
Clinical study of hydrazine sulfate in advanced cancer patients. Cancer Chemother
Pharmacol 1979;3:121–4.
(11) Gershanovich ML, Danova LA, Ivin BA, Filov VA. Results of clinical study of antitumor
action of hydrazine sulfate. Nutr Cancer
1981;3:7–12.
(12) Gold J. Use of hydrazine sulfate in terminal
and preterminal cancer patients: results of investigational new drug (IND) study in 84
evaluable patients. Oncology 1975;32:
1–10.
(13) Kardinal CG, Loprinzi CL, Schaid DJ, Hass
AC, Dose AM, Athmann LM, et al. A con-
Age- and Sex-Specific
Seroprevalence of Human
Herpesvirus 8 in Jamaica
A recent communication by Whitby
et al. (1) in the Journal reported that the
seroprevalence of human herpesvirus 8
(HHV-8) varies geographically in Italy,
an area with an incidence of Kaposi’s
sarcoma ranging from 0.5 to 1.5 per
100 000 population.
We evaluated the seroprevalence of
HHV-8 in Jamaica, an area with a low
incidence of Kaposi’s sarcoma (2), and
showed that the seroprevalence of
HHV-8 among the population varied
predominantly by age and sex. HHV-8
has been linked etiologically to classic
and acquired immune deficiency
syndrome-related Kaposi’s sarcoma,
primary effusion lymphomas, and multicentric Castleman’s disease by serologic and molecular evaluations (3). Although Jamaica has a low incidence of
Kaposi’s sarcoma, several cases of multicentric Castleman’s disease, a lymphoproliferative disorder, have been reported (4,5).
We analyzed HHV-8 seroprevalence
among two populations in Jamaica, 250
normal blood donors from the National
Transfusion Service, Kingston, Jamaica,
and 146 women visiting gynecology
clinics affiliated with the University
Hospital of the West Indies in Kingston.
The median age among the blood donors
was 41 years (range, 18–64 years), and
50% of them were female. The median
age of the gynecology clinic patients
was 33 years (range, 19–78 years). Sera
were tested by use of whole virus (purified on a sucrose gradient) in an enzyme-linked immunoassay (Advanced
Biotechnologies Inc. [ABI], Columbia,
MD) and an immunofluorescence assay
to detect lytic and latent proteins (ABI
or Science Applications International
Journal of the National Cancer Institute, Vol. 90, No. 14, July 15, 1998
Plaza North, Suite 434, Bethesda, MD 208927370.
Response
Fig. 1. Prevalence, expressed as percent seropositivity, of human herpesvirus 8 (HHV-8) in Jamaican
blood donors—by age and sex. To yield a positive result, serum samples were required to test positive
both to whole virus by use of an enzyme-linked immunoassay and to lytic and latent proteins of HHV-8
by use of an immunofluorescence assay.
Corp., Frederick, MD) (6). Serum
samples were interpreted as seropositive
if both immunoassays yielded positive
results.
The overall seroprevalence among
the blood donors tested was 3.6% (9/
250). Among the normal blood donors,
5.0% of men (6/119) and 2.4% of
women (3/122) had detectable levels of
HHV-8 antibodies. Men were two times
more likely to be seropositive than
women (odds ratio 4 2.1; 95% confidence interval 4 0.43–12.9). Blood donors over the age of 40 years had a 2.9fold greater likelihood of HHV-8
seropositivity (odds ratio 4 2.89; 95%
confidence interval 4 0.53–29). The
highest number of seropositives (6.9%)
among both sexes was detected in individuals over the age of 50 years (Fig. 1).
Among the women attending the gynecology clinics, only 0.68% (1/146) were
seropositive, and that one seropositive
patient was 44 years old. Thus, in the
evaluation of HHV-8 seroepidemiology
data among different subject populations, both age and sex of the individuals
need to be considered.
ANGELA MANNS
HOWARD D. STRICKLER
BARRIE HANCHARD
DEANNA M. MANASSARAM
DAVID WATERS
DHARAM V. ABLASHI
References
(1) Whitby D, Luppi M, Barozzi P, Boshoff
C, Weiss RA, Torelli G. Human herpes-
(2)
(3)
(4)
(5)
(6)
virus 8 seroprevalence in blood donors
and lymphoma patients from different regions of Italy. J Natl Cancer Inst 1998;90:
395–7.
Brooks SE, Wolff C. Age-specific incidence
of cancer in Kingston & St. Andrew, Jamaica. Part II: 1983–1987. West Indian Med
J 1991;40:128–33.
Chang Y. Kaposi’s sarcoma and Kaposi’s
sarcoma-associated herpesvirus (human herpesvirus 8): where are we now? [editorial]. J
Natl Cancer Inst 1997;89:1829–31.
Hanchard B, Williams N, Green M. Concurrent multicentric angiofollicular lymph node
hyperplasia and peripheral T-cell lymphoma.
West Indian Med J 1987;36:104–7.
Browne D, Barton EN, Barrow KO, Williams NP, Hanchard B. Multicentric angiofollicular lymph node hyperplasia in ulcerative
colitis. A case report. West Indian Med J
1996;45:34–6.
Chatlynne LG, Lapps W, Handy M, Huang
YQ, Masood R, Hamilton AS, et al. Detection and titration of HHV-8 specific antibodies in sera from blood donors, AIDS patients
and Kaposi’s sarcoma patients using a whole
virus ELISA. Blood. In press.
Notes
Affiliations of authors: A. Manns, H. D. Strickler, Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer
Institute, Bethesda, MD; B. Hanchard, Department
of Pathology, University of the West Indies,
Kingston, Jamaica; D. M. Manassaram, George
Washington University, School of Public Health
and Health Services, Washington, DC; D. Waters,
Science Applications Information Corporation,
National Cancer Institute-Frederick Cancer Research and Development Center, MD; D. V. Ablashi, Advanced Biotechnologies Inc., Columbia,
MD, and Georgetown University School of Medicine, Washington, DC.
Correspondence to: Angela Manns, M.D.,
M.P.H., National Institutes of Health, Executive
Journal of the National Cancer Institute, Vol. 90, No. 14, July 15, 1998
Manns et al. investigated the seroprevalence of human herpesvirus 8
(HHV-8) in blood donors and gynecologic patients from Jamaica. The overall
prevalence in the blood donor population was low, 3.6%, which confirms our
finding that the seroprevalence of
HHV-8 mirrors the incidence of Kaposi’s sarcoma (1), with the exception of
findings in West Africa (2). The observed male-to-female ratio reported by
Manns et al. (2.0 : 1) is similar to the
ratio of 1.7 : 1 reported by us for the Italian population (1), although another study
of HHV-8 distribution in blood donors in
Italy indicated that HHV-8 antibodies
were distributed equally between men and
women (3). It is more interesting that
Mann et al. also documented higher
HHV-8 seroprevalence rates in older
people. Because the prevalence of HHV-8
in Jamaica is low, the number of seropositives analyzed was small.
In a series of 184 blood donors (1)
and 63 children from Apulia, southern
Italy, an endemic area for classic Kaposi’s sarcoma, we observed that HHV-8
seroprevalence rates steadily increased
with age, from 3.2% (2/63) in children
under 18 years to 33% (8/24) in persons
50 years of age or older (Fig. 1). Similar
findings have been reported by others
(3). The striking differences in HHV-8
seroprevalence observed between regions with low and high incidences of
Kaposi’s sarcoma are greatest in older
age groups. However, in the San Francisco Men’s Health Study, Martin et al.
(4) did not observe a correlation between HHV-8 seroprevalence rates and
age in homosexual men infected with
human immunodeficiency virus (HIV).
It is possible, therefore, that the differences observed by Manns et al. in Jamaica, by us in Italy (1), and Calabro et
al. in Italy (3) may be due to a cohort
effect or to a difference in the pattern
and route of transmission of HHV-8 between HIV-infected homosexual men
and within other populations at risk for
Kaposi’s sarcoma. The data on HHV-8
antibodies in children in southern Italy
presented here and also reported previously by Calabro et al. suggest that nonsexual routes of transmission occur in
CORRESPONDENCE 1103