Download Nessun titolo diapositiva

Taylor MM, The Journal of Infectious Diseases 2004; 190:484–8
Manifestazioni cliniche in 81 bambini correlate con
i risultati del test serologico e della PCR per
HHV8
Resultati di IFA e PCR per HHV8 (%)
Dati clinici
Ab - / PCR +
(n=6)
Ab + / PCR +
(n=14)
Ab + / PCR (n=17)
Ab - / PCR (n=44)
esantema
5 (83.3)*
2 (14.3)
3 (17.6)
5 (11.3)
tosse
2 (33.3)
5 (35.7)
7 (44.1)
17 (38.6)
angina
5 (83.3)
13 (92.8)
16 (94.1)
40 (90.9)
linfoadenopatia
0
7 (50)
13 (76.5)
32 (72.7)
diarrea
1 (16.6)
2 (14.3)
4 (23.6)
13 (29.5)
convulsioni
1 (16.6)
1 (7.2)
1 (5.9)
6 (13.6)
ulcere orali
dolorose
0
2 (14.3)
4 (23.6)
8 (18.2)
altro
0
0
2 (11.8)
2 (4.5)
*p= 0.016
3/3 casi sieroconversione a 6 mesi
Andreoni JAMA. 2002 Mar 13;287(10):1295-300
Sarcoma di Kaposi
Sarcoma di Kaposi orale e polmonare
Coinfezione
HIV-HHV8-HBV-HCV-Lue
• Nel 2001-2002 abbiamo valutato
359 pazienti HIV+ italiani afferenti
alla Divisione Clinicizzata di
Malattie Infettive di Verona
Omosessuali = 88 ( 24,5%)
%
B-C-
B+C-
B-C+
B+C+
HHV8-
19
24
2
2
HHV8+
11
37
2
1
51%
Tossicodipendenti = 191
( 53,5%)
%
B-C-
B+C-
B-C+
B+C+
HHV8-
8
3
23
45
HHV8+
2
3
6
10
21%
Eterosessuali = 80 (22%)
%
B-C-
B+C-
B-C+
B+C+
HHV8-
36
24
5
9
HHV8+
10
11
5
0
26%
Coinfezione con Lue
• pz con Lue : 37 (10,3%)
• tra questi: 30 Omo, 5 Td, 2 Ete.
• tra i 30 Omo, 20 erano H+, 16
H+B+C- (il 18 % della coorte Omo)
Pazienti extracomunitari
43 soggetti HIV+
• HHV8+ = 51%
• HBV+ = 63%
• Lue+ = 7%
Distribuzione dei Titoli
Anti litici
20 - 80
Anti litici
160 - 320
Anti litici
640 – 1280
1986-88
38%
31%
31%
1997-98
37%
52%
11%
HIV neg
+ 11,5%
65%
35%
There are many controversies on the tests used to
detect HHV-8 antibodies and on their significance.
Lytic antigen assays appear to be more sensitive and
yield not only higher, but more accurate
seroprevalence rates [Hudnall 2003]. On the other
hand, HHV-8-DNA in serum was detected only in
individuals with antibodies to both latent and lytic
antigens of HHV-8 [Enbom 2002].
The presence of anti-lytic antibodies indicates that
active virus replication is necessary for diffusion of the
virus or viral DNA to serum. An increased lysis of
infected cells and thereby exposure of latent antigens
is a possible explanation for the presence of anti-latent
antibodies in DNA-positive subjects.
Risk factors for HHV8 infection among inmates in Italy: cOR
and 95% CI (2)
95%CI
HHV-8 pos/total
(%)
cOR
None
8/70 (11.4)
1
At least one
138/588 (23.4)
2.3
< 1 year
62/283 (21.9)
1
> 1 year
150/503 (20.8)
0.9
0.6-1.3
HIV pos
20/73 (27.4)
1.5
0.8-2.6
HCV pos
88/370 (23.8)
1.3
0.9-1.8
0.07
AbHBc pos
137/512 (26.7)
2.2
1.6-3.1
0.001
HSV-2 pos
53/186 (28.5)
1.7
1.1-2.5
0.006
Variable
P
Previous imprisonment
1.1-5.8
0.022
Duration of imprisonment
Viral infections
Risk factors for HHV8 infection among italian
inmates, multivariate analysis: aOR and 95% CI
Variable
cOR
95%CI
P
Age >30 vs <30yrs
Educational level
(<8 vs >8yrs)
1.6
1.9
0.8-3.0
1.2-3.3
0.12
0.011
Previous
imprisonments (yes vs
no)
1.3
0.4-3.6
0.62
HCV-positive
1.3
0.8-1.9
0.27
AbHBc-positive
2.7
1.7-4.4
<0.001
HSV-2-positive
1.8
1.1-3.1
0.015
Correlation between HHV8 Antibody titers, duration
of imprisonment, HBV e HSV
HHV8 Ab
P
Neg
N° 585
40-320
N°123
>640
N° 35
Imprison.
duration
72,2+74,5
90+80
101+70,4
0,03
Age
36,9+10,6
39,3+10,4
40,2+9,9
0,006
HSV-2
19,2%
28,6%
30,6%
0,016
HBcAb
46,6%
68,9%
63,4%
0,000
Many Thanks