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Seroprevalence of kaposi sarcoma-associated herpesvirus and other serologic markers in the Brazilian Amazon.

Kaposi sarcoma-associated herpesvirus herpesvirus, any of the family (Herpesviridae) of common DNA-containing viruses, many of which are associated with human disease. See cytomegalovirus; Epstein-Barr virus; herpes simplex; herpes zoster.  (KSHV KSHV Kaposi's Sarcoma-Associated Herpesvirus ) is the cause of Kaposi sarcoma Kaposi sarcoma

Usually lethal cancer appearing as red-purple or blue-brown spots on the skin and other organs. It has been linked to one of the herpes viruses, and there is considerable debate about how it should be classified.
 (KS) and certain lymphoproliferative diseases (1). KSHV seroprevalence seroprevalence Immunology The proportion of a population that is seropositive–ie, has been exposed to a particular pathogen or immunogen; the seropositivity of a population is calculated as the number of individuals who produce a particular antibody divided  is low (<5%) in most Western populations (1) and reaches 50% in some African populations (2), mirroring KS incidence rates (3). However, the highest KSHV seroprevalences worldwide (>80% in adults) have been reported in Amerindian tribes from the Amazon regions of Brazil Brazil is currently divided in five regions, by the Instituto Brasileiro de Geografia e Estatistica (IBGE). These divisions are composed by states with similar cultural, economical, historical and social aspects, and although through the scientific point of view information given by this  (4,5) and Ecuador (6), despite the apparently low KS incidence in these populations (7). KSHV is thought to be transmitted through saliva between young siblings in disease-endemic areas such as French Guiana French Guiana (gēăn`ə, –än`–), Fr. La Guyane française, officially Department of Guiana, French overseas department (2005 est. pop.  (8) or Africa (9), whereas sexual transmission in low-prevalence countries occurs within risk groups such as men who have sex with men Men who have sex with men (MSM) is a term used mostly in the United States to classify men who engage in sex with other men, regardless of whether they self-identify as gay, bisexual, or heterosexual.  (10). Modes of transmission have not been clearly determined in Amerindian populations.

The Study

We conducted a cross-sectional study cross-sectional study
n.
See synchronic study.


cross-sectional study,
n the scientific method for the analysis of data gathered from two or more samples at one point in time.
 during February 2003-April 2004 to investigate the seroprevalence and factors associated with KSHV infection in Amerindian and non-Amerindian populations living in 2 regions of the Brazilian Amazon: a remote rural region of Para State (Mapuera, on the banks of the Trombetas River) and Manaus, the capital city of Amazonas State (Figure). Serologic se·rol·o·gy  
n. pl. se·rol·o·gies
1. The science that deals with the properties and reactions of serums, especially blood serum.

2.
 markers of fecal-oral (hepatitis A virus Noun 1. hepatitis A virus - the virus causing hepatitis A
enterovirus - any of a group of picornaviruses that infect the gastrointestinal tract and can spread to other areas (especially the nervous system)
 [HAV HAV hepatitis A virus.

HAV
abbr.
hepatitis A virus


HAV Hepatitis A virus, see there
]), blood-borne (hepatitis B Hepatitis B Definition

Hepatitis B is a potentially serious form of liver inflammation due to infection by the hepatitis B virus (HBV). It occurs in both rapidly developing (acute) and long-lasting (chronic) forms, and is one of the most common chronic
 and C viruses [HBV HBV hepatitis B virus.

HBV
abbr.
hepatitis B virus
, HCV HCV
abbr.
hepatitis C virus


HCV 1 Hepatitis C virus, see there 2. Human coronavirus. See Coronavirus.
]) and sexually transmitted infections (Treponema pallidum Treponema pal·li·dum
n.
A spirochete that causes syphilis in humans.


Treponema pallidum Infectious disease The spirochete that causes syphilis Epidemiology 9000 cases/yrs–US, primarily in the SE US.
 [syphilis] and herpes simplex virus Herpes simplex virus
A virus that can cause fever and blistering on the skin, mucous membranes, or genitalia.

Mentioned in: Conjunctivitis


herpes simplex virus
 type 2 [HSV-2]) were used as proxies to identify possible routes of KSHV transmission in these populations.

A convenience sample of unselected Amerindians and non-Amerindians living in the Mapuera area and a consecutive sample of nonpaid first-time blood donors from the Manaus blood bank (HemoAm) consented to collection of blood samples, as previously reported (4,11) Ethical approval was obtained from the institutional review board of HemoAm, the ethical board of the Brazilian Ministry of Health, and the ethics committee ethics committee A multidisciplinary hospital body composed of a broad spectrum of personnel–eg, physicians, nurses, social workers, priests, and others, which addresses the moral and ethical issues within the hospital. See DNR, Institutional review board.  of the London School of Hygiene and Tropical Medicine tropical medicine, study, diagnosis, treatment, and prevention of certain diseases prevalent in the tropics. The warmth and humidity of the tropics and the often unsanitary conditions under which so many people in those areas live contribute to the development and .

In the absence of a definitive test to determine KSHV infection, all serum specimens were tested by using a previously validated in-house whole-virus KSHV ELISA ELISA (e-li´sah) Enzyme-Linked Immuno-Sorbent Assay; any enzyme immunoassay using an enzyme-labeled immunoreactant and an immunosorbent.

ELISA
n.
 (12) and 2 immunofluorescence Immunofluorescence

A technique that uses a fluorochrome to indicate the occurrence of a specific antigen-antibody reaction. The fluorochrome labels either an antigen or an antibody.
 assays (IFAs) that detected antibodies against lytic lytic /lyt·ic/ (lit´ik)
1. pertaining to lysis or to a lysin.

2. producing lysis.


lyt·ic
adj.
1. Of, relating to, or causing lysis.

2.
 (IFA-lytic) and latent-associated nuclear antigens (IFA-LANA) (12). KSHV infection was defined as positivity by any of these serologic assays. Serum specimens were also tested for the agent of syphilis by using a T. pallidum-specific assay (Enzygnost Syphilis; Dade Behring, Marburg, Germany); for HSV-2 antibodies by using the type-specific HerpeSelect gG2 ELISA (Focus Technologies, Cypress Hill This article or section has multiple issues:
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, CA, USA), with a higher cut-off (>3.5) to increase specificity (13); and for HAV antibodies by using BioELISA HAV (Biokit, Barcelona, Spain). Presence of HBV anti-core antibodies was determined by using Ortho HBc ELISA (Ortho Diagnostics, Raritan, NJ, USA) in Mapuera serum specimens and Hepanostika anti-HBc Uni-Form (Organon-Teknika, Boxtel, the Netherlands) in Manaus serum specimens. HCV antibodies were detected by using Ortho HCV 3.0 ELISA (Ortho Diagnostics) in Mapuera serum specimens and Murex mu·rex  
n. pl. mu·ri·ces or mu·rex·es
Any of various marine gastropods of the genus Murex common in tropical seas and having rough spiny shells, especially M. trunculus, the source of Tyrian purple.
 Anti-HCV version 4.0 ELISA (Murex Biotech S.A., Kyalami, South Africa South Africa, Afrikaans Suid-Afrika, officially Republic of South Africa, republic (2005 est. pop. 44,344,000), 471,442 sq mi (1,221,037 sq km), S Africa. ) in Manaus serum specimens.

[FIGURE OMITTED]

KSHV seroprevalence was calculated separately for men and women and directly age-standardized to the Mapuera Amerindian population. The risk associated with KSHV infection was estimated with prevalence ratios (PRs) and 95% confidence intervals (CIs), adjusted for sex and age group (18-24 years, 25-34 years, and [greater than or equal to]35 years for the blood donor population; 0-9 years, 10-17 years, 18-24 years, 25-34 years, and [greater than or equal to]35 years for both Mapuera populations). The associations of KSHV with sociodemographic variables, indicators of socioeconomic status socioeconomic status,
n the position of an individual on a socio-economic scale that measures such factors as education, income, type of occupation, place of residence, and in some populations, ethnicity and religion.
, and other serologic markers were estimated with odds ratios (ORs) and 95% CIs. Variables associated with a significant increased risk for KSHV (p<0.05) in univariable analysis were included in a multivariable logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors.  model adjusted for age and sex.

We recruited 339 Amerindians (median age 22 years, interquartile range In descriptive statistics, the interquartile range (IQR), also called the midspread, middle fifty and middle of the #s, is a measure of statistical dispersion, being equal to the difference between the third and first quartiles.  [IQR IQR Interquartile Range (statistics)
IQR Internet Quick Reference
IQR Individual Qualification Record
IQR Internal Quality Review
] 13-37 years; 57.5% female) and 181 non-Amerindians (median age 17 years, IQR 9-35 years; 58.6% female) in the Mapuera communities and 1,133 blood donors (median age 25 years, IQR 21-32 years; 22.9% female) in Manaus. The blood donor population had a similar age distribution to that of the adult population in Manaus in the 2000 regional census (14).

Among Mapuera Amerindians, KSHV seroprevalence was 65.0% in those 0-9 years, increasing to 92.9% in those >35 years. In contrast, among Mapuera non-Amerindians, KSHV seroprevalence was 9.8% in those 0-9 years of age, increasing to 50.0% in those [greater than or equal to]35 years of age. Among blood donors, KSHV seroprevalence was 31.3% in those [greater than or equal to]35 years of age and 53.8% in the 13 who were of Amerindian descent. After age standardization, KSHV seroprevalence remained lower among Mapuera non-Amerindians (30% and 27% among men and women, respectively) and blood donors (16% and 23%, respectively) than among Mapuera Amerindians. When results were compared with those of the Mapuera Amerindians, the age-and sex-adjusted PRs were 0.35 (95% CI 0.28-0.45) and 0.59 (95% CI 0.56-0.63) in Mapuera non-Amerindians and blood donors, respectively.

In each population, KSHV seroprevalence was slightly higher among females, and increased with age (p for trend <0.001) in Mapuera Amerindians and non-Amerindians, but not among (adult) blood donors (Table 1). KSHV seroprevalence varied little with house crowding (socioeconomic indicator), and hepatitis infections, but was associated with HSV-2 infection in non-Amerindians (OR 4.2, 95% CI 2.1-8.5) and blood donors (OR 1.3, 95% CI 1.0-1.7). In Amerindians, KSHV infection was not associated with HSV-2 in univariable analysis (OR 0.7, 95% CI 0.3-1.9).

In multivariable analysis (Table 2), KSHV infection remained associated with female sex among blood donors (age- and sex-adjusted OR [aOR] 1.3, 95% CI 1.0-1.7), and increased significantly with age in both Mapuera populations (p for trend <0.001). KSHV infection was associated with HSV-2 infection among Mapuera non-Amerindians (aOR 2.7, 95% CI 1.2-6.5) and Manaus blood donors (aOR 1.3, 95% CI 1.0-1.6), but was inversely associated with HSV-2 infection in Mapuera Amerindians (aOR 0.3, 95% CI 0.1-0.9).

Conclusions

Our data confirm the high KSHV seroprevalence observed among Amazonian Amerindian populations (5,7). However, the inclusion of convenience samples of remote populations and first-time blood donors, who may not necessarily be representative of the adult general population and notably exclude persons who report a range of potentially high-risk behavior high-risk behavior Public health A lifestyle activity that places a person at ↑ risk of suffering a particular condition. See Safe sex practices.  for sexually transmitted and bloodborne infections, may have limited the generalizibility of our findings. High KSHV seroprevalence combined with an apparent lack of KS development among Amerindian populations support the theory of genetic predisposition genetic predisposition Molecular medicine The tendency to suffer from certain genetic diseases–eg, Huntington's disease, or inherit certain skills–eg, musical talent  to KSHV acquisition, as hypothesized for other Amazonian populations, in whom segregation genetic analysis has suggested that an unidentified recessive gene recessive gene
n.
A gene that is phenotypically expressed in the homozygous state but has its expression masked in the presence of a dominant gene.
 may influence KSHV serostatus (15).

The high KSHV seroprevalence (65%) among Mapuera Amerindians <10 years of age contrasts with the low (9.8%) seroprevalence among non-Amerindians of the same age group living in the same area, which suggests different transmission modes in these neighboring populations. Although we did not collect data on the age of initial sexual experience in either population, the high prevalence in childhood and inverse association with HSV-2 supports nonsexual transmission of KSHV in Amerindians. Conversely, the association of KSHV infection with HSV-2 among Mapuera non-Amerindians and blood donors supports a role for sexual transmission in these groups, although saliva transmission in younger urban inhabitants
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 cannot be ruled out. Universal HAV infection status and low rates of HBV and HCV in all populations precluded any meaningful analysis of transmission routes associated with hepatitis viruses.

In summary, this study contributes data on the epidemiology of KSHV infection and transmission in some Brazilian Amazonian populations. Irrespective of irrespective of
prep.
Without consideration of; regardless of.

irrespective of
preposition despite 
 urban or rural setting, our data are consistent with a predominant nonsexual transmission of KSHV (most likely through saliva) in Amerindian tribes compared with a probable combination of sexual and nonsexual modes of transmission among non-Amerindian populations living in the same region.

Acknowledgments

We thank Katia Torres, Adele Schwartz-Benzaken, David Mabey, and Onno Dekker for their support of the study. Data collection was carried out at the Laboratory of Virology virology, study of viruses and their role in disease. Many viruses, such as animal RNA viruses and viruses that infect bacteria, or bacteriophages, have become useful laboratory tools in genetic studies and in work on the cellular metabolic control of gene expression , Instituto de Medicina Tropical de Sao Paulo, Universidade de Sao Paulo, and the Department of Infectious and Parasitic Diseases, Faculdade de Medicine, Universidade de Sao Paulo; laboratory testing was also performed at the Laboratory of Virology; and data analysis was conducted at the Department of Infectious and Tropical Diseases and the Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK (LSHTM LSHTM London School of Hygiene and Tropical Medicine ).

The study in blood banks was supported by the Conselho Nacional de Desenvolvimento Cientifico e Technologico, an agency of the Brazilian Ministry of Science and Technology (grants 304879/2003-7, 305258/2006-0 and 473867/2006-0). The study among Mapuera populations was supported by grants from the Welcome Trust (grant 075454/B/04/Z), CNPq 300317/97-2, and Fundacao Faculdade de Medicina, University of Sao Paulo, Brazil. Additional financial support was provided by the United Kingdom Department for International Development-funded Research Programme Consortium on Research and Capacity Building on Sexual and Reproductive Health Within the framework of WHO's definition of health[1] as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene  and HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States.  in Developing Countries of the LSHTM.

Dr Nascimento is a research associate scientist in the Laboratory of Virology, Instituto de Medicina Tropical de Sao Paulo, Universidade de Sao Paulo, Brazil. Her main interests are in the epidemiology and molecular epidemiology molecular epidemiology Molecular medicine An evolving field that combines the tools of standard epidemiology–case studies, questionnaires and monitoring of exposure to external factors with the tools of molecular biology–eg, restriction endonucleases,  of viral infections that cause cancer, in particular, the serologic diagnosis and epidemiology of Kaposi sarcoma-associated herpesvirus infection in various populations in Brazil.

References

(1.) Boshoff C, Weiss RA. Epidemiology and pathogenesis of Kaposi's sarcoma-associated herpesvirus “KSHV” redirects here. For the television station with this callsign, see KSHV (TV).
Kaposi's sarcoma-associated herpesvirus (KSHV) is the eighth human herpesvirus; its formal name according to the International Committee on Taxonomy of Viruses is HHV-8.
. Philos Trans R Soc Lond B Biol Sci. 2001;356:517-34. DOI (Digital Object Identifier) A method of applying a persistent name to documents, publications and other resources on the Internet rather than using a URL, which can change over time. : 10.1098/rstb.2000.0778

(2.) Newton R, Ziegler J, Bourboulia D, Casabonne D, Beral V, Mbidde E, et al. The sero-epidemiology of Kaposi's sarcoma-associated herpesvirus (KSHV/HHV-8) in adults with cancer in Uganda. Int J Cancer. 2003;103:226-32. DOI: 10.1002/ijc.10817

(3.) Newton R, Ziegler J, Bourboulia D, Casabonne D, Beral V, Mbidde E, et al. Infection with Kaposi's sarcoma-associated herpesvirus (KSHV) and human immunodeficiency virus human immunodeficiency virus
n.
HIV.


Human immunodeficiency virus (HIV)
A transmissible retrovirus that causes AIDS in humans.
 (HIV) in relation to the risk and clinical presentation of Kaposi's sarcoma Kaposi's sarcoma (käp`əshē', kəpō`sē), a usually fatal cancer that was considered rare until its appearance in AIDS patients.  in Uganda. Br J Cancer. 2003;89:502-4. DOI: 10.1038/sj.bjc.6601113

(4.) de Souza De Souza or D'Souza is a common Portuguese family name. Although it is still quite common outside Portugal -- especially in Brazil and India --, Souza is the old spelling of present-day Sousa.  VA, Sumita LM, Nascimento MC, Oliveira J, Mascheretti M, Quiroga M, et al. Human herpesvirus-8 infection and oral shedding in Amerindian and non-Amerindian populations in the Brazilian Amazon region. J Infect Dis. 2007;196:844-52. DOI: 10.1086/520549

(5.) Cunha AM, Caterino-de-Araujo A, Costa SC, Santos-Fortuna E, Boa-Sorte NC, Goncalves MS, et al. Increasing seroprevalence of human herpesvirus 8 (HHV-8) with age confirms HHV-8 endemicity in Amazon Amerindians from Brazil. J Gen Virol. 2005;86:2433-7. DOI: 10.1099/vir.0.81087-0

(6.) Whitby D, Marshall VA, Bagni RK, Wang CD, Gamache CJ, Guzman JR, et al. Genotypic characterization of Kaposi's sarcoma-associated herpesvirus in asymptomatic infected subjects from isolated populations. J Gen Virol. 2004;85:155-63. DOI: 10.1099/vir.0.19465-0

(7.) Mohanna S, Maco V, Bravo F, Gotuzzo E. Epidemiology and clinical characteristics of classic Kaposi's sarcoma, seroprevalence, and variants of human herpesvirus 8 in South America South America, fourth largest continent (1991 est. pop. 299,150,000), c.6,880,000 sq mi (17,819,000 sq km), the southern of the two continents of the Western Hemisphere. : a critical review of an old disease. Int J Infect Dis. 2005;9:239-50. DOI: 10.1016/j. ijid.2005.02.004

(8.) Plancoulaine S, Abel L, van Beveren M, Tregouet DA, Joubert M, Tortevoye P, et al. Human herpesvirus 8 transmission from mother to child and between siblings in an endemic population. Lancet. 2000;356:1062-5. DOI: 10.1016/S0140-6736(00)02729-X

(9.) Bourboulia D, Whitby D, Boshoff C, Newton R, Beral V, Carrara H, et al. Serologic evidence for mother-to-child transmission mother-to-child transmission Vertical transmission, see there  of Kaposi sarcoma-associated herpesvirus infection. JAMA JAMA
abbr.
Journal of the American Medical Association
. 1998;280:31-2. DOI: 10.1001/jama.280.1.31-a

(10.) Engels EA, Atkinson JO, Graubard BI, McQuillan GM, Gamache C, Mbisa G, et al. Risk factors for human herpesvirus 8 infection among adults in the United States and evidence for sexual transmission. J Infect Dis. 2007;196:199-207. DOI: 10.1086/518791

(11.) Nascimento MC, de Souza VA, Sumita LM, Freire W, Weiss HA, Sabino EC, et al. Kaposi's sarcoma-associated herpesvirus (KSHV) infection among blood donors in Brazil: a multi-centre serosurvey. J Med Virol. 2008;80:1202-10. DOI: 10.1002/jmv.21188

(12.) Nascimento MC, de Souza VA, Sumita LM, Freire W, Munoz F, Kim J, et al. Comparative study of Kaposi's sarcoma-associated herpesvirus serological serological

pertaining to or emanating from serology.


serological test
one involving examination of blood serum usually for antibody.
 assays using clinically and serologically defined reference standards and latent class analysis. J Clin Microbiol. 2007;45:715-20. DOI: 10.1128/JCM.01264-06

(13.) Nascimento MC, Ferreira S, Sabino E, Hamilton I, Parry J, Pannuti CS, et al. Performance of the HerpeSelect (Focus) and Kalon enzyme-linked immunosorbent assays enzyme-linked immunosorbent assay
n.
ELISA.


Enzyme-linked immunosorbent assay (ELISA)
A diagnostic blood test used to screen patients for AIDS or other viruses.
 for detection of antibodies against herpes simplex virus type 2 using monoclonal antibody-blocking enzyme immunoassay Immunoassay

An assay that quantifies antigen or antibody by immunochemical means. The antigen can be a relatively simple substance such as a drug, or a complex one such as a protein or a virus.
 (MAb-EIA) and clinico-virological reference standards in Brazil. J Clin Microbiol. 2007;45:2309-11. DOI: 10.1128/JCM.00144-07

(14.) Contas Regionais do Brasil. [cited 2009 Jan 15]. Instituto Brasileiro de Geografia e Estatistica. Available from http://www.ibge.gov.br

(15.) Plancoulaine S, Gessain A, van Beveren M, Tortevoye P, Abel L. Evidence for a recessive recessive /re·ces·sive/ (re-ses´iv)
1. tending to recede; in genetics, incapable of expression unless the responsible allele is carried by both members of a pair of homologous chromosomes.

2.
 major gene predisposing to human herpesvirus 8 (HHV-8) infection in a population in which HHV-8 is endemic. J Infect Dis. 2003;187:1944-50. DOI: 10.1086/375345

DOI: 10.3201/eid1504.081488

Maria C. Nascimento, Laura M. Sumita, Vanda U. Souza, Helen A. Weiss, Juliane Oliveira, Melissa Mascheretti, Mariana Quiroga, Rodrigo A.R. Vela vela

plural of velum.
, Ester Sabino, Claudio S. Pannuti, and Philippe Mayaud

Address for correspondence: Maria C. Nascimento, Laboratory of Virology, Instituto de Medicina Tropical de Sao Paulo, Universidade de Sao Paulo, Av Dr Eneas de Carvalho Aguiar 470, 05403 000, Sao Paulo, SP, Brazil; email: maria.nascimento@lshtm.ac.uk

Author affiliations: Universidade de Sao Paulo, Sao Paulo, Brazil (M.C. Nascimento, L.M. Sumita, V.U. Souza, J. Oliveira, M. Mascheretti, M. Quiroga, R.A.R. Vela, E. Sabino, C.S. Pannuti); and London School of Hygiene and Tropical Medicine, London, UK (M.C. Nascimento, H.A. Weiss, P. Mayaud)

Use of trade names is for identification only and does not imply endorsement by the Public Health Service or by the U.S. Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979
Health and Human Services, HHS
.
Table 1. Seroprevalence of KSHV among 3 populations in the
Brazilian Amazon * ([dagger])

                             Mapuera Amerindians,
                             n = 339 ([dagger])

                             % KSHV positive
Variables                    (no. tested)      OR (95% CI)

Sex
  Male                       79.2 (144)        1
  Female                     82.6 (195)        1.2 (0.7-2.1)
  p value                                      0.4
Age group, y
  0-9                        65.0 (43)         0.1 (0.05-0.4)
  10-17                      70.0 (93)         0.2 (0.07-0.4)
  18-34                      86.5 (104)        0.5 (0.2-1.3)
  [greater than or           92.9 (99)         1
    equal to] 35
  p for trend                                  <0.001
Crowding ([double dagger])
  1-2                        93.7 (16)         1
  3                          91.3 (23)         0.7 (0.06-8.4)
  [greater than or           79.7 (300)        0.3 (0.03-2.0)
    equal to] 4
  p value                                      0.1
Ethnicity
  African                    --                --
  Caucasian                  --                --
  Indigenous                 100 (339)         --
  Other                      --                --
  p value
Hepatitis A virus
  Negative                   83.3 (6)          1
  Positive                   81.1 (333)        0.9 (0.1-7.5)
  p value                                      0.9
Hepatitis B virus
  Negative                   81.6 (315)        1
  Positive                   73.9 (23)         0.6 (0.2-1.7)
  p value                                      0.4
Hepatitis C virus
  Negative                   81.0 (338)
  Positive                   0
  p value
HSV-2
  Negative                   81.5 (314)        1
  Positive                   76.0 (25)         0.7 (0.3-1.9)
  p value                                      0.5
Trepomena pallidum
  Negative                   81.0 (338)        --
  Positive                   0
  p value

                             Mapuera non-Amerindians,
                             n = 181 ([dagger])

                             % KSHV positive
Variables                    (no. tested)            OR (95% CI)

Sex
  Male                       26.7 (75)               1
  Female                     27.4 (106)              1.0 (0.5-2.0)
  p value                                            0.1
Age group, y
  0-9                        9.8 (51)                0.1 (0.03-0.3)
  10-17                      22.5 (40)               0.3 (0.1-0.7)
  18-34                      27.3 (44)               0.4 (0.1-0.9)
  [greater than or           50.0 (46)               1
    equal to] 35
  p for trend                                        <0.001
Crowding ([double dagger])
  1-2                        55.6 (9)                1
  3                          33.3 (15)               0.4 (0.07-2.2)
  [greater than or           24.8 (145)              0.3 (0.07-1.3)
    equal to] 4
  p value                                            0.1
Ethnicity
  African                    --                      --
  Caucasian                  --                      --
  Indigenous                 --                      --
  Other                      100 (181)               --
  p value
Hepatitis A virus
  Negative                   12.5 (16)               1
  Positive                   28.5 (165)              2.8 (0.6-12.7)
  p value                                            0.2
Hepatitis B virus
  Negative                   32.0 (75) ([section])   1
  Positive                   53.3 (15) ([section])   2.4 (0.8-7.5)
  p value                                            0.1
Hepatitis C virus
  Negative                   36.0 (90) ([dagger])
  Positive                   0
  p value
HSV-2
  Negative                   18.1 (127)              1
  Positive                   48.1 (54)               4.2 (2.1-8.5)
  p value                                            <0.001
Trepomena pallidum           26.3(171)
  Negative                   40.0 (10)               1
  Positive                                           1.9 (0.5-6.9)
  p value                                            0.3

                             Manaus blood donors,
                             n = 1,133 ([dagger])

                             % KSHV positive
Variables                    (no. tested)             OR (95% CI)

Sex
  Male                       28.6 (874)               1
  Female                     34.4 (259)               1.3 (1.0-1.7)
  p value                                             0.08
Age group, y
  0-9                        --                       --
  10-17                      --                       --
  18-34                      29.6 (916)               0.9 (0.7-1.3)
  [greater than or           31.3 (217)               1
    equal to] 35
  p for trend
Crowding ([double dagger])
  1-2                        32.6 (175)               1
  3                          29.9 (941)               0.9 (0.6-1.2)
  [greater than or           6.2 (16)                 0.4 (0.2-1.0)
    equal to] 4
  p value                                             0.1
Ethnicity
  African                    29.6 (743)               1
  Caucasian                  30.5 (308)               1.0 (0.8-1.4)
  Indigenous                 53.8 (13                 2.8 (0.9-8.3)
  Other                      25.8 (66)                0.8 (0. 5-1.5)
  p value                                             0.08
Hepatitis A virus
  Negative                   42.9 (7) ([section])     1
  Positive                   28.6 (154) ([section])   0.5 (0.1-2.5)
  p value                                             0.4
Hepatitis B virus
  Negative                   30.2 (1,075)             1
  Positive                   25.0 (56)                0.8 (0.4-1.4)
  p value                                             0.4
Hepatitis C virus
  Negative                   29.9 (1,129)             1
  Positive                   25.0 (4)                 0.8 (0.1-7.5)
  p value                                             0.8
HSV-2
  Negative                   27.8 (715)               1
  Positive                   33.2 (406)               1.3 (1.0-1.7)
  p value                                             0.06
Trepomena
  Negative                   29.9 (1,122)             1
  Positive                   36.4 (11)                1.2 (0.6-2.3)
  p value                                             0.7

* Seroreactivity by any serologic assay, whole virus. KSHV, Kaposi
sarcoma-associated herpesvirus; OR, odds ratio; CI, confidence
interval; HSV-2, herpes simplex virus type 2.

([dagger]) Some figures do not add up to the total because of
missing data.

([double dagger]) Number of residents living in the house.

([section]) Only a random subsample tested.

Table 2. Multivariable analysis of risk factors for KSHV infection
among 3 populations in the Brazilian Amazon *

                     aOR (95% CI)

                     Mapuera Amerindians,   Mapuera non-Amerindians,
Variables            n = 339                n = 181
Sex
  Male               1                      1
  Female             1.2 (0.7-2.2)          1.0 (0.5-2.1)
  p value            0.5                    0.9
Age group, y
  0-9                0.1 (0.05-0.4)         0.1 (0.04-0.3)
  10-17              0.2 (0.07-0.4)         0.3 (0.1-0.7)
  18-34              0.5 (0.2-1.2)          0.4 (0.1-0.9)
  [greater than or   1                      1
    equal to] 35
  p value            <0.001                 <0.001
HSV-2
  Negative           1                      1
  Positive           0.3 (0.1-0.9)          2.7 (1.2-6.5)
  p value            0.03                   0.02

                     aOR (95% CI)

Variables            Manaus blood donors, n = 1,133

Sex
  Male               1
  Female             1.3 (1.0-1.7)
  p value            0.08
Age group, y
  0-9
  10-17
  18-34              0.9 (0.7-1.3)
  [greater than or   1
    equal to] 35
  p value            0.6
HSV-2
  Negative           1
  Positive           1.3 (1.0-1.6)
  p value            0.09

* Seroreactivity by any serologic assay (whole virus ELISA,
IFA-LANA, or IFA-lytic) in multivariable analysis. KSHV, Kaposi
sarcoma-associated herpesvirus; IFA-LANA, immunofluorescence assay
that detected latent-associated nuclear antigens; IFA-lytic, IFA
that detected lytic-associated nuclear antigens; aOR, age- and
sex-adjusted odds ratio; CI, confidence interval; HSV-2, herpes
simplex virus type-2.
COPYRIGHT 2009 U.S. National Center for Infectious Diseases
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2009 Gale, Cengage Learning. All rights reserved.

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Title Annotation:THE AMAZON REGION: DISPATCHES
Author:Nascimento, Maria C.; Sumita, Laura M.; Souza, Vanda U.; Weiss, Helen A.; Oliveira, Juliane; Mascher
Publication:Emerging Infectious Diseases
Article Type:Report
Geographic Code:3BRAZ
Date:Apr 1, 2009
Words:3299
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