Seroprevalence of HHV8 in Mozambique in relation with HIV/AIDS. Clinical evidence of Kaposi Sarcoma in a HIV+ cohort. Correlation with immune and viral state and Sarcoma regression in patients under HAART and treated or not treated with cytostatics

Abstract

Kaposi Sarcoma consists of several types differing in clinical and epidemiological patterns. In Sub-Saharan Africa, where the HIV epidemic has a high prevalence, the KS can be found also in HIV negative patients, and the diffusion of the HHV8 virus is endemic. The aim of the work was to evaluate the HHV8 seroprevalence in Mozambique, the Sarcoma incidence in a HIV positive cohort, and to correlate the immune and viral state of HIV positive patients with clinical evidence of Sarcoma, and cytostatic treatment. The study was carried out in collaboration with the DREAM Program, the Community of Sant’ Egidio initiative to fight AIDS in the Sub-Saharan Africa. The preliminary part of the work was setting up and optimising the local Laboratory, where the almost part of the analysis was processed. This part represent a very important contribution to the DREAM Program, from Pisa University and the Department of Oncology, Division of Surgical, Molecular and Ultrastructural Pathology especially. In fact, a major challenge for the Sub Saharan African health care providers is the implementation of an effective HIV therapeutic programme, supported by a minimum of laboratory monitoring that may guide patient management at locally affordable costs. According to literature, the Kaposi Sarcoma related with AIDS is different from the Classic African Sarcoma. In Mozambique the incidence is higher, up to tenfold the incidence registered before the AIDS diffusion, but not related with the HHV8 prevalence, which the study confirms the free circulation of the HHV8 virus in the Mozambican population, with a prevalence rate (51.1%) similar than that measured in bordering countries. As Malawi and Zambia. The tumour is responding to the antiretroviral treatment. The regression is evident even if patients are not treated with chemotherapy. Antiretroviral therapy increases the immunological response in Kaposi Sarcoma patients, and also in patients treated with cytostatics