Background The prevalence and titres of antibodies against Kaposi’s sarcoma associated herpesvirus (KSHV) in rural Africa are not completely understood, nor are their trends over time in populations in which HIV is also endemic. We examined prevalence, titres, temporal trends and determinants of anti KSHV antibodies in each of three time periods (1990-91, 1999-2000 and 2007-2008) within a long-standing, rural population-based cohort in southwestern Uganda. Methods For each period, we measured antibodies to the K8.1 and ORF73 KSHV antigens in ~ 3000 people of all ages (1:1 sex ratio). Results In all periods, KSHV prevalence increased rapidly through childhood to ~ 90% by age 15 years, plateauing at ~ 95% thereafter. Similarly, antibody titres, particularly against the lytic antigen K8.1, were amongst the highest seen and increased significantly with age, suggesting sustained viral replication in this population. Male sex was also independently associated with higher prevalence, whereas HIV co-infection was not. A modest reduction in prevalence among children was noted in the most recent period. Discussion KSHV seroprevalence and antibodies titres in this rural Ugandan population are the highest yet reported, perhaps reflecting frequent viral reactivation and persistently elevated transmission
