| Summary: | Transplantation-associated Kaposi's sarcoma (KS), causatively associated with human herpes virus 8 (HHV-8), is particularly prevalent in Saudi Arabia, although the prevalence rate of HHV-8 infection in the general population there is comparable to that in other geographical regions. The serologic and genomic prevalences of HHV-8 in samples representing the general population (n=238), patients with end-stage renal disease (n=78), and renal allograft recipients (n=66) were investigated. To evaluate if oral shedding of HHV-8 might play a role in transplantation KS, the extent of HHV-8 shedding in the mouth compared to other anatomical compartments, and the presence of multiple HHV-8 infection were also studied. PCR protocols were applied to amplify 3 fragments of the viral genome (from open reading frames 26 and K1) from whole-mouth saliva, parotid saliva, buccal and palatal exfoliates, plasma, sub sets of peripheral blood cells, and KS lesional tissue, and to quantify the salivary viral load. Demographic and clinical data were analysed to identify risk factors for HHV-8 infection. A higher HHV-8 seroprevalence was observed in patients with renal disease compared to the general population, but no significant difference in HHV-8 DNA detection rates in CD45+ cells was found. The oral cavity was identified as a major site of HHV-8 shedding in renal disease patients regardless of a previous history of KS. In patients with end-stage renal disease, HHV-8 DNA was more frequently detectable in oral samples than in blood. They and renal allograft recipients showed evidence of being multiply infected by HHV-8. These findings suggest that iatrogenic, salivary HHV-8 transmission between patients with renal disease prior to transplantation accounts for the relatively high prevalence of HHV-8 infection. Implementation of measures to minimise contamination of oral fluid between renal disease patients may play a role in controlling HHV-8 transmission and reduce the incidence of transplantation-associated KS.
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