HIV infection in utero and risk of primary KSHV infection in a Kenyan infant prospective cohort
Katherine Sabourin, PhD
BACKGROUND: Kaposi’s sarcoma (KS), a common pediatric cancer in sub-Saharan Africa with low survival, is associated with earlier Kaposi’s sarcoma-associated herpesvirus (KSHV) infection. HIV exposure in utero is associated with reduced transplacental antibody transfer, a child’s initial defense against infection, and poor childhood health outcomes. GAP: Whether HIV exposure in utero affects anti-KSHV antibody transplacental transfer and subsequent loss of maternally acquired antibodies is unknown. HYPOTHESIS: HIV exposure in utero will lead to reduced anti-KSHV antibody transplacental transfer, larger declines in maternally acquired anti-KSHV antibodies in children, and earlier ages of child KSHV seroconversion. METHODS: A prospective cohort of 227 Kenyan mother-child pairs were enrolled. Children born to HIV-positive women were considered HIV exposed in utero. Cord and maternal blood at delivery and child venous blood at ages 6, 12, 18, and 24 months will be tested for anti-KSHV antibodies by multiplex immunoassay and ELISA. Multiple linear regression will model associations between in utero HIV exposure and anti-KSHV antibody transplacental transfer (defined as cord-to-maternal antibody ratios). Linear mixed effects will model associations between in utero HIV exposure and decline of maternally acquired anti-KSHV antibodies. Cox proportional hazards will model associations between in utero HIV exposure and age of child KSHV seroconversion, defined as first detection of anti-KSHV antibodies. All models will be adjusted for relevant confounders. RESULTS: Pending. IMPACT: Elucidating the relationship between HIV and KSHV in sub-Saharan Africa, where both viruses are prevalent, will identify high risk populations and direct future research on KSHV and HIV prevention, vaccination, and treatment in children.