A recent study from Uganda demonstrated that transfusion with human herpesvirus 8 antibody-positive blood is associated with an increased risk of mortality. Human herpesvirus 8, or HHV-8, is also known as Kaposi’s sarcoma-associated herpesvirus. It can cause Kaposi’s sarcoma, lymphoma, and other diseases. HHV-8 is found primarily in the Middle East, the Mediterranean, and Africa. Seroprevalence is greater than 50% in some areas of sub-Saharan Africa, but little is known about the impact of acute infections.
Using a cohort of more than 1000 transfusion recipients in a hospital in Kampala, Uganda, it had previously been demonstrated that HHV-8 could be transmitted through blood transfusions. By analyzing data from this cohort, researchers compared the risk of death within six months of transfusion between patients who received HHV-8 antibody-positive blood and patients who received antibody-negative blood. The researchers also assessed the additional impact of the short-storage – or storage for four or fewer days – on mortality risk. The study was published in the Journal of Infectious Diseases.
The researchers found that while 7.9% of patients who received HHV-8 antibody negative blood died, 17% of patients who received HHV-8 antibody-positive blood stored for four days or less died. Furthermore, transfusion patients who received short-stored HHV-8 antibody-positive blood were about twice as likely to die as patients who had received HHV-8 antibody-negative blood.
The researchers also found that for each additional unit of short-stored HHV-8 antibody-positive blood received, patients were 1.8 times more likely to die than if they had not received the unit. Patients who received additional units of HHV-8 antibody-positive blood that had not been short-stored or additional units of HHV-8 antibody-negative blood, did not face a significantly elevated risk of mortality.
The research team, led by Dr. Wolfgang Hladik of the Centers for Disease Control and Prevention, noted that the reasons for the increased mortality risk associated with short-storage of HHV-8 antibody-positive blood transfusions are still unclear.
Here is Dr. Hladik.
“We don’t know whether the higher risk of death following transfusion was due to transfusion-associated HHV-8 infection, or some other factor. However, the results support the need for more research to determine the cause of death in such patients, and to examine the effect of potential interventions such as irradiation or leukoreduction.”
In an accompanying editorial, Dr. Eva Operskalski discussed potential explanations for and implications of this study’s findings. Dr. Operskalski noted that there appeared to be a dose-response relationship for the mortality risk associated with short-stored HHV-8 seropositive blood. However, that concurrent infection with cytomegalovirus and transfusion-associated immunosuppression may have contributed as well.
She also noted that in resource-limited settings, it may not be possible to pursue risk reduction methods other than donor exclusion. Transfusion policy in these settings would need to weigh the benefits of reducing the donor pool by excluding seropositive donors with the potential for transfusion-transmitted infections. Further studies of the mechanisms behind the association of transfusion with HHV-8 seropositive blood are needed.
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1. Hladik W, Pellett PE, Hancock J, Downing R, Gao H, Packel L, Mimbe D, Nzaro E, Mermin J: Association between transfusion with human herpesvirus 8 antibody-positive blood and subsequent mortality. The Journal of Infectious Diseases 2012;206:1497-1503.
2. Operskalski EA: Hhv-8, transfusion, and mortality. The Journal of Infectious Diseases 2012;206:1485-1487.