Kaposi's sarcoma-associated herpesvirus, but not Epstein-Barr virus, co-infection associates with coronavirus disease 2019 severity and outcome in South African patients. Blumenthal, M. J, Lambarey, H., Chetram, A., Riou, C., Wilkinson, R. J, & Schäfer, G. Frontiers in Microbiology, 12:795555, Frontiers, jan, 2022. ![Kaposi's sarcoma-associated herpesvirus, but not Epstein-Barr virus, co-infection associates with coronavirus disease 2019 severity and outcome in South African patients [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper doi abstract bibtex In South Africa, the COVID-19 pandemic occurs against the backdrop of high Human Immunodeficiency Virus (HIV-1), tuberculosis (TB) and non-communicable disease burdens as well as prevalent herpesviruses infections such as Epstein-Barr virus (EBV) and Kaposi's sarcoma-associated herpesvirus (KSHV). As part of an observational study of adults admitted to Groote Schuur Hospital, Cape Town, South Africa, during the period June – August 2020 and assessed for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, we measured KSHV serology and KSHV and EBV viral load (VL) in peripheral blood in relation to Coronavirus disease 2019 (COVID-19) severity and outcome. A total of 104 patients with PCR-confirmed SARS-CoV-2 infection were included. 61% were men and 39% women with a median age of 53 years (range 21 – 86). 29.8% (95% CI: 21.7 – 39.1%) of the cohort was HIV-1 positive and 41.1% (95% CI: 31.6 – 51.1%) were KSHV seropositive. EBV VL was detectable in 84.4% (95% CI: 76.1 – 84.4%) of the cohort while KSHV DNA was detected in 20.6% (95% CI: 13.6 – 29.2%), with dual EBV/KSHV infection in 17.7% (95% CI: 11.1 – 26.2%). On enrolment, 48 (46.2% (95% CI: 36.8 – 55.7%)) COVID-19 patients were classified as severe on the WHO ordinal scale reflecting oxygen therapy and supportive care requirements; 30 of these patients (28.8% (95% CI: 20.8 – 38.0%) died. In COVID-19 patients, detectable KSHV VL was associated with death after adjusting for age, sex, HIV-1 status and detectable EBV VL (p=0.036, adjusted OR=3.17 [95% CI: 1.08 – 9.32]). Furthermore, in HIV-1 negative COVID-19 patients, there was a trend indicating that KSHV VL was related to COVID-19 disease severity (p=0.054, unstandardized co-efficient 0.86 [95% CI: -0.015 – 1.74]) in addition to death (p=0.008, adjusted OR=7.34 [95% CI: 1.69 – 31.49]). While the design of our study cannot distinguish if disease synergy exists between COVID-19 and KSHV nor if either viral infection is fueling the other, these data point to a potential contribution of KSHV infection to COVID-19 outcome, or SARS-CoV-2 infection to KSHV reactivation, particularly in the South African context of high disease burden, that warrants further investigation.
@article{Blumenthal2022,
abstract = {In South Africa, the COVID-19 pandemic occurs against the backdrop of high Human Immunodeficiency Virus (HIV-1), tuberculosis (TB) and non-communicable disease burdens as well as prevalent herpesviruses infections such as Epstein-Barr virus (EBV) and Kaposi's sarcoma-associated herpesvirus (KSHV). As part of an observational study of adults admitted to Groote Schuur Hospital, Cape Town, South Africa, during the period June – August 2020 and assessed for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, we measured KSHV serology and KSHV and EBV viral load (VL) in peripheral blood in relation to Coronavirus disease 2019 (COVID-19) severity and outcome. A total of 104 patients with PCR-confirmed SARS-CoV-2 infection were included. 61{\%} were men and 39{\%} women with a median age of 53 years (range 21 – 86). 29.8{\%} (95{\%} CI: 21.7 – 39.1{\%}) of the cohort was HIV-1 positive and 41.1{\%} (95{\%} CI: 31.6 – 51.1{\%}) were KSHV seropositive. EBV VL was detectable in 84.4{\%} (95{\%} CI: 76.1 – 84.4{\%}) of the cohort while KSHV DNA was detected in 20.6{\%} (95{\%} CI: 13.6 – 29.2{\%}), with dual EBV/KSHV infection in 17.7{\%} (95{\%} CI: 11.1 – 26.2{\%}). On enrolment, 48 (46.2{\%} (95{\%} CI: 36.8 – 55.7{\%})) COVID-19 patients were classified as severe on the WHO ordinal scale reflecting oxygen therapy and supportive care requirements; 30 of these patients (28.8{\%} (95{\%} CI: 20.8 – 38.0{\%}) died. In COVID-19 patients, detectable KSHV VL was associated with death after adjusting for age, sex, HIV-1 status and detectable EBV VL (p=0.036, adjusted OR=3.17 [95{\%} CI: 1.08 – 9.32]). Furthermore, in HIV-1 negative COVID-19 patients, there was a trend indicating that KSHV VL was related to COVID-19 disease severity (p=0.054, unstandardized co-efficient 0.86 [95{\%} CI: -0.015 – 1.74]) in addition to death (p=0.008, adjusted OR=7.34 [95{\%} CI: 1.69 – 31.49]). While the design of our study cannot distinguish if disease synergy exists between COVID-19 and KSHV nor if either viral infection is fueling the other, these data point to a potential contribution of KSHV infection to COVID-19 outcome, or SARS-CoV-2 infection to KSHV reactivation, particularly in the South African context of high disease burden, that warrants further investigation.},
author = {Blumenthal, Melissa J and Lambarey, Humaira and Chetram, Abeen and Riou, Catherine and Wilkinson, Robert J and Sch{\"{a}}fer, Georgia},
doi = {10.3389/FMICB.2021.795555},
file = {:C$\backslash$:/Users/01462563/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Blumenthal et al. - 2022 - Kaposi's sarcoma-associated herpesvirus, but not Epstein-Barr virus, co-infection associates with coronavirus.pdf:pdf},
issn = {1664-302X},
journal = {Frontiers in Microbiology},
keywords = {COVID-19,KSHV,OA,OA{\_}PMC,SARS-CoV-2,South Africa,fund{\_}ack,genomics{\_}fund{\_}ack,lytic reactivation,original},
mendeley-tags = {OA,OA{\_}PMC,fund{\_}ack,genomics{\_}fund{\_}ack,original},
month = {jan},
pages = {795555},
pmid = {35069495},
publisher = {Frontiers},
title = {{Kaposi's sarcoma-associated herpesvirus, but not Epstein-Barr virus, co-infection associates with coronavirus disease 2019 severity and outcome in South African patients}},
url = {https://www.frontiersin.org/articles/10.3389/fmicb.2021.795555/full},
volume = {12},
year = {2022}
}
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As part of an observational study of adults admitted to Groote Schuur Hospital, Cape Town, South Africa, during the period June – August 2020 and assessed for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, we measured KSHV serology and KSHV and EBV viral load (VL) in peripheral blood in relation to Coronavirus disease 2019 (COVID-19) severity and outcome. A total of 104 patients with PCR-confirmed SARS-CoV-2 infection were included. 61% were men and 39% women with a median age of 53 years (range 21 – 86). 29.8% (95% CI: 21.7 – 39.1%) of the cohort was HIV-1 positive and 41.1% (95% CI: 31.6 – 51.1%) were KSHV seropositive. EBV VL was detectable in 84.4% (95% CI: 76.1 – 84.4%) of the cohort while KSHV DNA was detected in 20.6% (95% CI: 13.6 – 29.2%), with dual EBV/KSHV infection in 17.7% (95% CI: 11.1 – 26.2%). On enrolment, 48 (46.2% (95% CI: 36.8 – 55.7%)) COVID-19 patients were classified as severe on the WHO ordinal scale reflecting oxygen therapy and supportive care requirements; 30 of these patients (28.8% (95% CI: 20.8 – 38.0%) died. In COVID-19 patients, detectable KSHV VL was associated with death after adjusting for age, sex, HIV-1 status and detectable EBV VL (p=0.036, adjusted OR=3.17 [95% CI: 1.08 – 9.32]). Furthermore, in HIV-1 negative COVID-19 patients, there was a trend indicating that KSHV VL was related to COVID-19 disease severity (p=0.054, unstandardized co-efficient 0.86 [95% CI: -0.015 – 1.74]) in addition to death (p=0.008, adjusted OR=7.34 [95% CI: 1.69 – 31.49]). 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