Sex and Geographic Patterns of Human Herpesvirus 8 Infection in a Nationally Representative Population-Based Sample in Uganda

Background. Human herpesvirus 8 (HHV8), the infectious cause of Kaposi sarcoma, varies dramatically across Africa, suggesting that cofactors correlated with large-area geographic or environmental characteristics may influence risk of infection. Variation in HHV8 seropositivity across small-area regions within countries in Africa is unknown. We investigated this issue in Uganda, where Kaposi sarcoma distribution is uneven and well described. Methods. Archival samples from individuals aged 15–59 years randomly selected from a nationally epresentative 2004–2005 human immunodeficiency virus–AIDS serobehavioral survey were tested for HHV8 seropositivity with use of enzyme immunoassays based on synthetic peptides from the K8.1 and orf65 viral genes. Adjusted odds ratios and 95% confidence intervals (CIs) of association of HHV8 seropositivity with demographic risk factors were estimated. Results. Among 2681 individuals tested, HHV8 seropositivity was 55.4%. HHV8 seropositivity was lower in female than in male persons (adjusted odds ratio, 0.82 [95% CI, 0.69–0.97]) and increased 2.2% (95% CI, 1.0%–3.6%) in female persons and 1.2% (95% CI, 1.0%–2.3%) in male persons per year of age. HHV8 seropositivity was inversely associated with education (P = .01 for trend) and was elevated in the West Nile region, compared with the Central region (adjusted odds ratio, 1.49 [95% CI, 1.02–2.18]) but not with other regions. Conclusions. Our findings suggest that HHV8 seropositivity in Uganda may be influenced by cofactors correlated with small-area geography, age, sex, and education.