Clinicopathologic study of Kaposi's sarcoma and strain analysis of human herpesvirus 8 (HHV-8) DNA in the Hua-Lien area of eastern Taiwan.

BACKGROUND AND PURPOSE Kaposi's sarcoma (KS) is a spindle cell malignancy of endothelial cell origin. The tumor has been demonstrated to be associated with human herpesvirus 8 (HHV-8) or Kaposi's sarcoma-associated herpesvirus-like virus (KSHV). Previous studies have revealed the distribution of unique viral strains in different ethnic populations. Eastern Taiwan has an ethnically mixed population with a relatively high incidence of KS. This study was designed to characterize the clinicopathologic features of KS and to evaluate the HHV-8 strain distribution in the Hua-Lien area of Eastern Taiwan. METHODS Clinical records and laboratory data were collected from 15 cases of KS diagnosed and treated between 1993 and 1999 in Tzu-Chi General Hospital. For nine cases, paraffin blocks were available for the molecular study of HHV-8. HHV-8 genomic variation was analyzed using polymerase chain reaction nucleotide sequencing of ORF26 and ORF75 of HHV-8 genomes derived from different subgroups of KS. RESULTS Among the 15 patients with KS, two had AIDS-associated disease, four had gouty arthritis and psoriasis and were receiving corticosteroid therapy (iatrogenic type), and nine had classical KS. Nine of the 15 cases occurred in aborigines, including one with AIDS-associated disease, four with iatrogenic disease, and four with classical disease. Among the nine cases for which tissue was available for DNA analysis, eight were positive for HHV-8 DNA. Sequence analysis revealed that the C strain occurred in three Han Chinese KS patients, whereas a hitherto rarely described strain (strain D) occurred in all four aborigines tested (including one with AIDS-associated KS) and one Han Chinese with AIDS from Burma. CONCLUSION This study found a high proportion of iatrogenic KS and the finding of a rarely described strain D virus in Eastern Taiwan aborigines. Our studies further confirm the distribution of different types of KS and virus strains in different ethnic populations.