Kaposi’s Sarcoma-associated Herpesvirus Infection and Its Association
with All-Cause and Cardiovascular Mortality in the General Adults: A
Prospective Cohort Study
Abstract
Object: To investigate the association between Kaposi’s
sarcoma-associated herpesvirus (KSHV)/human herpesvirus 8 (HHV8)
infection and both all-cause and cardiovascular mortality in a
representative cohort of US adults. Methods: Data from the
National Health and Nutrition Examination Survey III (NHANES III;
1988-1994) were analyzed, including 13,993 participants aged 18-90 years
who underwent KSHV serology evaluations. Mortality outcomes were
ascertained through December 2019 using the National Death Index. Cox
proportional hazards models were employed to examine the association
between KSHV seropositivity and mortality, adjusting for potential
confounders such as age, sex, ethnicity, body mass index, and smoking
status. Results: Over a median follow-up period of 26.5 years,
5,503 deaths were recorded. KSHV seropositivity was associated with an
increased hazard of all-cause mortality (Hazard Ratio [HR]: 1.32,
95% Confidence Interval [CI]: 1.03-1.69) and cardiovascular
mortality (HR: 1.58, 95% CI: 1.00-2.50) after adjusting for age, sex,
ethnicity, and body mass index. However, further adjustment for smoking
status attenuated these associations. Notably, the association between
KSHV infection and all-cause mortality persisted among women (HR: 1.32,
95% CI: 1.02-1.72) after adjusting for all confounders, whereas the
association with cardiovascular mortality was only statistically
significant for men (HR: 1.90, 95% CI: 1.02, 3.53).
Conclusions: KSHV infection may represent an independent risk
factor for all-cause and cardiovascular mortality among US adults. These
findings highlight the need for further research to validate these
associations in independent populations and to elucidate the biological
mechanisms underlying the observed increased mortality associated with
KSHV infection.