The goal of this study is to elucidate the epidemiology of human immunodeficiency virus type 1 (HIV-1) related Kaposi's sarcoma (KS) and its relationship to KS Herpesvirus (KSHV), also know as the Human Herpesvirus type 8 (HHV-8).
A historical cohort study is being nested within the Multicenter AIDS Cohort Study (MACS) to address these specific aims:

• Determine the prevalence and incidence of KSHV infection in the MACS population
  
• Determine the KSHV route of transmission and the concordance of characteristics found to be associated with the virus to risk factors for KS
  
• Determine rates and biological markers of progression to KS among KSHV seropositive, HIV-1 infected homosexual men, and factors which may modify disease progression
  
• Examine the effect of anti-retroviral and anti-herpes treatments on KS disease progression in the presence of KSHV infection
  
• Examine the health effects of KSHV in the absence of HIV-1 progression, independent of its role in KS disease
  

Behaviors under examination as risk factors include numbers of male sexual partners, types of sexual activity, and recreational drug use. Host characteristics including age, race, genotype, and immune status are being examined as effect modifiers for viral acquisition and disease progression. The effects of other environmental factors such as geographic location and co-infections will also be studied. Sera selected from visits for HIV-1 seroconverters with known dates of seroconversion within 1 year and a stratified random sample of 400 HIV-1 seroprevalent and 100 seronegative men are being tested for KSHV antibodies. KSHV seroprevalence also will be determined in a sample of injecting drug users from a cohort study with protocols similar to the MACS.

Establishing the epidemiology of the KS Herpesvirus, consistent with principles of causality, will provide direction for developing behavioral and therapeutic interventions against the development of Kaposi's sarcoma, and will guide virologic and biologic investigations determining the pathogenesis of this disease.

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