HHV-8 in Pulmonary Hypertension

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Abstract
Cool et al. (Sept. 18 issue)1 suggest that human herpesvirus 8 (HHV-8) has a role in the pathogenesis of primary pulmonary hypertension. We performed tests for HHV-8 antibodies in plasma samples from 49 patients with primary pulmonary hypertension who were negative for the human immunodeficiency virus and 17 patients with other forms of pulmonary hypertension (10 with chronic thromboembolic pulmonary hypertension and 7 with pulmonary arterial hypertension that was not due to primary pulmonary hypertension). Antibodies against a structural HHV-8 glycoprotein, K8.1, were detectable in three patients (one with primary pulmonary hypertension, one with chronic thromboembolic pulmonary hypertension, and one with pulmonary arterial hypertension that was not due to primary pulmonary hypertension), all of whom had been born and raised in Germany. Two of these three patients (the patient with primary pulmonary hypertension and the patient with chronic thromboembolic pulmonary hypertension) also had antibodies against latency-associated nuclear antigen 1 (LANA-1). Two of 73 healthy blood-donor controls were positive for K8.1 antibodies but were negative for LANA-1 antibodies. The sensitivity of these serologic assays is 80 percent for the LANA-1 immunofluorescence assay and more than 90 percent for the K8.1 enzyme-linked immunosorbent assay.2,3 Since we did not find a significant difference in the prevalence of HHV-8 between patients and controls in a country where HHV-8 infection is uncommon, we conclude that in countries where HHV-8 infection is not endemic, it is rarely involved in the pathogenesis of primary pulmonary hypertension.