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infections, and evade viral clearance by actively suppressing cellular apoptosis and by escaping
immune detection. By their persistence, these viral infections drive host cell transformation and
neoplasia, most often in the setting of immunodeficiency. KSHV is endemic in sub-Saharan
populations with seroprevalence of over 50% in adults. Transmission of KSHV in endemic
regions usually occurs during childhood, from parent to child or between children. In non-
endemic regions such as Europe, the seroprevalence is below 5% and it is often a sexually
transmitted agent. The seroprevalence is high in men having sex with men. An additional risk
factor for transmission of HHV-8 is injection drug use, but the transmission of HHV-8 by needle
sharing is less efficient than for HIV. HHV-8 is present in all cases of AIDS-associated Kaposi's
sarcoma, and is invariably present in primary effusion lymphoma of body cavities. It has been
detected in multicentric Castleman disease and in plasmablastic lymphomas.[471,472]
