The unusual geographical distribution of KS has long suggested an infective cause. Epidemiological evidence, including the 20 times greater frequency of AIDS-related KS in homosexual men compared with haemophiliacs, suggested a sexually transmitted cofactor. In 1994, Chang et al. described the identification of fragments of a novel herpes virus in a biopsy of an AIDS-related KS lesion.8 KS-associated herpes virus (KSHV), also known as human herpes virus 8 (HHV8), can be identified in virtually all KS specimens regardless of subtype, but is absent from uninvolved skin. The KSHV genome encodes proteins that are homologous to human oncoproteins and have the potential to induce cellular proliferation and inhibit apoptosis. The presence of KSHV seems to be necessary for the development of KS but the role of cofactors such as host immunosuppression, cytokines and HIV is unclear.
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