In Reply: We agree with Dr O'Brien and colleagues
that it can often be problematic to infer incidence from prevalence data.
As we noted, our data are not inconsistent with some increase in KSHV prevalence
with the first wave of HIV infection. Our principal objective in documenting
the robust prevalence of KSHV in 1978 in HIV-uninfected men, however, was
not to make a strict comparison with 1984 and 1985, but rather to show that
KSHV infection was probably not introduced recently in homosexual men. This
has implications for understanding KSHV transmission. If acts that are practiced
by both homosexuals and heterosexuals, such as kissing, are significant routes
of KSHV transmission, KSHV would likely be widespread in heterosexual populations,
but actual prevalence estimates range from 0% to 9%.1- 3
Low prevalence in heterosexual groups despite spread by kissing would be plausible
if KSHV were recently introduced, but our data from 1978 do not support this.
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