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To the Editor: Dr Osmond and colleagues¹ found that the prevalence of Kaposi sarcoma–associated herpesvirus (KSHV) in 1978 and 1979 was 26.5% among homosexual men who later enrolled in the San Francisco City Clinic Cohort (SFCCC) study. This finding is important for understanding the subsequent epidemic of Kaposi sarcoma and its relationship with human immunodeficiency virus (HIV) in San Francisco. It was inappropriate, however, for Osmond et al to infer that the incidence of KSHV has not changed from 1978 through 1996 based on cross-sectional prevalence data from 3 heterogeneous studies, and to use these data in an ecological analysis of how behavior change might affect KSHV transmission.

Determining KSHV incidence from prevalence data is problematic² and requires assumptions that are not met in this analysis. One is that there was no net migration of KSHV-uninfected homosexual men into San Francisco during this period and no excess deaths among KSHV-infected . . . [Full Text of this Article]

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