Again, the sustain is incredible during team fights, especially for those two hard hitting champions. I usually run support or AD with him in the game, but occasionally I'll just say fuck it and run another AP (usually Malz just because his ratios are so retarded that even with a lot of MR he's a serious threat) with WoTA so ours stacks together. When he nails people with his Q it gives him incredible sustain. He is hands down one of the best Karthus' I've ever seen and he uses WoTA.
I have a friend who, for better or worse, plays ONLY Karthus. I would just swap over to something that gives me more damage rather than the sustain. Riot is usually pretty good with game balance, so I'm not too concerned if they nerf this item. When I play against a champ that has amazing sustain it's usually because it is part of their mechanics, not because of WoTA.
It has been around for as long as I have played (1.5 yrs now) and I don't think it has ever been an issue. I haven't noticed it being built more often than it already was
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