AIDS‐related Kaposi's sarcoma: epidemiological, diagnostic, treatment and control aspects in sub‐Saharan Africa

Sissolak, Gerhard; Mayaud, Philippe

doi:10.1111/j.1365-3156.2005.01491.x

Cited by 43 publications

(38 citation statements)

References 88 publications

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“…Here malignant disease contributes significantly to morbidity and mortality particularly in this community [19]. The opportunity has therefore been taken extending our previous observations on KS and NHL [20] and [21] to examine a similar possible association for HL.…”

Section: Introductionmentioning

confidence: 97%

Human immunodeficiency and Hodgkin lymphoma

Sissolak

Jacobs

2010

Transfusion and Apheresis Science

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Presentation of Hodgkin lymphoma (HL) is distinctive in the infected individual being more advanced, accompanied by B symptoms and the presence of extranodal disease particularly lymphadenopathy of the head and neck. Bone marrow involvement may be found in over 50% of cases. Virtually all co express gamma-herpesvirus. Phenotypically there is prominence of the mixed-cellularity and lymphocyte depleted histopathologic subtypes that define an aggressive clinical course in comparison to other variants. Prior to the induction of cART, median survival was only 1-2 years. Notably the first chemotherapy trial using ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in 21 patients, without treating the viral infection, resulted in a 43% complete remission rate accompanied by severe haematological toxicities but did not extend median survival with this being 1.5 years matching the negative cases.Significant change accompanied concomitant anti-retroviral therapy that could be given safely even with dose intensive regimens exemplified by BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) in 12 patients or the Stanford V regimen (doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin, prednisone) coupled with involved-field radiation for bulky disease studied in 59 patients. BEACOPP extended overall survival (OS) to 83% at 2 years. A similar trend was seen 1 when using the Stanford V regimen with an OS rate of 51% at 3 years, disease-free survival (DFS) of 68% and freedom from progression (FFP) in 60%. Additional benefits accrued from supportive care with stimulatory peptides such as G-CSF and when combined with bacterial prophylaxis results approached that found in the uninfected reference group. Current consensus holds this particular lymphoma as still among the non-AIDS defining cancers being lung, stomach, liver or anal despite these having recently gained more attention as several of these neoplasms may be occurring more commonly in the era of cART.While the relative risk of developing a non-AIDS-defining neoplasm in HIV-infected persons on the average is 2-3 times, the risk for developing HL in HIV-infected cases impressively ranges between 5 and 25 times when compared to the general population. Based on the precedent in which Kaposi sarcoma and the non-Hodgkin lymphomas distinctively alter the course of this retroviral infection in a way indistinguishable from concurrent Hodgkin lymphoma we propose that this entity be similarly regarded and the hypothesis tested in large randomised prospective study.

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Section: Introductionmentioning

confidence: 97%

Human immunodeficiency and Hodgkin lymphoma

Sissolak

Jacobs

2010

Transfusion and Apheresis Science

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“…10 In the early 1980s, this disease reportedly accounted for 9% of maligancies in Ugandan males and approximately 10% of all cancers in Zaire. The relationship to the HIV epidemic has somewhat clouded the issue of endemic disease, but there remains a subset of patients who are uninfected with HIV who seem to have an endemic form of KS; [13][14][15] this presumably relates to HHV8 serotypes in various endemic areas. [13][14][15] A third epidemiological subgroup at risk for KS is composed of individuals (primarily transplant patients) receiving potent, high-dose or long-term immunosuppressive therapy.…”

Section: Kaposi Sarcomamentioning

confidence: 99%

Gastrointestinal tract spindle cell lesions—just like real estate, it's all about location

Voltaggio

Montgomery

2015

Modern Pathology

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Interpretation of gastrointestinal tract mesenchymal lesions is simplified merely by knowing in which anatomic layer they are usually found. For example, Kaposi sarcoma is detected on mucosal biopsies, whereas inflammatory fibroid polyp is nearly always in the submucosa. Gastrointestinal stromal tumors (GISTs) are generally centered in the muscularis propria. Schwannomas are essentially always in the muscularis propria. Mesenteric lesions are usually found in the small bowel mesentery. Knowledge of the favored layer is even most important in interpreting colon biopsies, as many mesenschymal polyps are encountered in the colon. Although GISTs are among the most common mesenchymal lesions, we will concentrate our discussion on other mesenchymal lesions, some of which are in the differential diagnosis of GIST, and point out some diagnostic pitfalls, particularly in immunolabeling.

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“…Although the incidence of KS depends on the prevalence of HHV-8, several factors have been associated with disease development and, in many African countries, KS has risen dramatically since the onset of the AIDS epidemic [4,5]. Interestingly, the introduction of highly active antiretroviral therapy (HAART) reverted the increase in KS in wealthier countries [5], but because of limited access to antiretroviral therapies in Africa, KS continues to increase in this geographic area.…”

Section: Human Herpesvirus 8 (Hhv-8) Is Considered As the Etiologicalmentioning

confidence: 99%

“…The exact mechanism by which HAART controls KS progression is unknown, but it has been speculated that the control of HIV viral load by HAART and consequent low Tat protein production, which is thought to be involved in HHV-8 entry into the cell, leads to a decrease in virus spreading and HHV-8-associated diseases. In addition, reconstitution of the immune system after HAART could improve and/or prevent KS lesions [5,6]. Thus, knowledge of the prevalence of HHV-8, mostly among HIV-1-infected patients is necessary for the best control and management strategies for patients, as well as for controlling transmission/acquisition of stigmatizing and lethal AIDS-KS in Africa.…”

Section: Human Herpesvirus 8 (Hhv-8) Is Considered As the Etiologicalmentioning

confidence: 99%

“…Interestingly, the introduction of highly active antiretroviral therapy (HAART) reverted the increase in KS in wealthier countries [5], but because of limited access to antiretroviral therapies in Africa, KS continues to increase in this geographic area. The exact mechanism by which HAART controls KS progression is unknown, but it has been speculated that the control of HIV viral load by HAART and consequent low Tat protein production, which is thought to be involved in HHV-8 entry into the cell, leads to a decrease in virus spreading and HHV-8-associated diseases.…”

Section: Human Herpesvirus 8 (Hhv-8) Is Considered As the Etiologicalmentioning

confidence: 99%

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First survey for detecting the presence of human herpesvirus 8 infection (HHV-8) in Maputo, Mozambique

Caterino–de–Araujo¹,

Manuel²,

Bianco³

et al. 2009

Braz J Infect Dis

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Human herpesvirus 8 (HHV-8), the etiological agent of Kaposi's sarcoma (KS), is endemic in parts of the subSaharan, and KS has increased concomitantly with the HIV/AIDS epidemic. In Mozambique (MZ), no data concerning HHV-8 infection was available, thus the main of this work was to investigate, for the first time, the presence of HHV-8 infection in Maputo, MZ. Latent and lytic HHV-8-specific antibodies were assessed in blood samples from 189 individuals from the Central Hospital of Maputo, MZ, using "in-house" immunofluorescence assays conducted in São Paulo, Brazil. The results obtained were analyzed according to socio-demographic and clinical variables using the Chi-square test and logistic regression. An HHV-8 seropositivity of 1.8% and 9.7% was detected among 57 medical students and 31 individuals from the staff, respectively, in contrast to 16.4% detected among 67 out-patients. Concerning 34 hospitalized patients from the Dermatology Unit, 47.1% were HHV-8-seropositive overall, while the rate was 85.7% among KS patients. The present survey, conducted in Maputo, MZ, demonstrates great variation in HHV-8 infection frequencies depending on the group analyzed and epidemiological variables. An association between HHV-8 seropositivity and male gender (OR 5.72), the central origin of patients (OR 5.33), blood transfusions (OR 3.25), and KS (OR 24.0) was detected among hospitalized patients, and primary school (OR 7.18) and HIV-1 infection (OR 8.76) among out-patients.

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AIDS‐related Kaposi's sarcoma: epidemiological, diagnostic, treatment and control aspects in sub‐Saharan Africa

Cited by 43 publications

References 88 publications

Human immunodeficiency and Hodgkin lymphoma

Human immunodeficiency and Hodgkin lymphoma

Gastrointestinal tract spindle cell lesions—just like real estate, it's all about location

First survey for detecting the presence of human herpesvirus 8 infection (HHV-8) in Maputo, Mozambique

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