Plasma HHV‐8 viral load in HHV‐8‐related lymphoproliferative disorders associated with HIV infection

Abstract

This is a mono-institutional analysis of the clinical features, immunological and virological findings, and prognostic factors of patients with HIV infection and HHV-8-lymphoproliferative disorders. Patients with Multicentric Castleman Disease and HHV-8-related lymphoma diagnosed and treated from April 1987 to June 2004 were included in the study. HHV-8 and HIV plasma viral load, CD4+ count, hematologic parameters, and general wellbeing (performance status) were assessed at the onset of the diseases and analyzed in order to identify possible prognostic factors. Nine patients with Multicentric Castleman disease, and 16 with HHV-8-related lymphomas (13 primary effusion lymphomas and 3 solid lymphomas), were diagnosed and treated out of 327 HIV-related non-Hodgkin's lymphomas. Four patients with Multicentric Castleman disease received only antiretroviral drugs; 5 HAART plus oral etoposide. Nine patients with primary effusion lymphoma were treated with a CHOP-like regimen (Cyclophosphamide, Prednisone anthracyclines, Vinca alkaloids, Bleomycin, Etoposide) and HAART; 1 with etoposide and HAART, 1 with HAART alone. The patients with solid lymphoma underwent CHOP-like chemotherapy. Patients with Multicentric Castleman disease showed lower median values of HHV-8 viral load and longer overall survival compared with HHV-8-related lymphomas. Patients with viral load of HHV-8, >40,000 cp/ml had a significant shorter overall survival. In the univariate analysis, HHV-8-related lymphoma, HHV-8 viral load >40,000 cp/ml and performance status >2 were associated with an increased risk of death. Multivariate analysis confirmed the diagnosis of lymphoma as an independent predictor of shorter survival.

Highly active antiretroviral therapy alone may be an effective treatment for HIV-associated multi-centric Castleman's disease

“…Median duration of HIV infection prior to MCD was two years (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. In all patients, nodes showed a mixture of reactive lymphoid follicles and follicles with irregular, regressed germinal centers.…”

Pulmonary manifestations of human herpesvirus-8 during HIV infection

“…The PCR-assessed viral load of HHV-8 is higher in PEL than Kaposi sarcoma. Indeed, blood viral load may be ,2 log copies per 10 5 peripheral blood mononuclear cells (PBMCs) in Kaposi sarcoma, 2-4 log copies per 10 5 PBMCs in MCD and .4 log copies per 10 5 PBMCs in PEL [28]. However, PCR alone cannot be used for the diagnosis, and PCR results must be interpreted with clinical and histological data (table 1).…”

“…A high HHV-8 viral load may predict an MCD flare [75]. Viral HHV-8 load is usually 2-4 log copies per 10 5 PBMCs [28] and, thus, HHV-8 serology is not helpful.…”

“…PCR typically reveals a 3-4 log ratio between pleura and blood [10]. In the blood, HHV-8 viral load is generally .4 log copies per 10 5 PBMCs [28].…”

Prevalence of antibodies against Kaposi's sarcoma associated herpes virus (KSHV) complement inhibitory protein (KCP) in KSHV-related diseases and their correlation with clinical parameters

“…The first group of patients suffering from KSHV-related diseases included 9 patients with Diagnostic criteria for these patients are described in [9].…”