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Kaposi's Sarcoma in Virally Suppressed People Living with HIV: An Emerging Condition. Cancers (Basel) 2021; 13:cancers13225702. [PMID: 34830857 PMCID: PMC8616070 DOI: 10.3390/cancers13225702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/27/2022] Open
Abstract
Simple Summary Kaposi’s sarcoma (KS) in people living with HIV (PLHIV) occurs in the vast majority of cases when viral replication is not controlled and when CD4 immunosuppression is important. However, clinicians are observing more and more cases of KS in PLHIV with suppressed viremia on antiretroviral treatment. These clinical forms seem less aggressive, but cause therapeutic dead ends. Indeed, despite repeated chemotherapy, recurrences are frequent. Immunotherapy and specific treatment regimens should be evaluated in this population. Abstract Since the advent of highly effective combined antiretroviral treatment (cART), and with the implementation of large HIV testing programs and universal access to cART, the burden of AIDS-related comorbidities has dramatically decreased over time. The incidence of Kaposi’s sarcoma (SK), strongly associated with HIV replication and CD4 immunosuppression, was greatly reduced. However, KS remains the most common cancer in patients living with HIV (PLHIV). HIV physicians are increasingly faced with KS in virally suppressed HIV-patients, as reflected by increasing description of case series. Though SK seem less aggressive than those in PLHIV with uncontrolled HIV-disease, some may require systemic chemotherapy. Persistent lack of specific anti-HHV-8 cellular immunity could be involved in the physiopathology of these KS. These clinical forms are a real therapeutic challenge without possible short-term improvement of anti-HHV-8 immunity, and no active replication of HIV to control. The cumulative toxicity of chemotherapies repeatedly leads to a therapeutic dead end. The introduction or maintenance of protease inhibitors in cART does not seem to have an impact on the evolution of these KS. Research programs in this emerging condition are important to consider new strategies.
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Shih WL, Fang CT, Chen PJ. Chapter XX Antiviral Treatment and Cancer Control. Recent Results Cancer Res 2021; 217:325-354. [PMID: 33200371 DOI: 10.1007/978-3-030-57362-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Hepatitis B virus (HBV), hepatitis C virus (HCV), human papilloma virus (HPV), Epstein-Barr virus (EBV), human T-cell lymphotropic virus type 1 (HTLV-1), Kaposi's sarcoma-associated herpesvirus (KSHV), and Merkel cell polyomavirus (MCV) contribute to about 10-15% global burden of human cancers. Conventional chemotherapy or molecular target therapies have been used to treat virus-associated cancers. However, a more proactive approach would be the use of antiviral treatment to suppress or eliminate viral infections to prevent the occurrence of cancer in the first place. Antiviral treatments against chronic HBV and HCV infection have achieved this goal, with significant reduction in the incidence of hepatocellular carcinoma in treated patients. Antiviral treatments for EBV, KSHV, and HTLV-1 had limited success in treating refractory EBV-associated lymphoma and post-transplant lymphoproliferative disorder, KSHV-associated Kaposi's sarcoma in AIDS patients, and HTLV-1-associated acute, chronic, and smoldering subtypes of adult T-cell lymphoma, respectively. Therapeutic HPV vaccine and RNA interference-based therapies for treating HPV-associated infection or cervical cancers also showed some encouraging results. Taken together, antiviral therapies have yielded promising results in cancer prevention and treatment. More large-scale studies in a real-world setting are necessary to confirm the efficacy of antiviral therapy. Further investigation for more effective and convenient antiviral regimens warrants more attention.
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Affiliation(s)
- Wei-Liang Shih
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-Jer Chen
- Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan.
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Demba RN, Aradi SM, Mwau M, Mwanda WO. Kaposi's sarcoma-associated herpesvirus protein ORF75 among HIV-1 patients in Kenya. Afr J Lab Med 2020; 9:939. [PMID: 32934910 PMCID: PMC7479412 DOI: 10.4102/ajlm.v9i1.939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 05/15/2020] [Indexed: 12/26/2022] Open
Abstract
Background Histology is used to identify Kaposi’s sarcoma (KS) in countries with low resources to fund healthcare costs. Approximately 95% of KS cases can be detected using a polymerase chain reaction. Objective To determine the presence of the open reading frame 75 (ORF75) gene associated with Kaposi’s sarcoma herpes virus among HIV-1/AIDS patients and to describe morphological presentations of KS. Methods This was a retrospective, descriptive study of archived tissue blocks collected from 2013 to 2016. Haematoxylin and eosin staining was used to identify KS. Deoxyribonucleic acid from archived tissue blocks was extracted and a nested polymerase chain reaction was used to detect the ORF75 gene. Results All 81 cases in this study had been diagnosed as HIV-1 positive, of which 68 had hallmark features of KS in the histology report and 13 had features suggestive of KS (‘KS-like’). Microscopic identification of KS by haematoxylin and eosin staining was considered a significant indicator of KS herpes virus ORF75 gene positivity (p = 0.002). The ORF75 gene was detected in 60.5% (49/81) of tissue blocks; 27.2% were men (22/81) and 33.3% were women (27/81). The ORF75 gene was observed to be present in up to 15.4% (2/13) of the cases reported to have KS-like features. Conclusion Following the initial diagnosis of KS by histology, the ORF75 gene was fur-ther detected from both cases that had hallmark features of KS as well as among cases with KS-like fea-tures.
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Affiliation(s)
- Rodgers N Demba
- School of Health Sciences, Kisii University, Kisii, Kenya.,Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Sylviah M Aradi
- Department of Internal Medicine, University of Nairobi, Nairobi, Kenya
| | - Matilu Mwau
- Center for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, Kenya
| | - Walter O Mwanda
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
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Poizot-Martin I, Obry-Roguet V, Duvivier C, Lions C, Huleux T, Jacomet C, Ferry T, Cheret A, Allavena C, Bani-Sadr F, Palich R, Cabié A, Fresard A, Pugliese P, Delobel P, Lamaury I, Hustache-Mathieu L, Brégigeon S, Makinson A, Rey D. Kaposi sarcoma among people living with HIV in the French DAT'AIDS cohort between 2010 and 2015. J Eur Acad Dermatol Venereol 2020; 34:1065-1073. [PMID: 31953902 PMCID: PMC7318618 DOI: 10.1111/jdv.16204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/17/2019] [Indexed: 01/16/2023]
Abstract
Background Although antiretroviral therapy (ART) has reduced the risk of Kaposi sarcoma (KS), KS cases still occur in HIV‐infected people. Objective To describe all KS cases observed between 2010 and 2015 in a country with high ART coverage. Methods Retrospective study using longitudinal data from 44 642 patients in the French Dat’AIDS multicenter cohort. Patients’ characteristics were described at KS diagnosis according to ART exposure and to HIV‐plasma viral load (HIV‐pVL) (≤50 or >50) copies/mL. Results Among the 209 KS cases diagnosed during the study period, 33.2% occurred in ART naïve patients, 17.3% in ART‐experienced patients and 49.5% in patients on ART, of whom 23% for more than 6 months. Among these patients, 24 (11.5%) had HIV‐pVL ≤50 cp/mL, and 16 (66%) were treated with a boosted‐PI‐based regimen. The distribution of KS localization did not differ by ART status nor by year of diagnosis. Limitations Data on human herpesvirus 8, treatment modalities for KS and response rate were not collected. Conclusion Half of KS cases observed in the study period occurred in patients not on ART, reflecting the persistence of late HIV diagnosis. Factors associated with KS in patients on ART with HIV‐pVL ≤50 cp/mL remain to be explored.
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Affiliation(s)
- I Poizot-Martin
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, APHM Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, Marseille, France
| | - V Obry-Roguet
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, Marseille, France
| | - C Duvivier
- Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, APHP-Hôpital Necker-Enfants Malades, Paris, France.,IHU Imagine, Paris, France.,Institut Cochin - CNRS 8104 - INSERM U1016 - RIL Team: Retrovirus, Infection and Latency, Université de Paris, Paris, France.,Centre Médical de l'Institut Pasteur, Institut Pasteur, Paris, France
| | - C Lions
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, Marseille, France
| | - T Huleux
- Service Universitaire des Maladies Infectieuses et du Voyageur - Centre Hospitalier G. DRON, Tourcoing, France
| | - C Jacomet
- Centre Hospitalier Universitaire de Clermont-Ferrand, Département des Maladies Infectieuses et Tropicales, Clermont Ferrand, France
| | - T Ferry
- Service de Maladies Infectieuses, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - A Cheret
- Sorbonne Paris Cité, EA7327, Université Paris Descartes, Paris, France.,Service de Médecine Interne - Immunologie Clinique - Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - C Allavena
- Service des Maladies Infectieuses et Tropicales, CHU Hôtel-Dieu, Nantes, France
| | - F Bani-Sadr
- Département de Médecine Interne, Maladies Infectieuses et Immunologie Clinique, Hêpital Robert Debré, Centre Hospitalier Universitaire, Reims, France
| | - R Palich
- Service des Maladies Infectieuses et Tropicales, GHPS Pitié Salpêtrière APHP, Paris, France.,UMR 1136, Sorbonne Universités UPMC Université Paris 6-INSERM-IPLESP, Paris, France
| | - A Cabié
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort-de-France, France.,EA 4537 Maladies Infectieuses et Tropicales dans la Caraï be, Université des Antilles, Pointe-à-Pitre, France.,INSERM CIC1424 Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier Andrée Rosemon, Cayenne, France
| | - A Fresard
- Centre Hospitalier Universitaire de Saint-Étienne, Département des Maladies Infectieuses et Tropicales, Saint-Etienne, France
| | - P Pugliese
- CHU de Nice, Universite Côte d'Azur, Nice, France
| | - P Delobel
- CHU de Toulouse, Service des Maladies Infectieuses et Tropicales-INSERM, UMR1043-Université Toulouse III Paul Sabatier, Toulouse, France
| | - I Lamaury
- Département d'Infectiologie, Dermatologie et Immunologie Clinique, Pointe-à-Pitre Cedex, France
| | - L Hustache-Mathieu
- Service des Maladies Infectieuses et Tropicales, CHRU de Besançon - Hôpital Jean Minjoz, Besançon, France
| | - S Brégigeon
- Aix-Marseille Université, APHM Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, Marseille, France
| | - A Makinson
- Centre Hospitalier Universitaire de Montpellier, Département des Maladies Infectieuses et Tropicales, INSERM U1175/IRD UMI 233, Montpellier, France
| | - D Rey
- Le Trait d'Union, Centre de Soins de l'infection par le VIH, Hôpitaux Universitaires, Strasbourg, France
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Colafigli M, Ciccullo A, Borghetti A, Fanti I, Melis F, Modica S, Uccella I, Bonadies A, Ferraresi V, Anzalone E, Pennica A, Migliano E, Rossetti B, Madeddu G, Cauda R, Cristaudo A, Di Giambenedetto S, Latini A. Impact of Antiretroviral Therapy on the Risk of Recurrence in HIV-1 Infected Patients with Kaposi Sarcoma: A Multicenter Cohort Experience. J Clin Med 2019; 8:jcm8122062. [PMID: 31771172 PMCID: PMC6947508 DOI: 10.3390/jcm8122062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 12/17/2022] Open
Abstract
Kaposi sarcoma (KS) remains a relevant malignancy in human immunodeficiency virus (HIV)-infected patients with a non-standardized management; despite past suggestions that ritonavir-boosted protease inhibitor (bPI)-based regimens could be preferable, no combination antiretroviral therapy (cART) regimen was demonstrated to outperform the others and the impact of new drugs, drug classes or paradigms was never investigated nor proven better than previous therapeutic regimes. In order to do this, we retrospectively collected data regarding HIV-infected patients with a diagnosis of KS last seen in six Italian centers after 1 January 2013. A total of 104 KS cases in 99 patients was analyzed for 945.34 patient-year follow-up (PYFU). Twenty-six patients had visceral localizations. Thirty-three patients were treated with chemotherapy, four with electrochemotherapy, and 12 with α-interferon (α-IFN). At censor, 22% received a bPI-based, 14% a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based, and 28% an integrase inhibitor (INI)-based standard cART, 24% a less drug regimen and 12% a mega-cART. Twelve recurrence episodes were observed in seven patients for an incidence of 1.27 per 100 PYFU. Two patients with no evidence of recurrence episodes died for other reasons. In our experience, KS recurrence episodes were infrequent. Despite the increasing use of new antiretroviral drug classes and new treatment paradigms, no excess of recurrence episodes was observed in patients receiving such cART regimens.
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Affiliation(s)
- Manuela Colafigli
- Infectious Dermatology and Allergology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
- Correspondence ; Tel.: +39-0652662808
| | - Arturo Ciccullo
- Clinical Infectious Diseases, Catholic University of S. Heart, 00168 Rome, Italy
| | - Alberto Borghetti
- Clinical Infectious Diseases, Catholic University of S. Heart, 00168 Rome, Italy
| | - Iuri Fanti
- Clinical Infectious Diseases, Catholic University of S. Heart, 00168 Rome, Italy
| | - Federico Melis
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari Italy
| | - Sara Modica
- Department of Medical Biotechnologies, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
| | | | - Antonio Bonadies
- Plastic Surgery, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
| | - Virginia Ferraresi
- First Division of Medical Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | | | | | - Emilia Migliano
- Plastic Surgery, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
| | - Barbara Rossetti
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari Italy
| | - Roberto Cauda
- Clinical Infectious Diseases, Catholic University of S. Heart, 00168 Rome, Italy
| | - Antonio Cristaudo
- Infectious Dermatology and Allergology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
| | | | - Alessandra Latini
- Infectious Dermatology and Allergology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
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Sigel K, Park L, Justice A. HIV and cancer in the Veterans Health Administration System. Semin Oncol 2019; 46:334-340. [PMID: 31703932 DOI: 10.1053/j.seminoncol.2019.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/25/2019] [Indexed: 12/18/2022]
Abstract
Cancer is a leading cause of death for people with HIV (PWH). The Veterans Healthcare System (VA) is the largest single institutional provider of HIV care in the United States. Cancer among Veterans with HIV is major issue and clinical research has expanded significantly during the antiretroviral therapy (ART) era providing numerous insights regarding cancer incidence, risk factors, prevention, treatment and outcomes for this unique group of patients. This work has been greatly facilitated by the availability of national VA data sources. Notably, patterns of cancer incidence have changed for Veterans with HIV during the ART era; non-AIDS defining malignancies now are the most common tumors. Despite better HIV control in the ART era, immunosuppression measured by low CD4 counts and HIV viremia have been associated with increased cancer risk. Cancer outcomes for Veterans with HIV may now be similar to uninfected Veterans, but information on outcomes and cancer treatment patterns remains limited, requiring further study to help inform prevention and treatment strategies.
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Affiliation(s)
- Keith Sigel
- Icahn School of Medicine at Mount Sinai, NY, NY.
| | - Lesley Park
- Stanford University School of Medicine, Palo Alto, CA
| | - Amy Justice
- VA Connecticut Healthcare System, West Haven, CT; Yale University School of Medicine
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Cisse Diallo VMP, Deguenonvo LF, Mbaye KD, Ka D, Lakhe NA, Ndiaye I, Thioub D, Diop Nyafouna SA, Massaly A, Dièye A, Diop M, Ndour CT, Seydi M. [TB/HIV co-infection associated with Kaposi's sarcoma under opioid substitution treatment using methadone: about a case]. Pan Afr Med J 2017; 28:43. [PMID: 29158866 PMCID: PMC5687882 DOI: 10.11604/pamj.2017.28.43.11161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 08/30/2017] [Indexed: 11/11/2022] Open
Abstract
Le diagnostic tardif de l’infection à VIH peut être fatal car favorisant l’apparition d’infections opportunistes dont la prise en charge nécessite l’utilisation de plusieurs molécules pouvant provoquer des interactions médicamenteuses. Nous rapportons le cas d’une patiente de 45 ans, sous traitement de substitution à l’héroïne par la méthadone, VIH1 sous traitement antirétroviral. Cette patiente présentait un tableau pulmonaire non spécifique associant une toux quinteuse sèche avec une dyspnée d’apparition progressive évoluant dans un contexte fébrile. Par ailleurs l’examen notait un lymphœdème du membre inferieur gauche surmontée de nodules angiomateux indolores évoluant depuis trois ans associé à des plaques, des nodules angiomateux d’apparition plus récente au niveau de la face antérieure du thorax. Le GeneXpert sur les crachats avait permis d’isoler Mycobacterium tuberculosis. Le diagnostic retenu était celui d’une tuberculose pulmonaire associée à une maladie de kaposi cutané sur un terrain d’immunodépression au VIH.
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Affiliation(s)
- Viviane Marie Pierre Cisse Diallo
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann Dakar /Université Cheikh Anta Diop de Dakar, BP 5035 Dakar, Sénégal
| | - Louise Fortes Deguenonvo
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann Dakar /Université Cheikh Anta Diop de Dakar, BP 5035 Dakar, Sénégal
| | - Khardiata Diallo Mbaye
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann Dakar /Université Cheikh Anta Diop de Dakar, BP 5035 Dakar, Sénégal
| | - Daye Ka
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann Dakar /Université Cheikh Anta Diop de Dakar, BP 5035 Dakar, Sénégal
| | - Ndeye Aissatou Lakhe
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann Dakar /Université Cheikh Anta Diop de Dakar, BP 5035 Dakar, Sénégal
| | - Ibrahima Ndiaye
- Service de Psychiatrie / Centre Hospitalier National Universitaire de Fann Dakar/Université Cheikh Anta Diop de Dakar, BP 5035 Dakar, Sénégal
| | - Daouda Thioub
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann Dakar /Université Cheikh Anta Diop de Dakar, BP 5035 Dakar, Sénégal
| | - Sylvie Audrey Diop Nyafouna
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann Dakar /Université Cheikh Anta Diop de Dakar, BP 5035 Dakar, Sénégal
| | - Aminata Massaly
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann Dakar /Université Cheikh Anta Diop de Dakar, BP 5035 Dakar, Sénégal
| | - Alassane Dièye
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann Dakar /Université Cheikh Anta Diop de Dakar, BP 5035 Dakar, Sénégal
| | - Moustapha Diop
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann Dakar /Université Cheikh Anta Diop de Dakar, BP 5035 Dakar, Sénégal
| | - Cheikh Tidiane Ndour
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann Dakar /Université Cheikh Anta Diop de Dakar, BP 5035 Dakar, Sénégal
| | - Moussa Seydi
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann Dakar /Université Cheikh Anta Diop de Dakar, BP 5035 Dakar, Sénégal
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Abstract
: The search for the etiologic agent for Kaposi sarcoma led to the discovery of Kaposi sarcoma-associated herpesvirus (KSHV) in 1994. KSHV, also called human herpesvirus-8, has since been shown to be the etiologic agent for several other tumors and diseases, including primary effusion lymphoma (PEL), an extracavitary variant of PEL, KSHV-associated diffuse large B-cell lymphoma, a form of multicentric Castleman disease, and KSHV inflammatory cytokine syndrome. KSHV encodes several genes that interfere with innate and specific immunity, thwart apoptosis, enhance cell proliferation and cytokine production, and promote angiogenesis, and these play important roles in disease pathogenesis. HIV is an important cofactor in Kaposi sarcoma pathogenesis, and widespread use of antiretroviral therapy has reduced Kaposi sarcoma incidence. However, Kaposi sarcoma remains the second most frequent tumor arising in HIV-infected patients in the United States and is particularly common in sub-Saharan Africa. KSHV prevalence varies substantially in different populations. KSHV is secreted in saliva, and public health measures to reduce its spread may help reduce the incidence of KSHV-associated diseases. Although there have been advances in the treatment of Kaposi sarcoma, KSHV-multicentric Castleman disease, and PEL, improved therapies are needed, especially those that are appropriate for Kaposi sarcoma in resource-poor regions.
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Abstract
Kaposi sarcoma (KS) is the most common neoplasm of people living with HIV today. In Sub-Saharan Africa, KS is among the most common cancers in men, overall. Not only HIV-positive individuals present with KS; any immune compromised person infected with KS-associated herpesvirus (KSHV) or human herpesvirus 8 is at risk: the elderly, children in KSHV-endemic areas, and transplant recipients. KS diagnosis is based on detection of the viral protein latency-associated nuclear antigen (LANA) in the biopsy, but not all cases of KS are the same or will respond to the same therapy. Standard KS therapy has not changed in 20 years, but newer modalities are on the horizon and will be discussed.
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Changing Incidence and Risk Factors for Kaposi Sarcoma by Time Since Starting Antiretroviral Therapy: Collaborative Analysis of 21 European Cohort Studies. Clin Infect Dis 2016; 63:1373-1379. [PMID: 27535953 PMCID: PMC5091347 DOI: 10.1093/cid/ciw562] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/04/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Kaposi sarcoma (KS) remains a frequent cancer in human immunodeficiency virus (HIV)-positive patients starting combination antiretroviral therapy (cART). We examined incidence rates and risk factors for developing KS in different periods after starting cART in patients from European observational HIV cohorts. METHODS We included HIV-positive adults starting cART after 1 January 1996. We analyzed incidence rates and risk factors for developing KS up to 90 and 180 days and 1, 2, 5, and 8 years after cART start and fitted univariable and multivariable Cox regression models. RESULTS We included 109 461 patients from 21 prospective clinical cohorts in Europe with 916 incident KS cases. The incidence rate per 100 000 person-years was highest 6 months after starting cART, at 953 (95% confidence interval, 866-1048), declining to 82 (68-100) after 5-8 years. In multivariable analyses adjusted for exposure group, origin, age, type of first-line regimen, and calendar year, low current CD4 cell counts increased the risk of developing KS throughout all observation periods after cART initiation. Lack of viral control was not associated with the hazard of developing KS in the first year after cART initiation, but was over time since starting cART increasingly positively associated (P < .001 for interaction). CONCLUSION In patients initiating cART, both incidence and risk factors for KS change with time since starting cART. Whereas soon after starting cART low CD4 cell count is the dominant risk factor, detectable HIV-1 RNA viral load becomes an increasingly important risk factor in patients who started cART several years earlier, independently of immunodeficiency.
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Abstract
People living with human immunodeficiency virus (HIV) are living longer since the advent of effective combined antiretroviral therapy (cART). While cART substantially decreases the risk of developing some cancers, HIV-infected individuals remain at high risk for Kaposi sarcoma, lymphoma, and several solid tumors. Currently HIV-infected patients represent an aging group, and malignancies have become a leading cause of morbidity and mortality. Tailored cancer-prevention strategies are needed for this population. In this review we describe the etiologic agents and pathogenesis of common malignancies in the setting of HIV, as well as current evidence for cancer prevention strategies and screening programs.
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Affiliation(s)
- Priscila H Goncalves
- HIV & AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jairo M Montezuma-Rusca
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Robert Yarchoan
- HIV & AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thomas S Uldrick
- HIV & AIDS Malignancy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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12
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HAART and lungs: do HIV protease inhibitors impact cancer risk? AIDS 2015; 29:1111-2. [PMID: 26125143 DOI: 10.1097/qad.0000000000000644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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