Increased seroprevalence of human herpesvirus 8 in patients with hematological disorders

Change in Pattern of Secondary Cancers After Kaposi Sarcoma in the Era of Antiretroviral Therapy

Importance

Studies performed in the 1980s and early 1990s have shown that people who develop Kaposi sarcoma (KS) are at higher risk of developing other cancers. The demographics of those affected with human immunodeficiency virus (HIV)/AIDS and KS have changed, and individuals with HIV/AIDS and KS now live longer.

Objectives

To test the hypothesis that the secondary cancers developing in patients with KS have changed in recent years and to assess the risk of secondary cancers after KS in different periods.

Design, Setting, and Participants

Longitudinal data from 9 cancer registries in the Surveillance, Epidemiology, and End Results (SEER) database were used to identify cases of KS diagnosed from January 1973 to December 2013. The dates of the analysis were November 2016 to February 2017.

Main Outcomes and Measures

The primary outcome was the development of secondary cancers in individuals with KS. Secondary cancers were considered only if diagnosed 2 months after a diagnosis of KS. Standardized incidence ratios (SIRs) were calculated for the development of new secondary cancers in the pre-AIDS era (1973-1979), pre-highly active antiretroviral therapy (HAART) era (1980-1995), and HAART era (1996-2013). Stratified analysis was then performed on a subset of the cases diagnosed from 1996 to 2013 based on age at diagnosis (<65 and ≥65 years), latency period between KS and the development of secondary cancers (1 year, 2-5 years, >5 to 10 years, and >10 years), and registries with higher vs lower reported rates of HIV/AIDS.

Results

Among 14 905 individuals with diagnosed KS, 13 721 (92.1%) were younger than 65 years at the time of diagnosis, and 14 356 (96.3%) were male. From 1980 to 1995, SIRs were 2.01 (95% CI, 1.00-3.60) for cancer of the rectum, 49.70 (95% CI, 33.53-70.94) for cancer of the anus, 4.98 (95% CI, 2.79-8.22) for cancer of the liver, 13.70 (95% CI, 2.82-40.03) for cancer of the cervix, 6.40 (95% CI, 2.76-12.60) for Hodgkin lymphoma, and 48.97 (95% CI, 44.85-53.36) for non-Hodgkin lymphoma. From 1996 to 2013, cancer of the anus, Hodgkin lymphoma, non-Hodgkin lymphoma, and cancer of the liver remained associated with KS, with the addition of the following significant SIRs: 6.99 (95% CI, 3.20-13.27) for cancer of the tongue, 10.28 (95% CI, 1.24-37.13) for cancer of the penis, and 17.62 (95% CI, 3.63-51.49) for acute lymphocytic leukemia. The SIR of developing any tumor after KS decreased significantly from 3.36 to 1.94 from the pre-HAART era to the HAART era.

Conclusions and Relevance

There has been a significant decline in the overall risk of secondary cancers after KS. Certain cancers, including acute lymphocytic leukemia, cancer of the tongue, and cancer of the penis, are increasingly becoming more common in the HAART era compared with the pre-HAART era. Close monitoring and screening for these secondary cancers is desirable in patients with KS.

Bone Marrow Involvement in Multicentric Castleman Disease in a HIV Negative Patient

There are few reports on the bone marrow involvement in multicentric Castleman disease in human immunodeficiency virus (HIV) negative patients, mostly the characteristic morphologic findings within the bone marrow are reported in HIV-positive patients. Here we describe bone marrow involvement in a HIV-negative patient with multicentric Castleman disease.

Mother-to-child HIV and HHV-8 transmission in neonates at Saint Camille Medical Centre in Burkina Faso

In Sub-Saharan Africa, many HIV infected people are co-infected with Human Herpes Virus 8 (HHV-8). Therefore, the present study aimed to: (1) identify the pregnant women co-infected by HIV and HHV-8 at Saint Camille Medical Centre; (2) use three molecules (Zidovudine, Nevirapine and Lamivudine) to interrupt the vertical transmission of HIV and (3) use the PCR technique to diagnose children, who were infected by these viruses, in order to offer them an early medical assistance. A total of 107 pregnant women, aged from 19 to 42 years were diagnosed to be HIV positive at Saint Camille Centre; among them 13 were co-infected with HHV-8. All included women received the HAART. Two to six months after childbirth their babies underwent PCR diagnosis for HIV and HHV-8. The results revealed that, among these mothers, 68.2% were housewives, 34.6% were illiterates and 60.7% did not have university degree. The prevalence of HHV-8 among these pregnant women was 12.15% and the rate of vertical transmission of both HIV and HHV-8, was 0.0%. The issue of this study revealed that the antiretroviral therapy increased the mother CD4 T-cells, prevented the transcription of the mRNA of HHV-8 and blocked HIV vertical transmission.

Viruses

Viral infections are an important and often unrecognized component of disease in immunocompromised patients. The diagnosis and management of viral infections have expanded largely because of new quantitative molecular diagnostic assays. Well-recognized pathogens such as herpes simplex virus (HSV), cytomegalovirus (CMV), and respiratory viruses have been joined by newly recognized pathogens such as BK virus, human herpesvirus-6 (HHV-6), and human metapneumovirus in this highly susceptible patient population. The role of Epstein-Barr virus (EBV) and Human herpesvirus-8 (HHV-8) in lymphoproliferative diseases also continue to be clarified. As a result, the management of viral infections in patients with hematologic malignancies continues to be a growing challenge for the clinician.

Human herpesvirus 8 DNA load in the leukocytes correlates with the platelet counts in HIV type 1-infected individuals

Abstract Human herpes virus 8 (HHV-8) is known to be reactivated in immunocompromised situations and it is associated with Kaposi's sarcoma (KS) and some hematological diseases. The aim of this study was to analyze the effect of HHV-8 on HIV-1 infection, especially on thrombocytopenia complicated with HIV infection. The HHV-8 DNA load was determined by a quantitative real-time PCR, using leukocytes from 125 HIV-1-infected individuals. HHV-8 DNA was detected in 37 individuals. The increased HIV-1 load and reduced percentage of CD4-positive T cells were significantly associated with the presence of HHV-8. The prevalence and load for HHV-8 are higher in patients with KS than in patients without KS, but the difference is not significant. The increased HHV-8 DNA load was significantly correlated with thrombocytopenia, and platelet counts were significantly lower in individuals with HHV-8 than in individuals without HHV-8. We also obtained the negative correlations between changes in platelet counts and changes in HHV-8 DNA loads. The association between thrombocytopenia and HHV-8 has never been reported previously, apart from some case reports of Castleman's disease and KS. Various cytokines or chemokines are produced by HHV-8-infected cells, some of which have been reported to inhibit hematopoiesis. This may be one of the mechanisms by which HHV-8 infection induces thrombocytopenia. These results indicate that HHV-8 DNA in leukocytes may provide useful information for the assessment of the clinical appearance of HIV-1 infection.

Bone Marrow Findings in Multicentric Castleman Disease in HIV-negative Patients

Because bone marrow histology in multicentric Castleman disease in human immunodeficiency virus-negative patients is not well reported, we investigated sequential bone marrow biopsies of 3 affected human immunodeficiency virus-negative patients, of which one was human herpes virus 8 (HHV8)-positive. The histologic evaluation of the bone marrow revealed lymphoid follicles with regressed germinal centers in 1 patient. Another patient showed tumorlike but bland polyclonal plasmacytosis with large perivascular plasma cell clusters. The HHV8-positive patient revealed interstitial HHV8-positive cells accompanied by a mild plasmacytosis. The atypical lymphoid follicles could be regarded as a bone marrow manifestation of multicentric Castleman disease, whereas the plasmacytosis most likely is the result of excess interleukin 6 production. The presence of HHV8-positive cells within the bone marrow may indicate the dissemination of the virus in a compromised immune system.