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Mukasine MC, Mulundu G, Kawimbe M, Mutale K, Mumba C, Lidenge SJ, Ngalamika O. Association between KSHV-Specific Humoral and T Cell Responses with Recurrence of HIV-Associated Kaposi Sarcoma. Trop Med Infect Dis 2024; 9:134. [PMID: 38922046 PMCID: PMC11209129 DOI: 10.3390/tropicalmed9060134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/28/2024] [Accepted: 06/11/2024] [Indexed: 06/27/2024] Open
Abstract
Kaposi sarcoma (KS) is an AIDS-defining angio-proliferative malignancy, with the Kaposi sarcoma-associated herpes virus (KSHV) as its etiologic agent. Upon treatment with chemotherapy, a proportion of HIV-associated KS patients experience disease recurrence within a few months of completing treatment. We aimed at determining whether KSHV-specific adaptive immune responses were associated with KS recurrence upon complete remission. We conducted a prospective cohort study. The primary outcome was the recurrence of HIV-associated KS. An immunofluorescence assay was used to determine anti-KSHV antibodies, an enzyme-linked immunospot was conducted for T cell responses, PCR was carried out to determine KSHV status, and flow cytometry was used for CD4 counting and immunophenotyping. KSHV detection in PBMCs was high and not associated with KS recurrence-free survival (p = 0.29). Anti-KSHV antibody titers were high and not associated with recurrence-free survival (p = 0.63). KSHV-specific T cell responses dropped from baseline levels among individuals with recurrence, but the drop was not statistically significant. Individuals experiencing KS recurrence had a significantly higher proportion of T cell subsets expressing PD1, while those with sustained remission had a significant increase in CD4 T cell counts from baseline levels during the follow-up period (p = 0.02). Anti-KSHV antibodies are not a good correlate of protection from KS recurrence. T cells in individuals experiencing KS recurrence hadhigh PD1 expression, while an increase in CD4 counts was associated with sustained KS remission.
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Affiliation(s)
- Marie-Claire Mukasine
- Department of Pathology and Microbiology, University of Zambia School of Medicine, Lusaka P.O. Box 50110, Zambia; (M.-C.M.); (G.M.); (C.M.)
- HHV8 Research Molecular Virology Laboratory, University Teaching Hospital, Lusaka P.O. Box 50110, Zambia; (M.K.); (K.M.)
| | - Gina Mulundu
- Department of Pathology and Microbiology, University of Zambia School of Medicine, Lusaka P.O. Box 50110, Zambia; (M.-C.M.); (G.M.); (C.M.)
| | - Musonda Kawimbe
- HHV8 Research Molecular Virology Laboratory, University Teaching Hospital, Lusaka P.O. Box 50110, Zambia; (M.K.); (K.M.)
| | - Keagan Mutale
- HHV8 Research Molecular Virology Laboratory, University Teaching Hospital, Lusaka P.O. Box 50110, Zambia; (M.K.); (K.M.)
| | - Chibamba Mumba
- Department of Pathology and Microbiology, University of Zambia School of Medicine, Lusaka P.O. Box 50110, Zambia; (M.-C.M.); (G.M.); (C.M.)
| | - Salum J. Lidenge
- Ocean Road Cancer Institute, Dar es Salaam P.O. Box 3592, Tanzania;
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
| | - Owen Ngalamika
- HHV8 Research Molecular Virology Laboratory, University Teaching Hospital, Lusaka P.O. Box 50110, Zambia; (M.K.); (K.M.)
- Dermatology and Venereology Division, University Teaching Hospital, University of Zambia School of Medicine, Lusaka P.O. Box 50110, Zambia
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Russo I, Marino D, Cozzolino C, Del Fiore P, Nerjaku F, Finotto S, Cattelan A, Calabrò ML, Belloni Fortina A, Russano F, Mazza M, Galuppo S, Bezzon E, Sbaraglia M, Krengli M, Brunello A, Mocellin S, Piaserico S, Alaibac M. Kaposi's Sarcoma: Evaluation of Clinical Features, Treatment Outcomes, and Prognosis in a Single-Center Retrospective Case Series. Cancers (Basel) 2024; 16:691. [PMID: 38398082 PMCID: PMC10887034 DOI: 10.3390/cancers16040691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Kaposi's sarcoma (KS) is a rare angioproliferative tumor classified in four different clinical-epidemiological forms. The diagnosis is based on histopathological and immunohistochemical analyses. The treatment is heterogeneous and includes several local and systemic therapeutic strategies. Methods: This is a retrospective cohort study including 86 KS patients treated between 1993 and 2022 at the University Hospital of Padua (AOPD) and at the Veneto Institute of Oncology (IOV). The data were extracted from an electronic database. Survival curves were generated using the Kaplan-Meier method, and Cox regression models were employed to explore associations with overall and disease-free survival. The male sex (89.53%), classical variant (43.02%), and cutaneous involvement (77.9%) were predominant. More than 61.6% of patients received a single treatment. Surgery, antiretroviral therapy, and chemotherapy were the mostly adopted approaches. A persistent response was observed in approximately 65% of patients, with a 22% relapse rate (at least 2 years). The overall survival ranges from 90 to 70% at 2 to 10 years after the diagnosis. Iatrogenic KS demonstrated a higher mortality (52.9%). This study reflects our experience in the management of KS. Comorbidities are very frequent, and treatments are heterogeneous. A multidisciplinary approach involving multiple referral specialists is essential for the appropriate management of this disease during diagnosis, treatment, and follow-up.
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Affiliation(s)
- Irene Russo
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV – IRCCS, 35128 Padova, Italy; (I.R.); (C.C.); (F.R.); (M.M.); (S.M.)
| | - Dario Marino
- Oncology 1 Unit, Department of Oncology, Veneto Institute of Oncology IOV – IRCCS, 35128 Padova, Italy (S.F.)
| | - Claudia Cozzolino
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV – IRCCS, 35128 Padova, Italy; (I.R.); (C.C.); (F.R.); (M.M.); (S.M.)
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35128 Padova, Italy
| | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV – IRCCS, 35128 Padova, Italy; (I.R.); (C.C.); (F.R.); (M.M.); (S.M.)
| | - Fitnete Nerjaku
- Department of Medicine (DIMED), School of Medicine, University of Padova, 35128 Padova, Italy; (F.N.); (M.S.)
| | - Silvia Finotto
- Oncology 1 Unit, Department of Oncology, Veneto Institute of Oncology IOV – IRCCS, 35128 Padova, Italy (S.F.)
| | - Annamaria Cattelan
- Infectious and Tropical Diseases Unit, Padova University Hospital, 35128 Padova, Italy;
| | - Maria Luisa Calabrò
- Immunology and Molecular Oncology, Veneto Institute of Oncology IOV – IRCCS, 35128 Padova, Italy;
| | - Anna Belloni Fortina
- Dermatology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy; (A.B.F.); (S.P.); (M.A.)
- Pediatric Dermatology Regional Center, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy
| | - Francesco Russano
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV – IRCCS, 35128 Padova, Italy; (I.R.); (C.C.); (F.R.); (M.M.); (S.M.)
| | - Marcodomenico Mazza
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV – IRCCS, 35128 Padova, Italy; (I.R.); (C.C.); (F.R.); (M.M.); (S.M.)
| | - Sara Galuppo
- Radiotherapy Unit, Veneto Institute of Oncology IOV – IRCCS, 35128 Padova, Italy; (S.G.); (M.K.)
| | - Elisabetta Bezzon
- Radiology Unit, Veneto Institute of Oncology, IOV – IRCCS, 35128 Padova, Italy
| | - Marta Sbaraglia
- Department of Medicine (DIMED), School of Medicine, University of Padova, 35128 Padova, Italy; (F.N.); (M.S.)
- Department of Pathology, Azienda Ospedale—University of Padova, 35128 Padova, Italy
| | - Marco Krengli
- Radiotherapy Unit, Veneto Institute of Oncology IOV – IRCCS, 35128 Padova, Italy; (S.G.); (M.K.)
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padova, Italy
| | - Antonella Brunello
- Oncology 1 Unit, Department of Oncology, Veneto Institute of Oncology IOV – IRCCS, 35128 Padova, Italy (S.F.)
| | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV – IRCCS, 35128 Padova, Italy; (I.R.); (C.C.); (F.R.); (M.M.); (S.M.)
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, 35128 Padova, Italy
| | - Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy; (A.B.F.); (S.P.); (M.A.)
| | - Mauro Alaibac
- Dermatology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy; (A.B.F.); (S.P.); (M.A.)
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Nana BC, Esemu LF, Besong ME, Atchombat DHN, Ogai K, Sobgui TMP, Nana CMM, Seumko'o RMN, Awanakan H, Ekali GL, Leke RGF, Okamoto S, Ndhlovu LC, Megnekou R. Soluble biomarkers of HIV-1-related systemic immune activation are associated with high plasma levels of growth factors implicated in the pathogenesis of Kaposi sarcoma in adults. Front Immunol 2023; 14:1216480. [PMID: 37809059 PMCID: PMC10552755 DOI: 10.3389/fimmu.2023.1216480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background Human Herpesvirus-8 (HHV-8) is the etiologic agent of Kaposi's sarcoma (KS), a multicentric angio-proliferative cancer commonly associated with Human Immunodeficiency Virus (HIV) infection. KS pathogenesis is a multifactorial condition hinged on immune dysfunction yet the mechanisms underlying the risk of developing KS in HHV-8 seropositive adults remains unclear. Here we explored whether soluble markers of HIV-1-related systemic immune activation (SIA) and angiogenesis (VEGF and FGF acidic) are involved in the pathogenesis of KS in adults with HHV8. Methodology Blood samples from 99 HIV-1 infected and 60 HIV-1 uninfected adults were collected in Yaoundé, Cameroon. CD3+/CD4+ T cell counts and HIV-1 plasma viral load were determined using the Pima Analyzer and the RT-PCR technique, respectively. Plasma levels of SIA biomarkers (sCD163, sCD25/IL-2Rα, and sCD40/TNFRSF5) and biomarkers of progression to KS (VEGF and FGF acidic) were measured using the Luminex assay. Seropositivity (IgG) for HHV-8 was determined using the ELISA method. Results Overall, 20.2% (20/99) of HIV-1 infected and 20% (12/60) of HIV-1 uninfected participants were seropositive for HHV8. Levels of sCD163, sCD25/IL-2Rα, sCD40/TNFRSF5, and FGF acidic were higher in the HIV-1 and HHV8 co-infection groups compared to the HIV-1 and HHV8 uninfected groups (all P <0.05). In addition, Higher plasma levels of VEGF correlated with sCD163 (rs = 0.58, P =0.0067) and sCD40/TNFRSF5 (rs = 0.59, P = 0.0064), while FGF acidic levels correlated with sCD40/TNFRSF5 (rs = 0.51, P = 0.022) in co-infected. In HIV-1 mono-infected donors, VEGF and FGF acidic levels correlated with sCD163 (rs =0.25, P = 0.03 and rs = 0.30, P = 0.006 respectively), sCD25/IL-2Rα (rs = 0.5, P <0.0001 and rs = 0.55, P <0.0001 respectively) and sCD40/TNFRSF5 (rs = 0.7, P <0.0001 and rs = 0.59, P <0.0001 respectively) and even in patients that were virally suppressed sCD25/IL-2Rα (rs = 0.39, P = 0.012 and rs = 0.53, P = 0.0004 respectively) and sCD40/TNFRSF5 (rs = 0.81, P <0.0001 and rs = 0.44, P = 0.0045 respectively). Conclusion Our findings suggest that although the development of KS in PLWH is multifactorial, HIV-associated SIA might be among the key drivers in coinfections with HHV8 and is independent of the patients' viremic status.
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Affiliation(s)
- Benderli Christine Nana
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaounde, Cameroon
- Department of Animals Biology and Physiology of the Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Livo Forgu Esemu
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaounde, Cameroon
- Department of Biomedical Sciences of the Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Centre for Research on Emerging and Reemerging Diseases, Institute of Medical Research and Medicinal Plant Studies, Yaounde, Cameroon
| | - Michael Ebangha Besong
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaounde, Cameroon
| | - Derrick Hyacinthe Nyasse Atchombat
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaounde, Cameroon
- Department of Animals Biology and Physiology of the Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Kazuhiro Ogai
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Thérèse M Patricia Sobgui
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaounde, Cameroon
- Department of Animals Biology and Physiology of the Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Chris Marco Mbianda Nana
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaounde, Cameroon
- Department of Animals Biology and Physiology of the Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Reine Medouen Ndeumou Seumko'o
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaounde, Cameroon
- Department of Animals Biology and Physiology of the Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Honoré Awanakan
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaounde, Cameroon
| | - Gabriel Loni Ekali
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaounde, Cameroon
| | - Rose Gana Fomban Leke
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaounde, Cameroon
| | - Shigefumi Okamoto
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Lishomwa C Ndhlovu
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Rosette Megnekou
- The Immunology Laboratory of the Biotechnology Center, University of Yaoundé I, Yaounde, Cameroon
- Department of Animals Biology and Physiology of the Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Tian J, Janbey S, Hassanesfahani M, Bhatia S, Louis MA, Khan N. Kaposi sarcoma presenting as small bowel obstruction. J Surg Case Rep 2023; 2023:rjad385. [PMID: 37416496 PMCID: PMC10319745 DOI: 10.1093/jscr/rjad385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
Kaposi sarcoma (KS) is a low-grade tumor of the vascular endothelium. The majority of individuals affected have advanced human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). The disease typically manifests as cutaneous lesions but reports have shown that systemic disease is not uncommon. Because gastrointestinal KS is often asymptomatic, it is likely underdiagnosed. Those with symptoms can present with vague abdominal pain, nausea/vomiting or anemia. Rarely the tumors can cause bowel obstruction or perforation. We present a case of small bowel obstruction cause by KS tumors in a young transgender male to female patient with poorly controlled AIDS, supported by literature review of the clinical presentation, diagnosis and treatment recommendations.
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Affiliation(s)
- Jane Tian
- Correspondence address. Department of Surgery, Flushing Hospital Medical Center, Flushing, NY 11355, USA. Tel: 510-415-8916; Fax: 718-670-4449; E-mail:
| | - Selma Janbey
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY 11568, USA
| | | | - Shubham Bhatia
- Department of Surgery, Flushing Hospital Medical Center, Flushing, NY 11355, USA
| | - Martine A Louis
- Department of Surgery, Flushing Hospital Medical Center, Flushing, NY 11355, USA
| | - Noman Khan
- Department of Surgery, Flushing Hospital Medical Center, Flushing, NY 11355, USA
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Saberian C, Campbell BR. Rapidly Disseminated Kaposi's Sarcoma Despite Initiation of Antiretroviral Therapy. Cureus 2023; 15:e39627. [PMID: 37256167 PMCID: PMC10226159 DOI: 10.7759/cureus.39627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 06/01/2023] Open
Abstract
Kaposi's sarcoma (KS) is the most common malignancy in people living with HIV. The reported incidence of AIDS-related KS has been dramatically decreased with the introduction of antiretroviral therapy (ART). Systemic treatment with ART is indicated for patients with AIDS-related KS; however, some patients may develop KS-related immune reconstitution inflammatory syndrome characterized by sudden rapid progression of new or pre-existing KS within the initiation of ART. Here, we present a case of rapidly disseminated KS with widespread visceral involvement despite ART initiation in a 27-year-old African American man with advanced HIV/AIDS.
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Affiliation(s)
| | - Breanna R Campbell
- Department of Infectious Diseases, Baton Rouge General, Baton Rouge, USA
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Cuellar LE, Meza K, Holguín AM, Velarde J, Portillo-Alvarez D, Castro V, Sulca-Huamani O, Intimayta-Escalante C, Gaby-Pérez R, Patel A. Clinicopathological Features and Mortality in Patients With Kaposi Sarcoma and HIV: A Retrospective Analysis of a Thirty-Year Study From a Peruvian Oncologic Center. JCO Glob Oncol 2022; 8:e2100379. [PMID: 35728013 PMCID: PMC9232365 DOI: 10.1200/go.21.00379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Kaposi's sarcoma (KS) is a multifocal angioproliferative disease. In Peru, the implementation of the highly active antiretroviral treatment (HAART) program was in 2005, the model for treating patients with HIV-positive KS shifted to a potential cure. In this study, we aim to compare clinicopathological characteristics and prognostic factors associated with outcomes in patients with HIV-positive KS. METHODS We developed a retrospective cohort study that includes patients with HIV/AIDS and KS seen in the Instituto Nacional de Enfermedades Neoplasicas between 1987 and 2017. Patients were divided into two groups according to the implementation of HAART in our country: the non-HAART group and those treated with HAART after 2005. Multivariate analysis for overall survival (OS) was performed with the Cox proportional hazard regression model. RESULTS There was a greater visceral compromise and more extensive oral cavity involvement in the non-HAART group (60% 31.7%, P < .01). Regarding the immune status, there was a significant difference from the CD4 count at 1-year follow-up (73 v 335, P = .01). The CD4/CD8 rate were significant different before QT (0.23 v 0.13, P = .01) and at 1-year follow-up (0.12 v 0.32, P = .03.). The estimated 5-year OS rate was significantly lower (P = .0001) for the non-HAART group (41.7%; 95% CI, 25.9 to 56.9) compared with the HAART group (79.3%; 95% CI, 66.8 to 87.5). In the multivariate model for OS, full-HAART regimen and previous diagnosis of HIV/AIDS (P < .01) were significantly associated with longer survival. CONCLUSION Clinical and demographic characteristics of our patients are compatible with the literature, but we report a higher rate of gastrointestinal involvement. Furthermore, our findings provide evidence for the importance of HAART and its ability to reduce KS-related mortality. ![]()
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Affiliation(s)
- Luis E. Cuellar
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
- Facultad de Medicina Hipólito Unanue, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Kelly Meza
- Weill Cornell Medicine, New York, NY
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Juan Velarde
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | | | - Victor Castro
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Oliver Sulca-Huamani
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Rushmely Gaby-Pérez
- Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Arpan Patel
- Division of Hematology and Medical Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, NY
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Htet KZ, Waul M, Edelstein H, Mui S, Cherny S, Leslie K. Primary nasal Kaposi Sarcoma in well-controlled HIV-positive patient with normal CD4 count associated with long-term nasal steroid use. Int J STD AIDS 2021; 32:582-584. [PMID: 33533293 DOI: 10.1177/0956462420980644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Kaposi sarcoma (KS) is an angioproliferative disease that is caused by human herpesvirus 8. The epidemic form of KS is associated with acquired immunodeficiency syndrome (AIDS) and is common in HIV-positive patients with CD4 counts less than 200 cells/mm. We present the case of a 63-year-old man with well-controlled HIV and normal CD4 count developing atypical nasal KS associated with intranasal steroid use.
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Affiliation(s)
- Kyaw Zin Htet
- 12255Tulane University School of Medicine, New Orleans, LA, USA
| | - Michael Waul
- Department of Dermatology, 8785University of California, San Francisco, San Francisco, CA, USA
| | | | - Stanley Mui
- Department of Head and Neck Surgery, 7154Kaiser Permanente, San Francisco, CA, USA
| | - Sarah Cherny
- Department of Pathology, 7154Kaiser Permanente, San Francisco, CA, USA
| | - Kieron Leslie
- Department of Dermatology, 8785University of California, San Francisco, San Francisco, CA, USA
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8
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Castilho JL, Kim A, Jenkins CA, Grinsztejn B, Gotuzzo E, Fink V, Padgett D, Belaunzaran‐Zamudio PF, Crabtree‐Ramírez B, Escuder MM, Souza RA, Tenore SB, Pimentel SR, Ikeda MLR, de Alencastro PR, Tupinanbas U, Brites C, Luz E, Netto J, Cortes CP, Grangeiro A, Shepherd BE, McGowan CC. Antiretroviral therapy and Kaposi's sarcoma trends and outcomes among adults with HIV in Latin America. J Int AIDS Soc 2021; 24:e25658. [PMID: 33405281 PMCID: PMC7787071 DOI: 10.1002/jia2.25658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Kaposi's sarcoma (KS) remains the most frequent malignancy in persons living with HIV (PWH) in Latin America. We examined KS trends and outcomes from Latin American clinical sites in the era of increased access to antiretroviral therapy (ART). METHODS Cohorts in Brazil, Peru, Mexico, Honduras, Argentina and Chile contributed clinical data of PWH ≥16 years old from 2000 to 2017, excluding patients with KS diagnosed before clinic enrolment. We compared KS incidence over time using multivariable incidence rate ratios. Predictors of KS before/at or after ART initiation and of mortality after KS were examined using Cox regression. RESULTS Of 25 981 PWH, 481 had incident KS, including 200 ART-naïve and 281 ART-treated patients. From 2000 to 2017, the incidence of KS decreased from 55.1 to 3.0 per 1000 person-years. In models adjusting for CD4 and other factors, the relative risk for KS decreased from 2000 to 2008. Since 2010, the adjusted risk of KS increased in the periods before and ≤90 days after ART initiation but decreased >90 days after ART. In addition to low CD4 and male-to-male sex, KS risk after ART was associated with age and history of other AIDS-defining illnesses. Mortality after KS (approximately 25% after five years) was not associated with either year of KS diagnosis nor timing of diagnosis relative to ART initiation. CONCLUSIONS KS incidence in Latin America has remained stable in recent years and risk is highest before and shortly after ART initiation. Early diagnosis of HIV and ART initiation remain critical priorities in the region.
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Affiliation(s)
- Jessica L Castilho
- Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTNUSA
| | - Ahra Kim
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
| | - Cathy A Jenkins
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
| | | | - Eduardo Gotuzzo
- Universidad Peruana Cayetano HerediaInstituto de Medicina Tropical Alexander von HumboldtLimaPeru
| | - Valeria Fink
- Fundación HuéspedInvestigaciones ClínicasBuenos AiresArgentina
| | - Denis Padgett
- Instituto Hondureño de Seguridad Social and Hospital Escuela UniversitarioTegucigalpaHonduras
| | - Pablo F Belaunzaran‐Zamudio
- Deparatmento de InfectologiaInstituto Nacional de Ciencias Médicas y NutriciónSalvador Zubirán. Mexico CityMexico
| | - Brenda Crabtree‐Ramírez
- Deparatmento de InfectologiaInstituto Nacional de Ciencias Médicas y NutriciónSalvador Zubirán. Mexico CityMexico
| | | | - Rosa Alencar Souza
- São Paulo State Department of HealthAIDS Reference and Training CenterSão PauloBrazil
| | - Simone B Tenore
- São Paulo State Department of HealthAIDS Reference and Training CenterSão PauloBrazil
| | - Sidnei R Pimentel
- São Paulo State Department of HealthAIDS Reference and Training CenterSão PauloBrazil
| | - Maria Letícia Rodrigues Ikeda
- Care and Treatment Clinic of the Partenon SanatoriumRio Grande do Sul State Department of HealthPorto AlegreBrazil
- University of Vale do Rio dos SinosSão LeopoldoBrazil
| | - Paulo R de Alencastro
- Care and Treatment Clinic of the Partenon SanatoriumRio Grande do Sul State Department of HealthPorto AlegreBrazil
| | - Unai Tupinanbas
- Medical SchoolFederal University of Minas GeraisBelo HorizonteBrazil
| | - Carlos Brites
- Edgar Santos University Hospital ComplexFederal University of BahiaSalvadorBrazil
| | - Estela Luz
- Edgar Santos University Hospital ComplexFederal University of BahiaSalvadorBrazil
| | - Juliana Netto
- Instituto Nacional de Infectiologia Evandro ChagasFiocruzBrazil
| | - Claudia P Cortes
- Fundaciòn Arriaran and University of Chile School of MedicineSantiagoChile
| | - Alexandre Grangeiro
- Department of Preventive MedicineUniversity of São Paulo School of MedicineSão PauloBrazil
| | - Bryan E Shepherd
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
| | - Catherine C McGowan
- Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTNUSA
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9
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Kerkemeyer KLS, Mar A, Lai FYX. Kaposi's Sarcoma Occurring in HIV Infection Controlled on HAART. Am J Med 2020; 133:e294-e295. [PMID: 31751529 DOI: 10.1016/j.amjmed.2019.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Affiliation(s)
| | - Adrian Mar
- Department of Dermatology, Monash Health, Clayton, Victoria, Australia
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10
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Tajarernmuang P, Fiset PO, Routy JP, Beaudoin S. Intractable pleural effusion in Kaposi sarcoma following antiretroviral therapy in a Caucasian female infected with HIV. BMJ Case Rep 2020; 13:13/2/e233335. [PMID: 32111711 DOI: 10.1136/bcr-2019-233335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the case of a 57-year-old Caucasian woman with AIDS-related disseminated Kaposi sarcoma (KS) characterised by the combination of several unusual features. The chylous nature of the pleural effusions, the documented parietal pleural involvement at thoracoscopy and the marked clinical worsening through an immune reconstitution syndrome following antiretroviral therapy initiation represent several rare situations that occurred in the same female patient. In addition, the use of indwelling pleural catheters for dyspnoea palliation also represents a rare therapeutic intervention. This case is a reminder of the possibility of AIDS-related pleural KS, now uncommon in the era of antiretroviral therapy.
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Affiliation(s)
- Pattraporn Tajarernmuang
- Medicine, Division of Pulmonary, Critical Care, and Allergy, Chiang Mai University, Chiang Mai, Thailand
| | - Pierre-Olivier Fiset
- Department of Pathology, McGill University Health Centre, Montreal, Québec, Canada
| | - Jean-Pierre Routy
- Research Institute, McGill University Health Centre, Montreal, Québec, Canada.,Division of Haematology, McGill University Health Centre, Montreal, Québec, Canada
| | - Stéphane Beaudoin
- Division of Respirology, McGill University Health Centre, Montreal, Québec, Canada
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11
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Puronen CE, Ford ES, Uldrick TS. Immunotherapy in People With HIV and Cancer. Front Immunol 2019; 10:2060. [PMID: 31555284 PMCID: PMC6722204 DOI: 10.3389/fimmu.2019.02060] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/15/2019] [Indexed: 12/16/2022] Open
Abstract
HIV infection alters the natural history of several cancers, in large part due to its effect on the immune system. Immune function in people living with HIV may vary from normal to highly dysfunctional and is largely dependent on the timing of initiation (and continuation) of effective antiretroviral therapy (ART). An individual's level of immune function in turn affects their cancer risk, management, and outcomes. HIV-associated lymphocytopenia and immune dysregulation permit immune evasion of oncogenic viruses and premalignant lesions and are associated with inferior outcomes in people with established cancers. Various types of immunotherapy, including monoclonal antibodies, interferon, cytokines, immunomodulatory drugs, allogeneic hematopoietic stem cell transplant, and most importantly ART have shown efficacy in HIV-related cancer. Emerging data suggest that checkpoint inhibitors targeting the PD-1/PD-L1 pathway can be safe and effective in people with HIV and cancer. Furthermore, some cancer immunotherapies may also affect HIV persistence by influencing HIV latency and HIV-specific immunity. Studying immunotherapy in people with HIV and cancer will advance clinical care of all people living with HIV and presents a unique opportunity to gain insight into mechanisms for HIV eradication.
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Affiliation(s)
- Camille E Puronen
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Emily S Ford
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Thomas S Uldrick
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, United States.,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Division of Global Oncology, Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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12
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Abstract
Kaposi sarcoma (KS) is a mesenchymal tumour caused by KS-associated herpesvirus and is an AIDS-defining illness. Despite a decline in incidence since the introduction of combination anti-retroviral therapy, KS remains the most common cancer in people living with HIV in sub-Saharan Africa, where it causes significant morbidity and mortality. This review reflects on recent epidemiological data as well as current management, unmet needs and future perspectives in the treatment of HIV-associated KS with particular emphasis on the potential role of immune checkpoint inhibitors.
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Affiliation(s)
- Alessia Dalla Pria
- Imperial College London, London, UK
- Chelsea and Westminster Hospital, London, UK
| | - David J. Pinato
- Imperial College London, London, UK
- Chelsea and Westminster Hospital, London, UK
| | | | - Mark Bower
- Imperial College London, London, UK
- Chelsea and Westminster Hospital, London, UK
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13
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Abstract
Immunosuppressed patients are at significantly increased risk of developing cutaneous malignancies. These malignancies are often more aggressive compared with the general population and require multidisciplinary care. This article highlights the incidence and risk factors of cutaneous malignancies in this cohort. The treatment and prevention strategies are discussed. There continues to be a need for evidence-driven guidelines regarding the management of skin cancers in these patients.
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Affiliation(s)
- Lindsey Collins
- Department of Dermatology, The University of Oklahoma Health Sciences Center, 619 Northeast 13th Street, Oklahoma City, OK 73104, USA.
| | - Andrew Quinn
- Department of Dermatology, The University of Oklahoma Health Sciences Center, 619 Northeast 13th Street, Oklahoma City, OK 73104, USA
| | - Thomas Stasko
- Department of Dermatology, The University of Oklahoma Health Sciences Center, 619 Northeast 13th Street, Oklahoma City, OK 73104, USA
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14
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15
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Lepone LM, Rappocciolo G, Piazza PA, Campbell DM, Jenkins FJ, Rinaldo CR. Regulatory T Cell Effect on CD8 + T Cell Responses to Human Herpesvirus 8 Infection and Development of Kaposi's Sarcoma. AIDS Res Hum Retroviruses 2017; 33:668-674. [PMID: 28121161 DOI: 10.1089/aid.2016.0155] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We assessed CD8+ T cell reactivity to human herpesvirus 8 (HHV-8; Kaposi's sarcoma [KS]-associated herpesvirus) and the role of CD4+CD25hiFoxP3+ regulatory T cells (Treg) in HHV-8- and HIV-coinfected participants of the Multicenter AIDS Cohort Study who did or did not develop KS. There were similarly low CD8+ T cell interferon-γ responses to MHC class I-restricted epitopes of HHV-8 lytic and latent proteins over 5.7 years before KS in participants who developed KS compared to those who did not. T cell reactivity to HHV-8 antigens was low relative to responses to a combination of cytomegalovirus, Epstein-Barr virus and influenza A virus (CEF) peptide epitopes, and dominant HIV peptide epitopes. There was no change in %Treg in the HHV-8- and HIV-coinfected participants who did not develop KS, whereas there was a significant increase in %Treg in HHV-8- and HIV-coinfected participants who developed KS beginning 1.8 years before development of KS. Removal of Treg enhanced HHV-8-specific T cell responses in HHV-8- and HIV-coinfected participants who did or did not develop KS, with a similar pattern observed in response to CEF and HIV peptides. Thus, long-term, low levels of anti-HHV-8 CD8+ T cell reactivity were present in both HHV-8- and HIV-coinfected men who did and did not develop KS. This was related to moderately enhanced Treg function.
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Affiliation(s)
- Lauren M. Lepone
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Giovanna Rappocciolo
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Paolo A. Piazza
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Diana M. Campbell
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Frank J. Jenkins
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Charles R. Rinaldo
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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16
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Epelbaum O, Go R, Patel G, Braman S. Pulmonary Kaposi's Sarcoma and Its Complications in the HAART Era: A Contemporary Case-Based Review. Lung 2016; 194:163-9. [PMID: 26826066 DOI: 10.1007/s00408-015-9830-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/07/2015] [Indexed: 11/26/2022]
Abstract
The early years of the acquired immunodeficiency syndrome (AIDS) epidemic introduced the global medical community to Kaposi's sarcoma (KS), a heretofore seldom encountered angiosarcomatous neoplasm associated with human herpesvirus-8. At that time, clinicians treating these KS patients were routinely exposed to the pulmonary manifestations of this malignancy, including characteristic airway lesions, peribronchovascular opacities, and the typically hemorrhagic pleural effusions. They also witnessed uncommon complications of pulmonary KS such as chylous effusions, diffuse alveolar hemorrhage, and immune reconstitution inflammatory syndrome. Since the advent of highly active antiretroviral therapy, the incidence of KS has steadily declined and with that so has clinician familiarity with this disease. Herein, we present four KS cases recently encountered at our institution that illustrate both typical manifestations of pulmonary KS as well as its thoracic complications. The case descriptions are followed by a review of these clinical entities with the aim of restoring awareness among frontline physicians of what is now a rare but not quite extinct AIDS-defining neoplasm.
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Affiliation(s)
- Oleg Epelbaum
- Division of Pulmonary and Critical Care Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, 79-01 Broadway, Box D6-4, Elmhurst, NY, 11373, USA
| | - Ronaldo Go
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, 7 Dazian Building, First Avenue at 16 Street, New York, NY, 10003, USA
| | - Geminikumar Patel
- Department of Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, 79-01 Broadway, Room A1-16, Elmhurst, NY, 11373, USA
| | - Sidney Braman
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY, 10029-6754, USA.
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17
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Kaposi sarcoma presenting as “diffuse gingival enlargement”: Report of three cases. HIV & AIDS REVIEW 2016. [DOI: 10.1016/j.hivar.2016.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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18
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Lupia R, Wabuyia PB, Otiato P, Fang CT, Tsai FJ. Risk factors for Kaposi's sarcoma in human immunodeficiency virus patients after initiation of antiretroviral therapy: A nested case-control study in Kenya. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 50:781-788. [PMID: 26712092 DOI: 10.1016/j.jmii.2015.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/24/2015] [Accepted: 10/28/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE This study aimed to evaluate the association between highly active antiretroviral therapy (HAART) adherence and development of Kaposi's sarcoma (KS) in human immunodeficiency virus (HIV)/AIDS patients. METHODS We conducted a retrospective nested case-control study of 165 participants (33 cases and 132 controls) receiving HAART care at Maseno Hospital, Kenya, from January 2005 to October 2013. Cases were HIV-positive adults with KS, who were matched with controls in a ratio of 1:4 based on age (±5 years of each case), sex, and KS diagnosis date. Perfect adherence to HAART was assessed on every clinic visit by patients' self-reporting and pill counts. Chi-square tests were performed to compare socioeconomic and clinical statuses between cases and controls. A conditional logistic regression was used to assess the effects of perfect adherence to HAART, the latest CD4 count, education level, distance to health-care facility, initial World Health Organization stage, and number of regular sexual partners on the development of KS. RESULTS Only 63.6% participants reported perfect adherence, and the control group had a significantly higher percentage of perfect adherence (75.0%) than did cases (18.2%). After adjustment for potential imbalances in the baseline and clinical characteristics, patients with imperfect HAART adherence had 20-times greater risk of developing KS than patients with perfect HAART adherence [hazard ratios: 21.0, 95% confidence interval: 4.2-105.1]. Patients with low latest CD4 count (≤350 cells/mm3) had a seven-times greater risk of developing KS than did their counterparts (HRs: 7.1, 95% CI: 1.4-36.2). CONCLUSION Imperfect HAART adherence and low latest CD4 count are significantly associated with KS development.
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Affiliation(s)
- Rodgers Lupia
- Master Program in Global Health and Development, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Peter B Wabuyia
- Comprehensive Care Clinic Department, ACK Maseno Hospital, Maseno, Kenya
| | - Peter Otiato
- Comprehensive Care Clinic Department, ACK Maseno Hospital, Maseno, Kenya
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Feng-Jen Tsai
- Master Program in Global Health and Development, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
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19
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Visceral Kaposi's Sarcoma Presenting as Upper Gastrointestinal Bleeding. Case Rep Gastrointest Med 2015; 2015:438973. [PMID: 26064706 PMCID: PMC4438139 DOI: 10.1155/2015/438973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 04/22/2015] [Indexed: 12/20/2022] Open
Abstract
Since the advent of highly active antiretroviral therapy (HAART), the incidence of acquired immunodeficiency syndrome- (AIDS-) related Kaposi's sarcoma (KS) has decreased dramatically. While cutaneous KS is the most common and well-known manifestation, knowledge of alternative sites such as the gastrointestinal (GI) tract is important. GI-KS is particularly dangerous because of its potential for serious complications including perforation, obstruction, or bleeding. We report a rare case of GI-KS presenting as upper GI bleeding in a human immunodeficiency virus- (HIV-) infected transgendered individual. Prompt diagnosis and early initiation of therapy are the cornerstones for management of this potentially severe disease.
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Ureshino H, Ando T, Kojima K, Itamura H, Jinnai S, Doi K, Ohshima K, Kurogi K, Miyahara M, Kimura S. Rituximab-containing Chemotherapy (R-CHOP)-induced Kaposi's Sarcoma in an HIV-negative Patient with Diffuse Large B Cell Lymphoma. Intern Med 2015; 54:3205-8. [PMID: 26666614 DOI: 10.2169/internalmedicine.54.5103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Rituximab treatment may cause or exacerbate Kaposi's sarcoma (KS) in patients with human immunodeficiency virus (HIV)-associated multicentric Castleman's disease. Despite the widespread use of rituximab, rituximab-induced KS has not yet been reported in HIV-negative patients with diffuse large B cell lymphoma (DLBCL). We herein report a case of KS that developed after undergoing rituximab-containing chemotherapy in an HIV-negative patient with DLBCL. An 84-year-old man who received rituximab-containing chemotherapy for the treatment of DLBCL developed severe infection, and subsequently KS. Our observations indicate that serious infections under rituximab treatment may trigger KS. KS should therefore be considered when skin tumors appear in lymphoma patients receiving rituximab-containing chemotherapy.
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Affiliation(s)
- Hiroshi Ureshino
- Department of Internal Medicine, Karatsu Red Cross Hospital, Japan
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21
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Rohner E, Wyss N, Trelle S, Mbulaiteye SM, Egger M, Novak U, Zwahlen M, Bohlius J. HHV-8 seroprevalence: a global view. Syst Rev 2014; 3:11. [PMID: 24521144 PMCID: PMC3925012 DOI: 10.1186/2046-4053-3-11] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/21/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Human herpes virus 8 (HHV-8) is the underlying infectious cause of Kaposi sarcoma (KS) and other proliferative diseases; that is, primary effusion lymphoma and multicentric Castleman disease. In regions with high HHV-8 seroprevalence in the general population, KS accounts for a major burden of disease. Outside these endemic regions, HHV-8 prevalence is high in men who have sex with men (MSM) and in migrants from endemic regions. We aim to conduct a systematic literature review and meta-analysis in order 1) to define the global distribution of HHV-8 seroprevalence (primary objective) and 2) to identify risk factors for HHV-8 infection, with a focus on HIV status (secondary objective). METHODS/DESIGN We will include observational studies reporting data on seroprevalence of HHV-8 in children and/or adults from any region in the world. Case reports and case series as well as any studies with fewer than 50 participants will be excluded. We will search MEDLINE, EMBASE, and relevant conference proceedings without language restriction. Two reviewers will independently screen the identified studies and extract data on study characteristics and quality, study population, risk factors, and reported outcomes, using a standardized form. For the primary objective we will pool the data using a fully bayesian approach for meta-analysis, with random effects at the study level. For the secondary objective (association of HIV and HHV-8) we aim to pool odds ratios for the association of HIV and HHV-8 using a fully bayesian approach for meta-analysis, with random effects at the study level. Sub-group analyses and meta-regression analyses will be used to explore sources of heterogeneity, including factors such as geographical region, calendar years of recruitment, age, gender, ethnicity, socioeconomic status, different risk groups for sexually and parenterally transmitted infections (MSM, sex workers, hemophiliacs, intravenous drug users), comorbidities such as organ transplantation and malaria, test(s) used to measure HHV-8 infection, study design, and study quality. DISCUSSION Using the proposed systematic review and meta-analysis, we aim to better define the global seroprevalence of HHV-8 and its associated risk factors. This will improve the current understanding of HHV-8 epidemiology, and could suggest measures to prevent HHV-8 infection and to reduce its associated cancer burden.
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Affiliation(s)
- Eliane Rohner
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
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22
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Arruda É, Jacome AADA, Toscano ALDCC, Silvestrini AA, Rêgo ASB, Wiermann EG, Cunha GFD, Melo HRLD, Morejón KML, Goldani LZ, Pereira LC, Silva MH, Treistman MS, Pereira MCT, Romero PMBX, Schmerling RA, Guedes RAV, Camargo VPD. Consensus of the Brazilian Society of Infectious Diseases and Brazilian Society of Clinical Oncology on the management and treatment of Kaposi's sarcoma. Braz J Infect Dis 2014; 18:315-26. [PMID: 24525061 PMCID: PMC9427498 DOI: 10.1016/j.bjid.2014.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 01/23/2014] [Indexed: 12/26/2022] Open
Abstract
Kaposi's sarcoma is a multifocal vascular lesion of low-grade potential that is most often present in mucocutaneous sites and usually also affects lymph nodes and visceral organs. The condition may manifest through purplish lesions, flat or raised with an irregular shape, gastrointestinal bleeding due to lesions located in the digestive system, and dyspnea and hemoptysis associated with pulmonary lesions. In the early 1980s, the appearance of several cases of Kaposi's sarcoma in homosexual men was the first alarm about a newly identified epidemic, acquired immunodeficiency syndrome. In 1994, it was finally demonstrated that the presence of a herpes virus associated with Kaposi's sarcoma called HHV-8 or Kaposi's sarcoma herpes virus and its genetic sequence was rapidly deciphered. The prevalence of this virus is very high (about 50%) in some African populations, but stands between 2% and 8% for the entire world population. Kaposi's sarcoma only develops when the immune system is depressed, as in acquired immunodeficiency syndrome, which appears to be associated with a specific variant of the Kaposi's sarcoma herpes virus. There are no treatment guidelines for Kaposi's sarcoma established in Brazil, and thus the Brazilian Society of Clinical Oncology and the Brazilian Society of Infectious Diseases developed the treatment consensus presented here.
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Affiliation(s)
- Érico Arruda
- Sociedade Brasileira de Infectologia Infectologia, Vila Mariana, SP, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | - Mauro Sergio Treistman
- Serviço de Infectologia de Rede Hospitalar Privada e Câmara Técnica de Doenças Infecciosas do CREMERJ
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23
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Immunosenescence is associated with presence of Kaposi's sarcoma in antiretroviral treated HIV infection. AIDS 2013; 27:1735-42. [PMID: 23435301 DOI: 10.1097/qad.0b013e3283601144] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Some antiretroviral treated HIV-infected patients develop Kaposi's sarcoma despite long-term suppression of HIV replication. These Kaposi's sarcoma lesions are consistent with Kaposi's sarcoma observed in the elderly uninfected population ('classical Kaposi's sarcoma'). We investigated potential mechanisms for this phenomenon, focusing on measures of immune activation and T-cell senescence. DESIGN We compared markers of immunosenescence, naive T cells, activation, and inflammation in CD4+ and CD8+ T cells from antiretroviral-treated participants with new-onset Kaposi's sarcoma (cases, n = 19) and from treated individuals without Kaposi's sarcoma (controls, n = 47). RESULTS There was increased frequency of CD4+ and CD8+ T cells with an immunosenescence phenotype (CD57+ and CD28-) in cases vs. controls (CD4+ T cells: CD57+ 7.4 vs. 3.7%, P = 0.025; CD28- 9.1 vs. 4.8%, P = 0.025; CD8+ T cells: CD57+ 41.5 vs. 27.7%, P = 0.003; CD28- 60.5 vs. 51.3%, P = 0.041). Cases had lower proportions of naïve T cells (CD27+ CD28+ CD45RA+) in CD4+ (23.0 vs. 32.2%, P = 0.023) and CD8+ (11.3 vs. 20.7%, P < 0.001) T-cell compartments. CCR5 was more highly expressed in CD4+ (16.3 vs. 11.0%, P = 0.025), and CD8+ (43.1 vs. 28.3%, P < 0.001) T-cell compartments in cases vs. controls. There was no difference in telomere length or telomerase activity in peripheral blood mononuclear cells, or in T-cell expression of activation markers (HLADRCD38). CONCLUSION Among antiretroviral-treated patients, increased frequencies of T cells with an immunosenescence phenotype and lower frequencies of naive T cells were associated with presence of Kaposi's sarcoma among effectively treated patients. These data suggest that certain immunologic perturbations--including those associated with aging--might be causally associated with development of Kaposi's sarcoma.
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Abstract
This review of lung malignancies in human immunodeficiency virus (HIV) briefly highlights key epidemiologic and clinical features in the pulmonary involvement of AIDS-defining malignancies of Kaposi sarcoma and non-Hodgkin lymphoma. Then, focusing on non-AIDS defining lung cancer, the epidemiology and mechanisms, clinical presentation, pathology, treatment and outcomes, and prevention of HIV-associated lung cancer are discussed. Finally, the important knowledge gaps and future directions for research related to HIV-associated lung malignancies are highlighted.
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Affiliation(s)
- Allison A Lambert
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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25
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Daly ML, Fogo A, McDonald C, Morris-Jones R. Kaposi sarcoma: no longer an AIDS-defining illness? A retrospective study of Kaposi sarcoma cases with CD4 counts above 300/mm3at presentation. Clin Exp Dermatol 2013; 39:7-12. [DOI: 10.1111/ced.12163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 11/27/2022]
Affiliation(s)
- M.-L. Daly
- Department of Dermatology; King's College Hospital NHS Foundation Trust; London U.K
| | - A. Fogo
- Department of Dermatology; King's College Hospital NHS Foundation Trust; London U.K
| | - C. McDonald
- Department of Genito-Urinary Medicine; King's College Hospital NHS Foundation Trust; London UK
| | - R. Morris-Jones
- Department of Dermatology; King's College Hospital NHS Foundation Trust; London U.K
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26
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Suárez-García I, Jarrín I, Iribarren JA, López-Cortés LF, Lacruz-Rodrigo J, Masiá M, Gómez-Sirvent JL, Hernández-Quero J, Vidal F, Alejos-Ferreras B, Moreno S, Del Amo J. Incidence and risk factors of AIDS-defining cancers in a cohort of HIV-positive adults: Importance of the definition of incident cases. Enferm Infecc Microbiol Clin 2013; 31:304-12. [DOI: 10.1016/j.eimc.2012.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 02/22/2012] [Accepted: 03/16/2012] [Indexed: 10/26/2022]
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Schwarcz L, Chen MJ, Vittinghoff E, Hsu L, Schwarcz S. Declining incidence of AIDS-defining opportunistic illnesses: results from 16 years of population-based AIDS surveillance. AIDS 2013; 27:597-605. [PMID: 23079812 DOI: 10.1097/qad.0b013e32835b0fa2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To measure the incidence and risk factors of AIDS-defining opportunistic illnesses (AOIs) in the pre-highly active antiretroviral therapy (HAART) (1993-1995), early-HAART (1996-2000), and late-HAART (2001-2008) periods. DESIGN Prospective cohort analysis of AIDS surveillance data. METHODS Individuals living with, or diagnosed with AIDS from 1993 through 2008 were included. Poisson regression models were used to estimate annual incidence rates of the eight most frequently occurring AOIs, and to compare these rates in the pre-HAART (1993-1995), early-HAART (1996-2000), and late-HAART (2001-2008) periods. RESULTS There were 18 733 individuals with AIDS included; 5788 were diagnosed prior to 1993 and 12 945 were diagnosed between 1 January 1993 and 31 December 2008. The incidence rates of Pneumocystis jiroveci pneumonia, wasting syndrome, Kaposi's sarcoma, HIV encephalopathy, cytomegalovirus retinitis, cytomegalovirus, and esophageal candidiasis decreased during the study period, with the largest declines observed between the pre-HAART and early-HAART periods. Incidence rates also decreased between the early-HAART and late-HAART periods, though not as sharply. Incidence rate reductions between the earliest and latest period ranged from 84 to 99%. CONCLUSIONS Steep declines in incidence of AOIs were found following the introduction of HAART and continued into the late-HAART era. These declines reflect the impact of HIV diagnosis and treatment on a population level.
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Knowlton ER, Lepone LM, Li J, Rappocciolo G, Jenkins FJ, Rinaldo CR. Professional antigen presenting cells in human herpesvirus 8 infection. Front Immunol 2013; 3:427. [PMID: 23346088 PMCID: PMC3549500 DOI: 10.3389/fimmu.2012.00427] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 12/24/2012] [Indexed: 12/18/2022] Open
Abstract
Professional antigen presenting cells (APC), i.e., dendritic cells (DC), monocytes/macrophages, and B lymphocytes, are critically important in the recognition of an invading pathogen and presentation of antigens to the T cell-mediated arm of immunity. Human herpesvirus 8 (HHV-8) is one of the few human viruses that primarily targets these APC for infection, altering their cytokine profiles, manipulating their surface expression of MHC molecules, and altering their ability to activate HHV-8-specific T cells. This could be why T cell responses to HHV-8 antigens are not very robust. Of these APC, only B cells support complete, lytic HHV-8 infection. However, both complete and abortive virus replication cycles in APC could directly affect viral pathogenesis and progression to Kaposi's sarcoma (KS) and HHV-8-associated B cell cancers. In this review, we discuss the effects of HHV-8 infection on professional APC and their relationship to the development of KS and B cell lymphomas.
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Affiliation(s)
- Emilee R Knowlton
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh Pittsburgh, PA, USA
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29
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Nagata N, Shimbo T, Yazaki H, Asayama N, Akiyama J, Teruya K, Igari T, Ohmagari N, Oka S, Uemura N. Predictive clinical factors in the diagnosis of gastrointestinal Kaposi's sarcoma and its endoscopic severity. PLoS One 2012; 7:e46967. [PMID: 23226197 PMCID: PMC3511500 DOI: 10.1371/journal.pone.0046967] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 09/07/2012] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The diagnosis of gastrointestinal (GI) involvement in Kaposi's sarcoma (KS) is important to make because the need for treatment depends on the extent of the disease. Moreover, severe GI lesions can cause serious complications. Endoscopy with biopsy is an extremely useful method to diagnose GI-KS. However, determining the indications for endoscopy is difficult because KS can occur without GI symptoms or cutaneous KS. This study sought to clarify predictive clinical factors for GI-KS and its severity on endoscopy. METHODOLOGY/PRINCIPAL FINDINGS A total of 1,027 HIV-infected patients who underwent endoscopy were analyzed. Sexual behavior, CD4 count, HIV RNA, history of highly active antiretroviral therapy (HAART), GI symptoms, and cutaneous KS were assessed. Endoscopic severity including bulky tumor, ulceration, and number of lesions were evaluated. Thirty-three patients had GI-KS and 46 patients cutaneous KS. Among the GI-KS patients, 78.8% (26/33) had no GI symptoms and 24.2% (8/33) had no cutaneous KS. Univariate analysis identified men who have sex with men (MSM), CD4 <100 cells/µL, HIV RNA ≥10,000 copies/mL, no history of HAART, and cutaneous KS were significantly associated with GI-KS. Among these factors, cutaneous KS was closely related to GI-KS on multivariable analysis. Among patients without cutaneous KS, MSM and CD4 count <100 cells/µL were the only independent clinical factors related to GI-KS. Bulky tumor was significantly associated with CD4 <100 cells/µL and large number of lesions was significantly associated with HIV-RNA ≥10,000 copies/mL. CONCLUSIONS To diagnose GI-KS, clinical factors need to be considered before endoscopy. The presence of GI symptoms is not useful in predicting GI-KS. MSM and CD4 count <100 cells/µL are predictive factors among patients without cutaneous KS. Caution should be exercised especially in patients with low CD4 counts or high HIV viral loads as they are more likely to develop severe GI-KS lesions.
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Affiliation(s)
- Naoyoshi Nagata
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
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False-Negative Results of Endoscopic Biopsy in the Diagnosis of Gastrointestinal Kaposi's Sarcoma in HIV-Infected Patients. PATHOLOGY RESEARCH INTERNATIONAL 2012; 2012:854146. [PMID: 23227427 PMCID: PMC3513736 DOI: 10.1155/2012/854146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 10/29/2012] [Accepted: 10/29/2012] [Indexed: 01/18/2023]
Abstract
Kaposi's sarcoma (KS) is a rare endothelial neoplasm mainly involving the skin, but it is often associated with AIDS. Diagnosis of gastrointestinal (GI) tract KS, a common site of visceral involvement in AIDS, is important, but endoscopic biopsy carries a risk of false-negative results (FNRs) due to its submucosal appearance. This study sought to determine the rate and causes of FNR for endoscopic biopsy of GI-KS lesions. Endoscopic biopsy samples of 116 GI-KS lesions were reviewed retrospectively. All GI-KS lesions were confirmed to be resolved following KS therapy. FNRs were yielded for 41 of the lesions (35.3%). Among upper and lower GI sites, the esophagus was the only site significantly associated with FNRs (P < 0.01). Small size (<10 mm) and patches found on endoscopy were significantly associated with FNRs (P < 0.05). Findings of submucosal tumor (SMT) with ulceration were significantly associated with true-positive results (P < 0.05). In conclusion, FNRs were found in 35.3% of GI-KS lesions and were especially related to the site of the esophagus and endoscopic early stage (small size or patch appearance). An SMT with ulceration may be relatively easy to diagnose on endoscopic biopsy. Caution should be exercised when performing endoscopic biopsy of these lesions in AIDS patients and evaluating the histological features.
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31
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Borie R, Cadranel J, Galicier L, Couderc LJ. [Pulmonary involvement due to HHV-8 virus during the course of HIV infection]. Rev Mal Respir 2012; 29:1209-23. [PMID: 23228679 DOI: 10.1016/j.rmr.2012.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 02/08/2012] [Indexed: 12/01/2022]
Abstract
HHV-8 is a herpes virus discovered in 1994 in Kaposi sarcoma cells. Its involvement was later demonstrated in multicentric Castleman disease and in primary lymphoma effusion lymphoma. These diseases arise almost exclusively in immunocompromised patients, mostly in association with HIV infection. Apart from Kaposi's sarcoma, combined antiretroviral therapy does not seem to have reduced the incidence of these diseases, which remain rare. In these three diseases, pulmonary involvement is common and may be the presenting feature. Kaposi's sarcoma of the lung is usually asymptomatic but may require specific therapy. Pulmonary involvement is mostly associated with cutaneous disease. Patients with Castleman disease typically present with fever and lymphadenopathy, associated with interstitial lung disease without opportunistic infection. Patients with primary lymphoma effusion presents with fever and an exudative lymphocytic pleural effusion, without a pleural mass on the CT-scan. Rapid diagnosis of these conditions avoids unnecessary invasive examinations and leads to prompt specific treatment.
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Affiliation(s)
- R Borie
- Service de Pneumologie A, Centre de Compétence Maladies Rares Pulmonaires, Hôpital Bichat, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75877 Paris Cedex 18, France.
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32
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The Response of HIV-Associated Lymphadenopathic Kaposi Sarcoma to Highly Active Antiretroviral Therapy Evaluated by 18F-FDG PET/CT. Clin Nucl Med 2012; 37:692-3. [DOI: 10.1097/rlu.0b013e3182485261] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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Mankia S, Miller R, Edwards S, Ramsay A, Lee S. Highly Active Antiretroviral Therapy Alone is an Effective Treatment for Lymphadenopathic Kaposi Sarcoma Demonstrated by a Clinical and F-18 FDG Positron Emission Tomography/Computed Tomography Response. Clin Oncol (R Coll Radiol) 2012; 24:309-11. [DOI: 10.1016/j.clon.2012.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 01/06/2012] [Accepted: 01/25/2012] [Indexed: 11/26/2022]
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Valencia ME, Piedrafita V, Del Val D, Corcuera MT. [Aggressive Kaposi's sarcoma related to corticosteroids or immune reconstitution syndrome?]. Rev Clin Esp 2011; 211:321-2. [PMID: 21492846 DOI: 10.1016/j.rce.2010.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 11/21/2010] [Indexed: 11/19/2022]
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35
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Crum-Cianflone NF, Hullsiek KH, Ganesan A, Weintrob A, Okulicz JF, Agan BK. Is Kaposi's sarcoma occurring at higher CD4 cell counts over the course of the HIV epidemic? AIDS 2010; 24:2881-3. [PMID: 20827160 PMCID: PMC2978255 DOI: 10.1097/qad.0b013e32833f9fb8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We evaluated longitudinal rates of Kaposi's sarcoma and trends in CD4 cell counts at the time of Kaposi's sarcoma diagnosis during the HIV epidemic (1985-2008). Although rates of Kaposi's sarcoma have decreased, cases are now occurring at higher CD4 cell counts over time, with more than one-third of cases diagnosed in 2002-2008 occurring at CD4 cell counts of at least 350 cells/μl. These data support future studies evaluating the impact of highly active antiretroviral therapy initiation at higher CD4 cell counts to further reduce Kaposi's sarcoma.
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Affiliation(s)
- Nancy F Crum-Cianflone
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
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36
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Lee HF, Lu CL, Chang FY. A man with loose stool and periumbilical pain. Gastroenterology 2010; 139:734, 1068. [PMID: 20659462 DOI: 10.1053/j.gastro.2009.09.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 09/09/2009] [Accepted: 09/21/2009] [Indexed: 12/02/2022]
Affiliation(s)
- Hsing-Feng Lee
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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37
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Monofunctional and polyfunctional CD8+ T cell responses to human herpesvirus 8 lytic and latency proteins. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2010; 17:1507-16. [PMID: 20719985 DOI: 10.1128/cvi.00189-10] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Human herpesvirus 8 (HHV-8) is the etiological agent of Kaposi's sarcoma, primary effusion lymphoma, and multicentric Castleman's disease. It is postulated that CD8(+) T cell responses play an important role in controlling HHV-8 infection and preventing development of disease. In this study, we investigated monofunctional and polyfunctional CD8(+) T cell responses to HHV-8 lytic proteins gB (glycoprotein B) and K8.1 and latency proteins LANA-1 (latency-associated nuclear antigen-1) and K12. On the basis of our previous findings that dendritic cells (DC) reveal major histocompatibility complex (MHC) class I epitopes in gB, we used a DC-based system to identify 2 novel epitopes in gB, 2 in K8.1, 5 in LANA-1, and 1 in K12. These new HHV-8 epitopes activated monofunctional and polyfunctional CD8(+) T cells that produced various combinations of gamma interferon, interleukin 2, tumor necrosis factor alpha, macrophage inhibitory protein 1β, and cytotoxic degranulation marker CD107a in healthy HHV-8-seropositive individuals. We were also able to detect HHV-8-specific CD8(+) T cells in peripheral blood samples using HLA A*0201 pentamer complexes for one gB epitope, one K8.1 epitope, two LANA-1 epitopes, and one K12 epitope. These immunogenic regions of viral lytic and latency proteins could be important in T cell control of HHV-8 infection.
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38
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Clifford GM, Franceschi S. Cancer risk in HIV-infected persons: influence of CD4(+) count. Future Oncol 2009; 5:669-78. [PMID: 19519206 DOI: 10.2217/fon.09.28] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Persons infected with HIV are at increased risk for all cancers known or suspected to have an infectious cause, an effect believed to be primarily mediated by lowered host immunity via the depletion of CD4(+) cells. Whereas Kaposi sarcoma and non-Hodgkin lymphoma were recognised as AIDS-defining illnesses early in the HIV epidemic, the influence of declining CD4(+) count on other infection-related cancers has taken longer to establish, undoubtedly because the association is weaker and the dose-response relationship is less steep. However, following improved survival made possible by combined antiretroviral therapy, declining CD4(+) count starts showing an impact on the natural history of various carcinogenic infections and on the risk for an increasingly wide range of cancers, including Hodgkin lymphoma, cervical, anal and liver cancers.
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Affiliation(s)
- Gary M Clifford
- International Agency for Research on Cancer, Lyon Cedex 08, France.
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Mani D, Neil N, Israel R, Aboulafia DM. A Retrospective Analysis of AIDS-Associated Kaposi’s Sarcoma in Patients With Undetectable HIV Viral Loads and CD4 Counts Greater Than 300 cells/mm3. ACTA ACUST UNITED AC 2009; 8:279-85. [DOI: 10.1177/1545109709341852] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To compare the clinical course of patients with AIDS-related Kaposi’s sarcoma (KS) with CD4 counts >300 cells/mm3 and undetectable HIV viral loads (VLs) to patients with AIDS-KS with lesser CD4 counts and detectable HIV VLs. Methods: We retrospectively analyzed a cohort of 91 patients with AIDS-KS in a multispeciality clinic. We used χ2 and Student t tests to analyze intragroup differences; survival was determined by Kaplan-Meier analysis. Results: Twenty (22%) of the 91 patients had newly diagnosed, persistent or progressive KS despite CD4 counts >300 cells/mm3 and undetectable HIV VLs. Age, gender, ethnicity, mode and duration of HIV acquisition, type of antiretroviral therapy (ART), and KS therapy did not differ significantly (P ≤ .005) between this group and the remaining 71 patients. Although tumor stage and response to KS therapy were similar, there was a significantly greater risk of death among the patients with CD4 counts <300 cells/mm3 and detectable HIV VLs (P = .048). Conclusions: In the highly active antiretroviral (HAART) era, a substantial proportion of patients with KS had undetectable HIV VLs and CD4 counts greater than the level typically associated with opportunistic diseases. They required systemic therapy to control their KS but were significantly less likely to die and demonstrated a trend toward better 15-year survival than patients having KS with lesser CD4 counts and detectable HIV VLs.
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Affiliation(s)
- Deepthi Mani
- Division of Internal Medicine, Spokane Medical Centers, Spokane, Washington
| | - Nancy Neil
- School of Public Health, University of Washington, Seattle, Washington
| | - Rebecca Israel
- Division of Hematology and Oncology, Virginia Mason Medical Center. Seattle, Washington
| | - David M. Aboulafia
- Division of Hematology and Oncology, Virginia Mason Medical Center. Seattle, Washington,
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40
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Yu Y, Demierre MF, Mahalingam M. Anaplastic Kaposi's sarcoma: an uncommon histologic phenotype with an aggressive clinical course. J Cutan Pathol 2009; 37:1088-91. [DOI: 10.1111/j.1600-0560.2009.01389.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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41
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Schwartz RA, Micali G, Nasca MR, Scuderi L. Kaposi sarcoma: a continuing conundrum. J Am Acad Dermatol 2008; 59:179-206; quiz 207-8. [PMID: 18638627 DOI: 10.1016/j.jaad.2008.05.001] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 04/20/2008] [Accepted: 05/05/2008] [Indexed: 12/11/2022]
Abstract
UNLABELLED Kaposi sarcoma (KS) remains a challenge. Its classic or Mediterranean form tends to be benign. In transplant recipients it may be less so. As part of the AIDS pandemic, of which it was an original defining component, it may be life-threatening. It is due to human herpesvirus-8, which is necessary but not sufficient to produce the disease. KS has a low prevalence in the general population of the United States and United Kingdom, with an intermediate rate in Italy and Greece, and a high one in parts of Africa. In Italy, hot spots include its southern regions, the Po River Valley, and Sardinia, possibly related to a high density of blood-sucking insects. An important challenge is to treat KS patients without immunocompromising them. The potential of effective anti-herpes virus therapy and the use of sirolimus in transplantation recipients have added new opportunities for KS prevention. LEARNING OBJECTIVES At the conclusion of this learning activity, participants should be able to provide the most recent information about Kaposi sarcoma in the context in which it occurs. Its classic or Mediterranean form, its pattern in transplant recipients and others iatrogenically immunosuppressed, and its occurrence as a potentially life-threatening part of the AIDS pandemic will be stressed. Its etiology and transmission will be discussed in detail to facilitate understanding of Kaposi sarcoma and of human herpesvirus-8 infection in the general population of the United States and United Kingdom, in Italy and Greece, and in certain parts of Africa. Its therapy, including the concept of doing it without immunocompromising the patient, will be stressed. New opportunities for Kaposi sarcoma prevention will also be discussed.
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Affiliation(s)
- Robert A Schwartz
- Department of Dermatology, New Jersey Medical School, Newark, New Jersey 07103-2714, USA.
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42
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Singh NB, Lakier RH, Donde B. Hypofractionated radiation therapy in the treatment of epidemic Kaposi sarcoma--a prospective randomized trial. Radiother Oncol 2008; 88:211-6. [PMID: 18439694 DOI: 10.1016/j.radonc.2008.03.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Revised: 02/26/2008] [Accepted: 03/09/2008] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare a conventional fractionation regimen with a hypofractionated regimen in the treatment of Epidemic Kaposi sarcoma with radiation therapy. MATERIALS AND METHODS Sixty patients were randomized to receive a standard regimen of 24 Gy in 12 fractions (ARM A) or the study regimen of 20 Gy in five fractions (ARM B). Radiation technique was individualized. Treatment response, local control and toxicity were recorded. RESULTS Thirty five sites were treated in ARM A and 30 sites in ARM B. Treatment arms were similar for gender, ECOG performance score, treated site, antiretroviral therapy usage, T stage, I stage and S stage. The overall survival using the Kaplan Meier method was 37% at 1 year. Complete responses were recorded at 28 sites (13 Arm A,15 Arm B), partial responses at 19 sites (8 Arm A,11 Arm B) and stable disease at three sites (2 Arm A,1 Arm B). The mean time to maximum objective response was 3 months (range: 1-14 months). Response rates and local control were equal in the two arms (p=0.73 and 0.77, respectively, log rank test). Acute skin toxicity (p=0.77) and late skin toxicity (p=0.24) were equal in the two arms. CONCLUSION The two treatment regimens produced equivalent results for treatment response, local recurrence-free survival and toxicity.
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Affiliation(s)
- Niveditha B Singh
- Division of Radiation Oncology, Johannesburg Hospital, South Africa.
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43
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Feller L, Anagnostopoulos C, Wood NH, Bouckaert M, Raubenheimer EJ, Lemmer J. Human immunodeficiency virus-associated Kaposi sarcoma as an immune reconstitution inflammatory syndrome: a literature review and case report. J Periodontol 2008; 79:362-8. [PMID: 18251652 DOI: 10.1902/jop.2008.070225] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Kaposi sarcoma (KS) is the most common human immunodeficiency virus (HIV)-associated neoplasm (HIV-KS). Highly active antiretroviral therapy (HAART) results in a decrease in the incidence and prevalence of HIV-KS as well as in clinical improvement. However, in a subset of subjects who are HIV seropositive, KS may recrudesce early following the introduction of HAART as an immune reconstitution inflammatory syndrome (IRIS). METHODS The management of a patient who is HIV seropositive with rapid clinical worsening of oral KS lesions shortly after the initiation of HAART was documented. Repeated serologic testing for CD4(+) T-cell count and microscopic examination of two biopsy specimens of the oral lesion, one taken before and the other taken after cytotoxic chemotherapy, followed by surgical excision was the treatment modality used. RESULTS Microscopic examination of the incisional biopsy specimen taken from the oral lesion at the time of the initial consultation confirmed the clinical diagnosis of KS. The sequential serological tests showed a progressive increase in CD4(+) T-cell counts that paralleled the rapid clinical worsening of the KS disease. This was consistent with the diagnosis of IRIS-associated HIV-KS. Subsequent cytotoxic chemotherapy brought about resolution of the IRIS and regression of the HIV-KS lesions. Microscopic examination of a biopsy specimen obtained after cytotoxic chemotherapy did not show any of the original KS. The residual palatal exophytic mass was excised. CONCLUSIONS IRIS-associated HIV-KS is not a disease, but rather a temporary paradoxical immunoinflammatory reaction brought about by improvement in immune status following HAART. IRIS-associated HIV-KS can be controlled effectively by limited systemic cytotoxic chemotherapy in the setting of HAART.
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Affiliation(s)
- Liviu Feller
- Department of Periodontology and Oral Medicine, University of Limpopo, Medunsa Campus, Medunsa, South Africa.
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44
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Feller L, Lemmer J. Insights into pathogenic events of HIV-associated Kaposi sarcoma and immune reconstitution syndrome related Kaposi sarcoma. Infect Agent Cancer 2008; 3:1. [PMID: 18208585 PMCID: PMC2265259 DOI: 10.1186/1750-9378-3-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Accepted: 01/21/2008] [Indexed: 11/27/2022] Open
Abstract
A decrease in the incidence of human immune deficiency virus-associated Kaposi sarcoma (HIV-KS) and regression of some established HIV-KS lesions is evident after the introduction of highly active anti-retroviral treatment (HAART), and is attributed to generalized immune restoration, to the reconstitution of human herpesvirus (HHV)-8 specific cellular immune responses, and to the decrease in HIV Tat protein and HHV-8 loads following HAART. However, a small subset of HIV-seropositive subjects with a low CD4+ T cell count at the time of introduction of HAART, may develop HIV-KS as immune reconstitution inflammatory syndrome (IRIS) within 8 weeks thereafter.
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Affiliation(s)
- Liviu Feller
- Department of Periodontology and Oral Medicine, Box D26 School of Dentistry, University of Limpopo Medunsa Campus, Pretoria, South Africa.
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45
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Maurer T, Ponte M, Leslie K. HIV-associated Kaposi's sarcoma with a high CD4 count and a low viral load. N Engl J Med 2007; 357:1352-3. [PMID: 17898112 DOI: 10.1056/nejmc070508] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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46
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Wang J, Stebbing J, Bower M. HIV-Associated Kaposi Sarcoma and Gender. ACTA ACUST UNITED AC 2007; 4:266-73. [DOI: 10.1016/s1550-8579(07)80045-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2007] [Indexed: 12/12/2022]
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47
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Abstract
Kaposi's sarcoma (KS) is a multifocal vascular tumor that occurs most commonly in patients who have immunosuppression caused by HIV. KS-associated herpes virus (human herpes virus 8, KSHV) has been identified as the causative agent. There are marked geographic differences in the prevalence of both KS and seropositivity to KSHV. The incidence of the tumor has shown a marked decline in first-world countries with the widespread use of effective antiretroviral therapy. The most effective anthracycline is pegylated liposomal doxorubicin; however, few developing countries, where KS prevalence is highest, can afford to use these agents.
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Affiliation(s)
- Sue Jessop
- Division of Dermatology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
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48
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Grabar S, Abraham B, Mahamat A, Del Giudice P, Rosenthal E, Costagliola D. Differential impact of combination antiretroviral therapy in preventing Kaposi's sarcoma with and without visceral involvement. J Clin Oncol 2006; 24:3408-14. [PMID: 16849755 DOI: 10.1200/jco.2005.05.4072] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To study the impact of different potent combined antiretroviral treatment (cART) on the incidence of HIV-associated Kaposi's sarcoma (KS) with and without visceral involvement. PATIENTS AND METHODS Patients were selected from the French Hospital Database on HIV, a large hospital cohort. The risk of KS was estimated by using Cox proportional hazards models adjusting for age, the CD4 cell nadir, the HIV exposure category, prior AIDS, cART, and the type of cART regimen. cART regimens were distinguished according to whether they contained protease inhibitor (PI), non-nucleoside analog (NNRTI), both, or only nucleoside analog (NRTI). Separate analyzes were conducted according to the initial visceral involvement of KS. RESULTS Among the 54,999 patients included in this study (182,756 person-years of follow-up), 1,634 patients were diagnosed with KS during follow-up, of whom 421 had visceral involvement at diagnosis. The KS incidence rate fell from 32 per 1,000 person-years in 1993 to 1994 to 3 per 1,000 person-years after 1999. PI-containing and NNRTI-containing cART regimens were associated with similar reductions in the risk of KS (hazard ratio, 0.68; 95%CI, 0.61 to 0.75; HR, 0.62; 95% CI, 0.54 to 0.71, respectively). The risk of visceral KS fell more strongly than the risk of cutaneous KS (> 50% and < 30%, respectively). CONCLUSION The incidence of KS, and especially visceral KS, has fallen sharply since the advent of cART. This effect is likely due to immune restoration rather than to a specific effect on the tumoral process, as PI-containing and NNRTI-containing regimens had similar preventive efficacy.
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Affiliation(s)
- Sophie Grabar
- Service de Biostatistique et Informatique Médicale, Hôpital Cochin, Paris, France.
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49
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Bower M, Mazhar D, Stebbing J. Should cervical cancer be an acquired immunodeficiency syndrome-defining cancer? J Clin Oncol 2006; 24:2417-9. [PMID: 16735700 DOI: 10.1200/jco.2005.05.4908] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mark Bower
- Department of Oncology, Chelsea and Westminster Hospital, London, United Kingdom
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50
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Bower M, Palmieri C, Dhillon T. AIDS-related malignancies: changing epidemiology and the impact of highly active antiretroviral therapy. Curr Opin Infect Dis 2006; 19:14-9. [PMID: 16374212 DOI: 10.1097/01.qco.0000200295.30285.13] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Three cancers in people with HIV denote an AIDS diagnosis: Kaposi's sarcoma, high-grade B-cell non-Hodgkin's lymphoma and invasive cervical cancer. In addition a number of other cancers occur at increased frequency in this population group but are not AIDS-defining illnesses. This review discusses the impact of highly active antiretroviral therapy on the epidemiology and outcome of AIDS-defining cancers. RECENT FINDINGS The incidence of both Kaposi's sarcoma and non-Hodgkin's lymphoma has declined in the era of highly active antiretroviral therapy and the outcome of both tumours has improved. Moreover, highly active antiretroviral therapy alone produces a response in a majority of antiretroviral-naïve patients with Kaposi's sarcoma. In contrast, highly active antiretroviral therapy has had little impact on the incidence of human papilloma virus-associated tumours (cervical and anal cancer) in people with HIV, although it may improve survival by reducing opportunistic infection deaths. As people with HIV live longer with highly active antiretroviral therapy, an increased incidence of other non AIDS-defining cancers that have no known association with oncogenic infections is becoming apparent. SUMMARY For those with access to highly active antiretroviral therapy, the good news from the AIDS-defining cancers - particularly Kaposi's sarcoma and non-Hodgkin's lymphoma - may be balanced by the increasing numbers of non AIDS-defining cancers.
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Affiliation(s)
- Mark Bower
- Department of Oncology, Chelsea and Westminster Hospital, London, UK.
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