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Lurain KA, Ramaswami R, Krug LT, Whitby D, Ziegelbauer JM, Wang HW, Yarchoan R. HIV-associated cancers and lymphoproliferative disorders caused by Kaposi sarcoma herpesvirus and Epstein-Barr virus. Clin Microbiol Rev 2024:e0002223. [PMID: 38899877 DOI: 10.1128/cmr.00022-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
SUMMARYWithin weeks of the first report of acquired immunodeficiency syndrome (AIDS) in 1981, it was observed that these patients often had Kaposi sarcoma (KS), a hitherto rarely seen skin tumor in the USA. It soon became apparent that AIDS was also associated with an increased incidence of high-grade lymphomas caused by Epstein-Barr virus (EBV). The association of AIDS with KS remained a mystery for more than a decade until Kaposi sarcoma-associated herpesvirus (KSHV) was discovered and found to be the cause of KS. KSHV was subsequently found to cause several other diseases associated with AIDS and human immunodeficiency virus (HIV) infection. People living with HIV/AIDS continue to have an increased incidence of certain cancers, and many of these cancers are caused by EBV and/or KSHV. In this review, we discuss the epidemiology, virology, pathogenesis, clinical manifestations, and treatment of cancers caused by EBV and KSHV in persons living with HIV.
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Affiliation(s)
- Kathryn A Lurain
- The HIV and AIDS Malignancy Branch, Center for Cancer Research, Bethesda, Maryland, USA
| | - Ramya Ramaswami
- The HIV and AIDS Malignancy Branch, Center for Cancer Research, Bethesda, Maryland, USA
| | - Laurie T Krug
- The HIV and AIDS Malignancy Branch, Center for Cancer Research, Bethesda, Maryland, USA
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Joseph M Ziegelbauer
- The HIV and AIDS Malignancy Branch, Center for Cancer Research, Bethesda, Maryland, USA
| | - Hao-Wei Wang
- Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland, USA
| | - Robert Yarchoan
- The HIV and AIDS Malignancy Branch, Center for Cancer Research, Bethesda, Maryland, USA
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2
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Opie J, Verburgh E, Bailly J, Mayne E, Louw V. Hematological Complications of Human Immunodeficiency Virus (HIV) Infection: An Update From an HIV-Endemic Setting. Open Forum Infect Dis 2024; 11:ofae162. [PMID: 38601746 PMCID: PMC11004791 DOI: 10.1093/ofid/ofae162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/17/2024] [Indexed: 04/12/2024] Open
Abstract
Medical professionals, particularly in regions with a high burden of human immunodeficiency virus (HIV), should be alert to the hematological complications of HIV, which may include cytopenias, malignancy, and coagulation disturbances. Patients may present with these conditions as the first manifestation of HIV infection. Hematological abnormalities are often multifactorial with opportunistic infections, drugs, malignancy, and HIV infection itself contributing to the clinical presentation, and the diagnosis should consider all these factors. Life-threatening hematological complications requiring urgent diagnosis and management include thrombotic thrombocytopenic purpura, superior mediastinal syndrome, spinal cord compression, and tumor lysis syndrome due to aggressive lymphoma. Antiretroviral therapy is the therapeutic backbone, including for patients with advanced HIV, in addition to specific therapy for the complication. This article reviews the impact of HIV on the hematological system and provides a clinical and diagnostic approach, including the role of a bone marrow biopsy, focusing on perspectives from sub-Saharan Africa.
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Affiliation(s)
- Jessica Opie
- Division of Haematology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Estelle Verburgh
- Division of Clinical Haematology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Division of Clinical Haematology, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa
| | - Jenique Bailly
- Division of Haematology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Elizabeth Mayne
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Vernon Louw
- Division of Clinical Haematology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Division of Clinical Haematology, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa
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3
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Carbone A, Chadburn A, Gloghini A, Vaccher E, Bower M. Immune deficiency/dysregulation -associated lymphoproliferative disorders. Revised classification and management. Blood Rev 2024; 64:101167. [PMID: 38195294 DOI: 10.1016/j.blre.2023.101167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/13/2023] [Accepted: 12/30/2023] [Indexed: 01/11/2024]
Abstract
Significant advances in the field of lymphoma have resulted in two recent classification proposals, the International Consensus Classification (ICC) and the 5th edition WHO. A few entities are categorized differently in the ICC compared to the WHO. Nowhere is this more apparent than the immunodeficiency lymphoproliferative disorders. The three previous versions of the WHO classification (3rd, 4th and revised 4th editions) and the ICC focused on four clinical settings in which these lesions arise for primary categorization. In contrast the 2023 WHO 5th edition includes pathologic characteristics including morphology and viral status, in addition to clinical setting, as important information for lesion classification. In addition, the 2023 WHO recognizes a broader number of clinical scenarios in which these lesions arise, including not only traditional types of immune deficiency but also immune dysregulation. With this classification it is hoped that new treatment strategies will be developed leading to better patient outcomes.
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Affiliation(s)
- Antonino Carbone
- Centro di Riferimento Oncologico, Istituto di Ricovero e Cura a Carattere Scientifico, National Cancer Institute, Aviano, Italy.
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, United States of America.
| | - Annunziata Gloghini
- Department of Advanced Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Emanuela Vaccher
- Infectious Diseases and Tumors Unit, Department of Medical Oncology, Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, Aviano, Italy.
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London SW109NH, UK.
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4
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Wu Y, Wang V, Yarchoan R. Pacritinib inhibits proliferation of primary effusion lymphoma cells and production of viral interleukin-6 induced cytokines. Sci Rep 2024; 14:4125. [PMID: 38374336 PMCID: PMC10876599 DOI: 10.1038/s41598-024-54453-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/13/2024] [Indexed: 02/21/2024] Open
Abstract
Primary effusion lymphoma (PEL) and a form of multicentric Castleman's disease (MCD) are both caused by Kaposi sarcoma herpesvirus (KSHV). There is a critical need for improved therapies for these disorders. The IL-6/JAK/STAT3 pathway plays an important role in the pathogenesis of both PEL and KSHV-MCD. We explored the potential of JAK inhibitors for use in PEL and KSHV-MCD, and found that pacritinib was superior to others in inhibiting the growth of PEL cell lines. Pacritinib induced apoptosis in PEL cells and inhibited STAT3 and NF-κB activity as evidenced by reduced amount of phosphorylated moieties. Pacritinib also inhibits FLT3, IRAK1, and ROS1; studies utilizing other inhibitors of these targets revealed that only FLT3 inhibitors exhibited similar cell growth inhibitory effects. FLT3's likely contribution to pacritinib's cell growth inhibition was further demonstrated by siRNA knockdown of FLT3. RNA sequencing and RT-PCR showed that many key host genes including cyclins and IL-6 were downregulated by pacritinib, while KSHV genes were variably altered. Finally, pacritinib suppressed KSHV viral IL-6-induced human IL-6 and IL-10 production in peripheral blood mononuclear cells, which may model an important step in KSHV-MCD pathogenesis. These results suggest that pacritinib warrants testing for the treatment of KSHV-MCD and PEL.
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Affiliation(s)
- Yiquan Wu
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Building 10, Rm. 6N106, MSC 1868, Bethesda, MD, 20892-1868, USA
| | - Victoria Wang
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Building 10, Rm. 6N106, MSC 1868, Bethesda, MD, 20892-1868, USA
| | - Robert Yarchoan
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Building 10, Rm. 6N106, MSC 1868, Bethesda, MD, 20892-1868, USA.
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5
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Suneja G, Kimani SM, Gill H, Painschab MS, Knettel BA, Watt MH. Addressing the Intersectional Stigma of Kaposi Sarcoma and HIV: A Call to Action. JCO Glob Oncol 2024; 10:e2300264. [PMID: 38301182 PMCID: PMC10846783 DOI: 10.1200/go.23.00264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/17/2023] [Accepted: 12/05/2023] [Indexed: 02/03/2024] Open
Affiliation(s)
- Gita Suneja
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
- Department of Radiation Oncology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT
| | - Stephen M. Kimani
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
- Division of Oncology, Department of Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT
| | - Hailie Gill
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT
| | - Matthew S. Painschab
- Division of Hematology, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC
- UNC Project Malawi, Lilongwe, Malawi
| | - Brandon A. Knettel
- School of Nursing, Duke University, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
| | - Melissa H. Watt
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT
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6
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Brownlee AJ, Dewey M, Chagomerana MB, Tomoka T, Mulenga M, Khan S, Kampani C, Chimzimu F, Gastier-Foster JM, Westmoreland KD, Ozuah NW, Krysiak R, Malamba-Banda C, Painschab MS, Gopal S, Fedoriw Y. Update on pathology laboratory development and research in advancing regional cancer care in Malawi. Front Med (Lausanne) 2024; 11:1336861. [PMID: 38298817 PMCID: PMC10829605 DOI: 10.3389/fmed.2024.1336861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/02/2024] [Indexed: 02/02/2024] Open
Abstract
The pathology laboratory at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi was established in 2011. We published our initial experiences in laboratory development and telepathology in 2013 and 2016, respectively. The purpose of this paper is to provide an update on our work by highlighting the positive role laboratory development has played in improving regional cancer care and research. In addition, we provide a summary of the adult pathology data from specimens received between July 1, 2011, and May 31, 2019, with an emphasis on malignant diagnoses. We compare these summaries to estimates of cancer incidence in this region to identify gaps and future needs.
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Affiliation(s)
- Amy J. Brownlee
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Morgan Dewey
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Maganizo B. Chagomerana
- University of North Carolina (UNC) Project-Malawi, Lilongwe, Malawi
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Tamiwe Tomoka
- University of North Carolina (UNC) Project-Malawi, Lilongwe, Malawi
| | - Maurice Mulenga
- Kamuzu Central Hospital, Malawi Ministry of Health, Lilongwe, Malawi
| | - Shiraz Khan
- University of North Carolina (UNC) Project-Malawi, Lilongwe, Malawi
- Kamuzu Central Hospital, Malawi Ministry of Health, Lilongwe, Malawi
| | - Coxcilly Kampani
- University of North Carolina (UNC) Project-Malawi, Lilongwe, Malawi
| | - Fred Chimzimu
- University of North Carolina (UNC) Project-Malawi, Lilongwe, Malawi
| | - Julie M. Gastier-Foster
- Departments of Pediatrics and Pathology & Immunology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Kate D. Westmoreland
- University of North Carolina (UNC) Project-Malawi, Lilongwe, Malawi
- Division of Pediatric Hematology Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Nmazuo W. Ozuah
- Section of Hematology and Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Robert Krysiak
- University of North Carolina (UNC) Project-Malawi, Lilongwe, Malawi
| | - Chikondi Malamba-Banda
- University of North Carolina (UNC) Project-Malawi, Lilongwe, Malawi
- Malawi University of Science and Technology, Limbe, Malawi
- Malawi-Liverpool-Wellcome Trust Clinical Research Program, Blantyre, Malawi
| | - Matthew S. Painschab
- University of North Carolina (UNC) Project-Malawi, Lilongwe, Malawi
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- Division of Hematology, Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Satish Gopal
- Center for Global Health, National Cancer Institute (NIH), Bethesda, MD, United States
| | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
- University of North Carolina (UNC) Project-Malawi, Lilongwe, Malawi
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
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7
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Moorad R, Kasonkanji E, Gumulira J, Gondwe Y, Dewey M, Pan Y, Peng A, Pluta LJ, Kudowa E, Nyasosela R, Tomoka T, Tweya H, Heller T, Gugsa S, Phiri S, Moore DT, Damania B, Painschab M, Hosseinipour MC, Dittmer DP. A prospective cohort study identifies two types of HIV+ Kaposi Sarcoma lesions: proliferative and inflammatory. Int J Cancer 2023; 153:2082-2092. [PMID: 37602960 PMCID: PMC11074775 DOI: 10.1002/ijc.34689] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/15/2023] [Accepted: 06/29/2023] [Indexed: 08/22/2023]
Abstract
Kaposi sarcoma (KS) is the most common cancer in people living with HIV (PLWH) in many countries where KS-associated herpesvirus is endemic. Treatment has changed little in 20 years, but the disease presentation has. This prospective cohort study enrolled 122 human immunodeficiency virus (HIV) positive KS patients between 2017 and 2019 in Malawi. Participants were treated with bleomycin, vincristine and combination antiretroviral therapy, the local standard of care. One-year overall survival was 61%, and progression-free survival was 58%. The 48-week complete response rate was 35%. RNAseq (n = 78) differentiated two types of KS lesions, those with marked endothelial characteristics and those enriched in inflammatory transcripts. This suggests that different KS lesions are in different disease states consistent with the known heterogeneous clinical response to treatment. In contrast to earlier cohorts, the plasma HIV viral load of KS patients in our study was highly variable. A total of 25% of participants had no detectable HIV; all had detectable KSHV viral load. Our study affirms that many KS cases today develop in PLWH with well-controlled HIV infection and that different KS lesions have differing molecular compositions. Further studies are needed to develop predictive biomarkers for this disease.
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Affiliation(s)
- Razia Moorad
- Lineberger Comprehensive Cancer Centre, School of Medicine, University of North Carolina at Chapel Hill; Chapel Hill, USA
- Department of Immunology and Microbiology, University of North Carolina at Chapel Hill; Chapel Hill, USA
| | | | | | | | | | - Yue Pan
- Lineberger Comprehensive Cancer Centre, School of Medicine, University of North Carolina at Chapel Hill; Chapel Hill, USA
- Department of Biostatistics, The University of North Carolina at Chapel Hill; Chapel Hill
| | - Alice Peng
- Lineberger Comprehensive Cancer Centre, School of Medicine, University of North Carolina at Chapel Hill; Chapel Hill, USA
| | - Linda J. Pluta
- Lineberger Comprehensive Cancer Centre, School of Medicine, University of North Carolina at Chapel Hill; Chapel Hill, USA
| | - Evaristar Kudowa
- Department of Immunology and Microbiology, University of North Carolina at Chapel Hill; Chapel Hill, USA
| | | | | | | | | | | | | | - Dominic T Moore
- Lineberger Comprehensive Cancer Centre, School of Medicine, University of North Carolina at Chapel Hill; Chapel Hill, USA
| | - Blossom Damania
- Lineberger Comprehensive Cancer Centre, School of Medicine, University of North Carolina at Chapel Hill; Chapel Hill, USA
- Department of Immunology and Microbiology, University of North Carolina at Chapel Hill; Chapel Hill, USA
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill; Chapel Hill, USA
| | - Matthew Painschab
- Lineberger Comprehensive Cancer Centre, School of Medicine, University of North Carolina at Chapel Hill; Chapel Hill, USA
- UNC Project Malawi, Lilongwe, Malawi
| | - Mina C. Hosseinipour
- Lineberger Comprehensive Cancer Centre, School of Medicine, University of North Carolina at Chapel Hill; Chapel Hill, USA
- UNC Project Malawi, Lilongwe, Malawi
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill; Chapel Hill, USA
| | - Dirk P. Dittmer
- Lineberger Comprehensive Cancer Centre, School of Medicine, University of North Carolina at Chapel Hill; Chapel Hill, USA
- Department of Immunology and Microbiology, University of North Carolina at Chapel Hill; Chapel Hill, USA
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill; Chapel Hill, USA
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Gopal S. The case for prioritizing malignant hematology services in low- and middle-income countries. Semin Hematol 2023; 60:189-191. [PMID: 37723025 PMCID: PMC10840687 DOI: 10.1053/j.seminhematol.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/20/2023]
Abstract
A clear case for can be made for prioritizing malignant hematology services in low- and middle-income countries based on large public health burden, convincing demonstrations of cure and control, innovation opportunities with likely worldwide implications, and sizable returns on investment for health systems and societies. We must now ensure that need and opportunity are matched by commensurate levels of investment and attention.
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Affiliation(s)
- Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD.
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Patel R, Lurain K, Yarchoan R, Ramaswami R. Clinical management of Kaposi sarcoma herpesvirus-associated diseases: an update on disease manifestations and treatment strategies. Expert Rev Anti Infect Ther 2023; 21:929-941. [PMID: 37578202 PMCID: PMC10529793 DOI: 10.1080/14787210.2023.2247161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/08/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Kaposi sarcoma herpes virus (KSHV) is associated with several diseases including Kaposi sarcoma, a form of multicentric Castleman's disease, primary effusion lymphoma, and an inflammatory cytokine syndrome. These KSHV-associated diseases (KAD) can present with heterogenous signs and symptoms that are often associated with cytokine dysregulation that may result in multiorgan dysfunction. The inability to promptly diagnose and treat these conditions can result in long-term complications and mortality. AREAS COVERED Existing epidemiological subtypes of existing KSHV-associated diseases, specifically Kaposi sarcoma as well as the incidence of several KSHV-associated disorders are described. We review the KSHV latent and lytic phases as they correlate with KSHV-associated diseases. Given the complicated presentations, we discuss the clinical manifestations, current diagnostic criteria, existing treatment algorithms for individual KAD, and when they occur concurrently. With emerging evidence on the virus and host interactions, we evaluate novel approaches for the treatment of KAD. An extensive literature search was conducted to support these findings. EXPERT OPINION KSHV leads to complex and concurrent disease processes that are often underdiagnosed both in the United States and worldwide. New therapies that exist for many of these conditions focus on chemotherapy-sparing options that seek to target the underlying viral pathogenesis or immunotherapy strategies.
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Affiliation(s)
- Roshani Patel
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kathryn Lurain
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Robert Yarchoan
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ramya Ramaswami
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Diakite M, Shaw-Saliba K, Lau CY. Malignancy and viral infections in Sub-Saharan Africa: A review. FRONTIERS IN VIROLOGY (LAUSANNE, SWITZERLAND) 2023; 3:1103737. [PMID: 37476029 PMCID: PMC10358275 DOI: 10.3389/fviro.2023.1103737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
The burden of malignancy related to viral infection is increasing in Sub-Saharan Africa (SSA). In 2018, approximately 2 million new cancer cases worldwide were attributable to infection. Prevention or treatment of these infections could reduce cancer cases by 23% in less developed regions and about 7% in developed regions. Contemporaneous increases in longevity and changes in lifestyle have contributed to the cancer burden in SSA. African hospitals are reporting more cases of cancer related to infection (e.g., cervical cancer in women and stomach and liver cancer in men). SSA populations also have elevated underlying prevalence of viral infections compared to other regions. Of 10 infectious agents identified as carcinogenic by the International Agency for Research on Cancer, six are viruses: hepatitis B and C viruses (HBV and HCV, respectively), Epstein-Barr virus (EBV), high-risk types of human papillomavirus (HPV), Human T-cell lymphotropic virus type 1 (HTLV-1), and Kaposi's sarcoma herpesvirus (KSHV, also known as human herpesvirus type 8, HHV-8). Human immunodeficiency virus type 1 (HIV) also facilitates oncogenesis. EBV is associated with lymphomas and nasopharyngeal carcinoma; HBV and HCV are associated with hepatocellular carcinoma; KSHV causes Kaposi's sarcoma; HTLV-1 causes T-cell leukemia and lymphoma; HPV causes carcinoma of the oropharynx and anogenital squamous cell cancer. HIV-1, for which SSA has the greatest global burden, has been linked to increasing risk of malignancy through immunologic dysregulation and clonal hematopoiesis. Public health approaches to prevent infection, such as vaccination, safer injection techniques, screening of blood products, antimicrobial treatments and safer sexual practices could reduce the burden of cancer in Africa. In SSA, inequalities in access to cancer screening and treatment are exacerbated by the perception of cancer as taboo. National level cancer registries, new screening strategies for detection of viral infection and public health messaging should be prioritized in SSA's battle against malignancy. In this review, we discuss the impact of carcinogenic viruses in SSA with a focus on regional epidemiology.
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Affiliation(s)
- Mahamadou Diakite
- University Clinical Research Center, University of Sciences, Techniques, and Technologies, Bamako, Mali
| | - Kathryn Shaw-Saliba
- Collaborative Clinical Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Chuen-Yen Lau
- HIV Dynamics and Replication Program, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, United States
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Painschab MS, Mponda M, Tomoka T, Kampani C, Chimzimu F, Fedoriw Y, Gopal S. Case report: Multicentric Castleman disease as a manifestation of immune reconstitution inflammatory syndrome in Malawi. Front Oncol 2022; 12:969135. [PMID: 36578926 PMCID: PMC9791082 DOI: 10.3389/fonc.2022.969135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Multicentric Castleman disease (MCD) is a lymphoproliferative disorder characterized by systemic inflammation, lymphadenopathy, and cytopenias. MCD caused by Kaposi sarcoma herpesvirus (MCD-KSHV) frequently arises in the context of HIV. It can be associated with immune reconstitution inflammatory syndrome (IRIS), but MCD-IRIS is rarely reported in sub-Saharan Africa (SSA) where HIV and KSHV infection are common. Case description A 36-year-old woman in Malawi with HIV on antiretroviral therapy (ART) for nine years presented with fatigue, weight loss, and lymphadenopathy. Lymph node biopsy was consistent with HIV lymphadenitis without evident KSHV-MCD and HIV RNA was 4,244 copies/mL. She switched to second-line ART and returned four months later with worsening lymphadenopathy, fever, night sweats, weight loss, and anemia. A repeat lymph node biopsy demonstrated unequivocal KSHV-MCD features not present on the original biopsy. Her repeat HIV viral load was undetectable and she received chemotherapy with subsequent remission on continued ART for 24 months. Discussion This is among the first reported cases of MCD-IRIS from SSA, which has implications for a region where HIV and KSHV are highly prevalent. MCD-IRIS may contribute to early mortality after ART initiation in SSA, and increased awareness alongside improved diagnostic and treatment capacity are needed.
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Affiliation(s)
- Matthew S. Painschab
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States,*Correspondence: Matthew S. Painschab,
| | - Marriam Mponda
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
| | - Tamiwe Tomoka
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
| | - Coxcilly Kampani
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
| | - Fred Chimzimu
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi
| | - Yuri Fedoriw
- University of North Carolina (UNC) Project Malawi, Lilongwe, Malawi,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD, United States
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12
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Painschab MS, Westmoreland KD, Tomoka T. Improving outcomes for non-Hodgkin lymphoma in Sub-Saharan Africa: where to start? Br J Haematol 2020; 190:139-140. [PMID: 32207147 DOI: 10.1111/bjh.16617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Matthew S Painschab
- University of North Carolina Project-Malawi, Lilongwe, Malawi.,Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Katherine D Westmoreland
- University of North Carolina Project-Malawi, Lilongwe, Malawi.,Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Tamiwe Tomoka
- University of North Carolina Project-Malawi, Lilongwe, Malawi.,University of Malawi College of Medicine, Blantyre, Malawi
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Kamiyango W, Villiera J, Silverstein A, Peckham-Gregory E, Campbell LR, El-Mallawany NK. Navigating the heterogeneous landscape of pediatric Kaposi sarcoma. Cancer Metastasis Rev 2020; 38:749-758. [PMID: 31845111 DOI: 10.1007/s10555-019-09823-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Vivid descriptions of Kaposi sarcoma (KS) occurring in children and adolescents from central and eastern Africa originated over 50 years ago. Unique clinical characteristics of pediatric KS in Africa were well described within these geographic regions that were eventually understood to be endemic for human herpesvirus-8/Kaposi sarcoma herpesvirus (HHV-8/KSHV) infection, the causative agent of KS. Having catapulted in incidence with the HIV epidemic, KS is currently among the top five most common childhood cancers in numerous countries throughout the region. The main feature that differentiates the childhood form of KS from adult disease is clinical presentation with primarily bulging lymphadenopathy. This group of patients represents the most common clinical subtype of pediatric KS in KSHV-endemic regions. Lymphadenopathic KS in children is associated with other distinct features, such as sparse occurrence of prototypical hyperpigmented cutaneous lesions, frequent presentation with severe cytopenias and a normal CD4 count, and a fulminant clinical course if untreated with chemotherapy. Increased awareness and improved recognition of lymphadenopathic KS are critically important, particularly because this subset of patients typically experiences a favorable response to chemotherapy characterized by durable complete remission. Clinical phenotypes typically observed in adult KS also occur in children-mild/moderate disease limited to cutaneous and oral involvement, woody edema, and visceral disease. This review summarizes the heterogeneous patterns of disease presentation and treatment response observed among the divergent clinical phenotypes of pediatric KS, highlights additional KSHV-related malignancies, and explores some of the potential biological drivers of such clinical phenomena.
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Affiliation(s)
- William Kamiyango
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Texas Children's Cancer and Hematology Centers Global HOPE Program, Lilongwe, Malawi
| | - Jimmy Villiera
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Texas Children's Cancer and Hematology Centers Global HOPE Program, Lilongwe, Malawi
| | - Allison Silverstein
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Texas Children's Cancer and Hematology Centers Global HOPE Program, Lilongwe, Malawi.,Baylor College of Medicine, Houston, TX, USA
| | - Erin Peckham-Gregory
- Baylor College of Medicine, Houston, TX, USA.,Global HOPE (Hematology-Oncology Pediatric Excellence), Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, 1102 Bates Street, Feigin Tower, Room 1025.16, Houston, TX, 77030, USA
| | - Liane R Campbell
- Baylor College of Medicine, Houston, TX, USA.,Baylor College of Medicine Children's Foundation Tanzania, Mbeya, Tanzania
| | - Nader Kim El-Mallawany
- Baylor College of Medicine, Houston, TX, USA. .,Global HOPE (Hematology-Oncology Pediatric Excellence), Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, 1102 Bates Street, Feigin Tower, Room 1025.16, Houston, TX, 77030, USA.
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