Plasma HHV8 DNA predicts relapse in individuals with HIV-associated multicentric Castleman disease

• Published in: Blood 2011-07, Vol.118 (2), p.271-275
• Main Authors: Stebbing, Justin, Adams, Caroline, Sanitt, Adam, Mletzko, Salvinia, Nelson, Mark, Gazzard, Brian, Newsom-Davis, Tom, Bower, Mark
• Format: Article
• Language: English
• Subjects: Adult; Aged; AIDS-Related Opportunistic Infections - blood; AIDS-Related Opportunistic Infections - diagnosis; AIDS-Related Opportunistic Infections - virology; Antiretroviral Therapy, Highly Active; Biological and medical sciences; Biomarkers - analysis; Biomarkers - blood; Castleman Disease - blood; Castleman Disease - diagnosis; Castleman Disease - etiology; Castleman Disease - virology; DNA, Viral - blood; DNA, Viral - isolation & purification; Female; Follow-Up Studies; Hematologic and hematopoietic diseases; Herpesviridae Infections - blood; Herpesviridae Infections - complications; Herpesviridae Infections - diagnosis; Herpesviridae Infections - virology; Herpesvirus 8, Human - genetics; Herpesvirus 8, Human - isolation & purification; HIV Infections - complications; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - virology; Human viral diseases; Humans; Infectious diseases; Male; Medical sciences; Middle Aged; Other diseases. Hematologic involvement in other diseases; Prognosis; Recurrence; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Young Adult
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2011-02-335620

HIV-associated multicentric Castleman disease (HIV-MCD) is a rare lymphoproliferative disorder caused by infection with human herpesvirus-8. The disease follows a relapsing and remitting clinical course, with marked systemic symptoms during an active attack, which can prove fatal. Its incidence is rising, and new data indicate the utility of the anti-CD20 monoclonal antibody rituximab at inducing remissions in both first- and second-line settings, although biomarkers associated with relapse have not been previously identified. In 52 individuals with a histologic diagnosis of HIV-MCD, we performed univariate and multivariate analyses to predict factors associated with an HIV-MCD attack. Although a younger age (< 50 years) was associated with an attack, the strongest association was observed with plasma levels of human herpesvirus-8 DNA. Rising levels predicted an attack (hazard ratio = 2.9; 95% confidence interval, 1.3-6.7), and maintenance therapy with rituximab should be considered in these individuals.