Characteristics of patients admitted to the ICU with Kaposi sarcoma herpesvirus-associated diseases

Abstract

Objective: There are four conditions caused by Kaposi sarcoma herpesvirus (KSHV): Kaposi sarcoma, KSHV-associated multicentric Castleman disease (MCD), primary effusion lymphoma (PEL), and KSHV inflammatory cytokine syndrome (KICS). These KSHV-associated disorders (KADs) often occur in people with HIV and can lead to multiorgan dysfunction requiring admission to the ICU. However, little is known about patient outcomes in this setting.Methods: A retrospective study of patients with KADs admitted to the ICU between 2010 and 2021 was conducted, examining KAD admission diagnoses, HIV characteristics, selected cytokine profiles, and ICU interventions. Primary outcomes were 60-day and median overall survival from ICU admission to death from any cause.Results: Forty-seven patients (all but one with HIV coinfection) were included. At ICU admission, 44 patients (94%) were on antiretroviral therapy with a median CD4 þ count of 88 cells/ml and HIV viral load of 23 copies/ml. The most common presentation was respiratory failure alone (19%) or with hypotension (17%). Twenty-two (47%) patients had presumed KICS (with or without Kaposi sarcoma) at admission and an additional KAD was diagnosed in 36% of these patients. IL-6 levels did not vary across KAD subtype. Twenty (43%) patients received KAD-directed therapy in the ICU. Sixty-day survival was 70% and median overall survival was 9 months. Conclusion:The majority of patients with HIV and KADs admitted to the ICU had well controlled HIV. Additional KAD were diagnosed during ICU admission in a proportion of patients who presented with presumed KICS. Critical illness did not preclude a subset of patients from receiving KAD-directed therapy in the ICU.

Human herpes virus 8-related illness: still with us

“…Delays in recognition and diagnosis are common, particularly where multiple diseases are present concurrently, and can negatively affect outcomes. In the study by Hansen et al [4], multiple HHV-8/KSHV-associated diseases were commonly present: 85% had multiple diagnoses.…”

“…Delays in recognition and diagnosis are common, particularly where multiple diseases are present concurrently, and can negatively affect outcomes. In the study by Hansen et al [4], multiple HHV-8/KSHV-associated diseases were commonly present: 85% had multiple diagnoses. Even in this highly specialized centre, the diagnostic workup prior to ICU admission had not identified all the HHV-8/KSHV-associated diseases present in a significant minority of individuals: further workup in ICU yielded additional diagnoses of MCD and/or PEL in eight individuals (17%).…”

“…However, HHV-8/KSHV-associated diseases continue to cause significant morbidity and mortality in people with HIV. In this issue of AIDS , a case series from Hansen et al [4] serves to refresh our understanding of the ongoing impact of HHV-8/KSHV-associated diseases and underline the need for ongoing research in this field.…”

“…Hansen et al [4] focus on the most severe end of the clinical spectrum of HHV-8/KSHV-associated diseases, those individuals requiring support in ICUs. They provide a single-centre retrospective series of 47 such patients, almost all with HIV and the majority of whom were people of colour, at a national referral centre for HHV-8/KSHV-associated diseases.…”

Clinical value of 18F-FDG PET/CT in the management of HIV-associated lymphoma

“…Diffuse large B-cell lymphoma (DLBCL) and Burkitt's lymphoma (BL) are among the most common subtypes of NHL in ADC in the HAART era (2,9), with an incidence of 1.20 and 0.32 per 1000 person-years, respectively (9,10). Other rare forms of NHL, including plasmablastic lymphoma (PBL), primary effusion lymphoma (PEL), and primary central nervous system lymphoma (PCNSL), are also associated with HIV infection (11)(12)(13). Furthermore, compared to HIV-negative persons, the risk of HL which is not AIDS-defining is higher among HIV-infected persons (3).…”