HIV-associated Kaposi sarcoma and related diseases

Abstract

: The search for the etiologic agent for Kaposi sarcoma led to the discovery of Kaposi sarcoma-associated herpesvirus (KSHV) in 1994. KSHV, also called human herpesvirus-8, has since been shown to be the etiologic agent for several other tumors and diseases, including primary effusion lymphoma (PEL), an extracavitary variant of PEL, KSHV-associated diffuse large B-cell lymphoma, a form of multicentric Castleman disease, and KSHV inflammatory cytokine syndrome. KSHV encodes several genes that interfere with innate and specific immunity, thwart apoptosis, enhance cell proliferation and cytokine production, and promote angiogenesis, and these play important roles in disease pathogenesis. HIV is an important cofactor in Kaposi sarcoma pathogenesis, and widespread use of antiretroviral therapy has reduced Kaposi sarcoma incidence. However, Kaposi sarcoma remains the second most frequent tumor arising in HIV-infected patients in the United States and is particularly common in sub-Saharan Africa. KSHV prevalence varies substantially in different populations. KSHV is secreted in saliva, and public health measures to reduce its spread may help reduce the incidence of KSHV-associated diseases. Although there have been advances in the treatment of Kaposi sarcoma, KSHV-multicentric Castleman disease, and PEL, improved therapies are needed, especially those that are appropriate for Kaposi sarcoma in resource-poor regions.

KSHV viral load and Interleukin‐6 in HIV‐associated pediatric Kaposi sarcoma—Exploring the role of lytic activation in driving the unique clinical features seen in endemic regions

“…Based on the role of viral lytic activation in MCD and KICS, we hypothesized that there may be overlap in mechanisms of KSHV‐driven biology in children with lymphadenopathic KS. KSHV is known to encode viral interleukin (IL)‐6, the homolog of human IL‐6, and its expression is induced during viral activation and in response to inflammatory cytokines .…”

“…KSHV is known to encode viral interleukin (IL)‐6, the homolog of human IL‐6, and its expression is induced during viral activation and in response to inflammatory cytokines . Adult KS in the United States and Europe—regions with low KSHV prevalence and ready access to antiretroviral therapy—generally occurs in the context of latent phase KSHV infection, and few if any tumor cells express viral lytic genes . This is however, not the case in regions of endemic KS like Malawi, where approximately half of treatment‐naïve KS lesions in adult HIV‐infected KS patients show evidence of extensive lytic transcription .…”

Regression of human immunodeficiency virus‐associated oral Kaposi sarcoma with combined antiretroviral therapy: A case report and literature review

“…That is why the control of KSHV is so important. Theoretically, this control seems to be more effective when the circulating HIV viral load is lower, when the patient's immune system is more preserved and when the treatment with cART + PIs + ritonavir is implemented sooner …”

“…A grade ranging from 0 (low risk) to 1 (high risk), which indicates a worse prognosis, is used for each parameter. Therefore, T0 indicates a localized tumor and T1 indicates extensive and disseminated lesions; I0 indicates CD4 ≥ 150 cells/mm 3 and I1 indicates CD4 < 150 cells/mm 3 ; and S0 indicates patient without systemic disease and S1 indicates patient with present or previous systemic disease …”

Clinicopathological pattern of soft tissue sarcoma in a tertiary health institution in North Western Nigeria

“…Kaposi sarcoma is a soft tissue sarcoma seen in patients with AIDS. 15,16 However, most cases of soft tissue sarcoma do not have an identifiable cause. 13 The most affected site of the body of presentation of soft tissue sarcoma are the extremities with the lower limbs constituting most of the cases seen, followed by the lower limb while the least affected site was the retroperitoneum.…”