Predictors of immune reconstitution inflammatory syndrome associated with Kaposi’s sarcoma: a case report

Abstract

We present here a case of immune reconstitution inflammatory syndrome associated with Kaposi’s sarcoma (KS-IRIS) developed in an AIDS patient two months after initiation of antiretroviral therapy (ART). Baseline characteristics of this IRIS-KS case, within a cohort of 12 naïve AIDS-KS patients, were analyzed. No statistically significant differences in CD4 cell counts, plasma HIV RNA load, KS clinical staging, human herpesvirus 8 (HHV8) antibody titers and HHV8 load in peripheral blood mononuclear cells and saliva were evidenced. HHV8 load in plasma was found to be significantly higher in the KS-IRIS patient (> 6 log10 genome equivalents/ml, p = 0.01, t–test) compared to the 11 patients with KS regression. This case highlights that measurement of HHV8 load in plasma may be useful to identify patients at risk for KS-IRIS, and that this parameter should be included in the design of larger studies to define KS-IRIS risk predictors.

Immune reconstitution inflammatory syndrome in HIV infection: taking the bad with the good

“…CD8 + T cells specific for HHV‐8 also increase during IRIS; however, their role in driving IRIS is unknown (Krown, ). Baseline antigen load (HHV8 plasma levels) is a valuable predictor of KS‐IRIS (Cattelan et al , ). It has been suggested that KS progression could be the result of a KSHV‐specific immune response due to the initiation of ART.…”

Circulating miRNA‐375 as a potential novel biomarker for active Kaposi’s sarcoma in AIDS patients

“…The patient that during DP showed decreased miRNA levels (RQ < 1) was a case of unmasking KS‐IRIS. The different trends shown by the two KS‐IRIS patients might be influenced by the different clinical presentation of this rare inflammatory condition, as paradoxical KS‐IRIS is characterized by the worsening of a pre‐existing tumour whereas unmasking KS‐IRIS leads to the development of KS, both in the context of a sudden immune reconstitution during cART . In the screening phase, the comparison of cART‐treated AIDS‐KS vs naïve asymptomatic patients showed a down‐regulation of miR‐375, consistently with the patient with unmasking KS‐IRIS, suggesting that this rare KS presentation might indeed lead to decreased miR‐375 amounts.…”

Herpesvirus Regulation of Selective Autophagy

“…Like other herpesviruses, HHV-8 has two distinct infection stages in the host: latency (persistent infection) and lytic replication, both of which are implicated in HHV-8 pathogenesis. In particular, PEL and MCD are likely associated with lytic replication [ 68 , 69 , 70 ]. Recently, it has been demonstrated that HHV-8-encoded viral IFN regulatory factor 1 (vIRF-1) localizes in part to mitochondria, where it interacts directly with the mitophagy receptor NIX and promotes NIX-mediated mitophagy to remove dysfunctional mitochondria during lytic replication in HHV-8-infected PEL cells [ 41 ].…”