scholarly journals Profile of patients undergoing third line anti-retroviral therapy

2020 ◽  
Vol 7 (9) ◽  
pp. 1394
Author(s):  
Dhileeban Maharajan P. ◽  
T. Jeetenkumar Singh ◽  
S. Bhagyabati Devi ◽  
H. Rebachandra Singh ◽  
Dipul Rudra Paul ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Viral Suppression ◽  
Virologic Failure ◽  
Cd4 Count ◽  
Medical Sciences ◽  
Art Initiation ◽  
Number Of Patients ◽  
Third Line ◽  
One Year

Background: India has the third largest human HIV epidemic in the world. The advent of antiretroviral drug began a revolution in the management of HIV. Recent studies have shown that an increasing number of patients experiencing virologic failure on second line Antiretroviral therapy and require third line ART.Methods: This prospective cohort study was conducted in Regional Institute of Medical Sciences, Imphal for a period of two years, to study the clinical, immunological, and virological profile of patients undergoing third line Antiretroviral therapy and to study the early immuno-virological response to third line Antiretroviral therapy.Results: Mean CD4 count before third line ART initiation was 95.90±111.85 cells/μl with 60% of them had CD4 count <100 cells/μl. The mean CD4 count improved significantly (p<0.005) to 246.70±123.78 cells/μl after six months and 340.70±198.57 cells/μl after one year of the therapy. At the time of initiation of third line ART, none of the patients had viral load <150copies/ml while 60% of the population had viral load >100000 copies/ml. After one year of third line ART, 80 % of the patients showed viral suppression (VL<150copies/ml). At the end of one year, the improvement in CD4 count comparing to the Viral load was significant in those who showed viral suppression (VL<150 copies/ml).Conclusions: This study showed significant improvement in the CD4 count and viral suppression with third line medication without any major clinical adverse effect.

scholarly journals Impact of age on CD4 recovery and viral suppression over time among adults living with HIV who initiated antiretroviral therapy in the African Cohort Study

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Emmanuel Bahemana ◽  
◽  
Allahna Esber ◽  
Nicole Dear ◽  
Kavitha Ganesan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Viral Suppression ◽  
Cd4 Count ◽  
Age Group ◽  
Art Initiation ◽  
Living With Hiv ◽  
Over Time

Abstract Introduction With increased use of antiretroviral therapy (ART), HIV mortality rates are declining and people living with HIV (PLWH) are surviving longer. We characterized CD4 recovery and viral suppression among adults aged < 50 and ≥ 50 years living with HIV who initiated ART in the African Cohort Study (AFRICOS). Methods Beginning in January 2013, PLWH at twelve clinics in Kenya, Uganda, Tanzania and Nigeria underwent medical history review, CD4 and viral load testing as part of the ongoing African Cohort Study (AFRICOS). ART-naïve PLWH who initiated ART within 30 days of enrollment and had at least one year of follow-up were included in these analyses. To compare ART response in participants < 50 years and ≥ 50 years old, changes in CD4 count and viral load suppression after ART initiation were examined at different time points using linear and binomial regression with generalized estimating equations. Variables for time since ART initiation and the interaction between age group and time on ART were included in the model to evaluate longitudinal changes in CD4 recovery and viral suppression by age. Results Between January 2013 and September 2019, 2918 PLHV were enrolled in the cohort. Of these, 443 were ART naïve and initiated on ART within 30 days of enrollment, with 90% (n = 399) aged < 50 years old at ART initiation. At ART initiation, participants aged 50 and older had a higher median CD4 count compared to participants younger than 50 years of age although it did not reach statistical significance (306 cells/mm3, IQR:130–547 vs. 277cells/mm3, IQR: 132–437). In adjusted models examining CD4 recovery and viral suppression there were no significant differences by age group over time. By the end of follow-up viral suppression was high among both groups of adults (96% of adults ≥ 50 years old and 92% of adults < 50 years old). Conclusion This study found no difference in long-term CD4 recovery or viral suppression by age at ART initiation. We found that particularly among younger adults participants had lower median CD4 counts at ART initiation, suggesting the importance of identifying and putting this population on treatment earlier in the disease course.

scholarly journals Rapid Antiretroviral Therapy (ART) Initiation at a Community-Based Clinic in Jackson, MS

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Courtney E. Sims Gomillia ◽  
Kandis V. Backus ◽  
James B. Brock ◽  
Sandra C. Melvin ◽  
Jason J. Parham ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Median Time ◽  
Viral Suppression ◽  
Hiv Care ◽  
Virologic Suppression ◽  
Community Based ◽  
Art Initiation ◽  
Healthcare Center ◽  
The Impact

Abstract Background Rapid antiretroviral therapy (ART), ideally initiated within twenty-four hours of diagnosis, may be crucial in efforts to increase virologic suppression and reduce HIV transmission. Recent studies, including demonstration projects in large metropolitan areas such as Atlanta, Georgia; New Orleans, Louisiana; San Francisco, California; and Washington D.C., have demonstrated that rapid ART initiation is a novel tool for expediting viral suppression in clinical settings. Here we present an evaluation of the impact of a rapid ART initiation program in a community-based clinic in Jackson, MS. Methods We conducted a retrospective chart review of patients who were diagnosed with HIV at Open Arms Healthcare Center or were linked to the clinic for HIV care by the Mississippi State Department of Health Disease Intervention Specialists from January 1, 2016 to December 31, 2018. Initial viral load, CD4+ T cell count, issuance of an electronic prescription (e-script), subsequent viral loads until suppressed and patient demographics were collected for each individual seen in clinic during the review period. Viral suppression was defined as a viral load less than 200 copies/mL. Rapid ART initiation was defined as receiving an e-script for antiretrovirals within seven days of diagnosis. Results Between January 1, 2016 and December 31, 2018, 70 individuals were diagnosed with HIV and presented to Open Arms Healthcare Center, of which 63 (90%) completed an initial HIV counseling visit. Twenty-seven percent of patients were provided with an e-script for ART within 7 days of diagnosis. The median time to linkage to care for this sample was 12 days and 5.5 days for rapid ART starters (p < 0.001). Median time from diagnosis to viral suppression was 55 days for rapid ART starters (p = 0.03), a 22 day decrease from standard time to viral suppression. Conclusion Our results provide a similar level of evidence that rapid ART initiation is effective in decreasing time to viral suppression. Evidence from this evaluation supports the use of rapid ART initiation after an initial HIV diagnosis, including same-day treatment.

scholarly journals Determinants of Viral Suppression Among Adolescents on Antiretroviral Therapy in Ehlanzeni District, South Africa: A Retrospective Cohort Analysis

2021 ◽  
Author(s):  
Emeka Francis Okonji ◽  
Brian Van Wyk ◽  
Ferdinand C. Mukumbang ◽  
Gail Hughes
Keyword(s):  
South Africa ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Retrospective Cohort ◽  
Viral Suppression ◽  
Cohort Analysis ◽  
Cd4 Count ◽  
Second Line ◽  
Retrospective Cohort Analysis ◽  
Living With Hiv

Abstract Background Achieving undetectable viral loads is crucial for the reduction of HIV transmissions, AIDS related illnesses and death. Adolescents living with HIV on antiretroviral therapy (ART) have worse treatment adherence and lower viral suppression rates compared to adults. We report on the clinical factors associated with viral suppression among adolescents 10–19 years living with HIV in the Ehlanzeni district, Mpumalanga in South Africa. Methods A retrospective cohort analysis was conducted with 9,543 adolescents living with HIV, aged 10–19 years, who were enrolled in 136 ART clinics in the Ehlanzeni district. Clinical and immunological data were obtained from electronic medical records (Tier.net). Adolescents were categorized as having achieved viral suppression if their latest viral load count was < 1000 ribonucleic acid (RNA) copies/mL. Using a backward stepwise approach, a multivariate logistic regression analysis was performed to identify factors independently associated with viral suppression. Results The mean age of the participants was 14.75 years (SD = 2.8), and 55.43% were female. Mean duration on ART was 72.26 (SD = 42.3) months. Of the 9,543 adolescents with viral load results recorded, 74% had achieved viral suppression. After adjusting for other covariates, the likelihood of achieving viral suppression remained significantly higher among adolescents who were: female (AOR = 1.21, 95% CI 1.05–1.38), had CD4 count > 200 (AOR = 2.29, 95% CI 1.89–2.79), and on ART for more than 6 months (AOR = 2.75, 95% CI 1.74–4.34). Furthermore, the likelihood of having viral suppression was lower among adolescents with CD4 count < 200 at baseline (AOR = 0.76, 95% CI 0.64–0.90), and who were switched to second line regimen (AOR = 0.42, 95% CI 0.35–0.49). Conclusions Viral suppression amongst adolescents at 74% is considerably lower than the WHO target of 90%. Of particular concern for intervention is the lower rates of viral suppression amongst male adolescents. Greater emphasis should be placed to enrol adolescents on ART earlier before CD4 counts are depleted (< 200) and keeping them engaged in care (beyond 6 months). Furthermore, improved viral load monitoring may prevent unnecessary switching to second line treatment, which are costly and is a risk factor for viral non suppression.

scholarly journals Assessment of Antiretroviral therapy Initiation among pregnant Women under Option B+ Approach; Viral Load and CD4 Count Outcomes in selected Hospitals of West Zone Oromia, Ethiopia: Quantitative Prospective Cohort Study Design

2019 ◽  
Author(s):  
Dereje Bayissa Demissie ◽  
Gizachew Abdissa Bulto ◽  
Wagi Tosisa Mekuria ◽  
Fikru Negassa Dufera
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Treatment Outcomes ◽  
Prospective Cohort ◽  
Cd4 Count ◽  
Hiv Positive ◽  
Virologic Suppression ◽  
Art Initiation ◽  
Study Results

Abstract Abstract Background: Antiretroviral therapy (ART) is effective for elimination of mother-to-child transmission (eMTCT) of human immunodeficiency virus (HIV) infection, reducing infant mortality and ensuring maternal virologic suppression. While pregnant women require lifelong ART immediately they test HIV positive (“test and treat”) under Option B+ programs, eMTCT programs face challenges and information on the relationship between the time to ART initiation following HIV testing and treatment outcomes is limited in Ethiopia Methods: A quantitative prospective cohort design was employed to conduct the study. Five randomly selected Hospitals providing Option B+ services with routine viral load assessment by Oromia regional Laboratory (ORL) from January 2016 to January 2017 was randomly selected. Bivariate and multivariable analyses were conducted to determine factors affecting the time to ART initiation following an HIV test and logistic regression used to determine the correlation between time and treatment outcomes. Results: The study results produced and evidence of a mean VL (copies/ml) of 197.27 copies/ml. Respondents that were on ART for a shorter period ≤37 months had the least proportion of women 31% were suppressed with VL<1000 copies/ml compared to those on ART for >38 months (58.7%) were suppressed. The median (IQR) CD4 count change or difference among women that had initial and last CD4 was 581 cells/μl and mean of current CD4 count 629.17ceels/ml3 and more than 85.3% had increase CD4 count. Therefore, in this study identified that factors associated with viral load response were poor /fair adherence missing doses in the past month, missing appointments, baseline CD4 and maternal months on ART were statistically significant among HIV positive pregnant women that initiated lifelong ART on option B+ in Ethiopia. Conclusion: The study results demonstrated that HIV positive pregnant women Study results indicate that majority of the respondents 89.7% were suppressed of which 80.3% were undetectable (VL= 0 copies /ml3 and 85.3% had increased CD4 count and 10.3% were not suppressed (VL >1000 copies/ml). Therefore, strategies aimed at improving adherence among women on option B+ are to ensure that these women achieve adequate immunological outcomes. Keywords: ART Initiation Pregnant Women Option B +, Viral Load, CD4 Count

scholarly journals Comparison of Time to Viral Suppression Among Treatment-Naïve HIV-Infected Adults Initiating Combination Antiretroviral Therapy by Antiretroviral Regimen Class

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S432-S432
Author(s):  
Karen Jacobson ◽  
Onyema Ogbuagu
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Median Time ◽  
Viral Suppression ◽  
Limit Of Detection ◽  
Baseline Viral Load ◽  
Virologic Suppression ◽  
Hiv Patients ◽  
Art Initiation ◽  
Treatment Naïve

Abstract Background Antiretroviral therapy (ART) regimens for the treatment of HIV that incorporate the integrase strand inhibitor (INSTI) class of antiretroviral medications have high efficacy and tolerability, and may result in faster time to virologic suppression compared with regimens that contain protease inhibitors (PIs) or non-nucleoside reverse transcriptase inhibitors (NNRTIs). However, differences in viral suppression are not well-defined in routine clinical settings. Methods We performed a retrospective single-center chart review of treatment-naïve HIV patients initiating ART between 2013 and 2016. Among patients on different ART regimen types, we compared rates of achievement of viral suppression (defined as viral load less than limit of detection or &lt;20 copies/uL) over time and median time to viral suppression using chi-square and independent samples median testing. Patients who were prescribed nonstandard regimens, were nonadherent, or discontinued or changed ART within 6 months were excluded. Results One hundred and fifty-five patients—45 (29.0%) female and 110 (71%) male—met study inclusion criteria. Mean age at ART initiation was 41.3 years (SD 12.5), and mean baseline viral load was 293,974 copies/uL. Twelve (7.7%) patients had an opportunistic infection diagnosed at time of ART initiation. Seventy-one (45.8%) initiated an INSTI-based ART regimen, 58 (37.4%) initiated a NNRTI-based regimen, and 26 (16.8%) initiated a PI-based regimen. Eighty-one (52.3%) patients had documented viral suppression, with median time to viral suppression 105 days (IQR 49–159). Patients on INSTI regimens were more likely to achieve viral suppression by 6 months (93.2% compared with 69.7% on NNRTIs and 30.8% on PIs), and had lower median time to suppression (62.6 days vs. 140.5 days on NNRTI regimens and 154.5 days on PI regimens, P = 0.002). Conclusion In this cohort, patients on INSTI-based ART regimens experienced higher rates of viral suppression at 6 months and shorter time from ART initiation to viral suppression. In HIV patients on INSTI-based ART regimens, virologic failure should be suspected prior to the current recommendation of 6 months. Disclosures All authors: No reported disclosures.

scholarly journals Baseline Viral Load Predicts Antiretroviral Therapy Outcomes Among HIV-Infected Patients: An Observational Cohort Study

2021 ◽  
Author(s):  
Chao Zhou ◽  
Wei Zhang ◽  
Rong-Rong Lu ◽  
Lin Ouyang ◽  
Hui Xing ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Mortality Rate ◽  
Virologic Failure ◽  
Early Stage ◽  
Strong Predictor ◽  
Early Mortality ◽  
Baseline Viral Load ◽  
Art Initiation ◽  
Overall Mortality

Abstract Background Many factors are associated with human immunodeficiency virus (HIV) antiretroviral therapy (ART) outcomes. Viral load (VL) is a strong predictor of disease progression among HIV-infected patients. The aim of this study was to evaluate the influence of baseline VL on treatment-related mortality and virologic failure. Methods This retrospective study observed HIV-infected patients who were initiated on ART between 2012 and 2018 in Chongqing, China. Mortality assessment included the early mortality rate (deaths within the first 12 months) and the overall mortality rate (deaths during entire observation period). Virologic failure was defined as VL ≥ 200 copies/mL at 12 (range 9–15) months after treatment initiation. Cox proportional hazards regression and logistic regression models were used to evaluate the effects of baseline VL on mortality and virologic failure. Results The cohort included 9791 HIV patients; 50.1% of patients had baseline VL test at ART initiation, and only 18.4% had a baseline VL level of < 10,000 copies/mL. ART initiation at higher VL was significantly associated with the early mortality (10,000–99,999 copies/mL: AHR = 2.4; ≥100,000 copies/mL: AHR = 3.4) and the overall mortality (≥ 100,000 copies/mL: AHR = 1.7). Patients with VL ≥ 100,000 copies/mL and without baseline VL at ART initiation had higher virologic failure rate (AOR = 3.5 and AOR = 3.2, respectively). Conclusions ART initiation with higher VL was significantly associated with a greater risk of mortality and virologic failure, especially in the early stage of treatment. Baseline VL is essential for medical staff as it allows monitoring of treatment effect and allows for interventions to reduce HIV transmission. Continued efforts are needed to enhance the coverage of baseline VL testing.

scholarly journals Mortality and survival benefits in people living with human immunodeficiency virus initiated newly with Antiretroviral therapy irrespective of CD4 count

2020 ◽  
Vol 7 (2) ◽  
pp. 272
Author(s):  
Diwakar T. N. ◽  
Raghavendra B. C. ◽  
Keerthi Kumar N.
Keyword(s):  
Antiretroviral Therapy ◽  
Pulmonary Tuberculosis ◽  
Opportunistic Infections ◽  
Cd4 Count ◽  
People Living With Hiv ◽  
Art Initiation ◽  
Global Pandemic ◽  
Kaplan Meier ◽  
One Year ◽  
Living With Hiv

Background: HIV is a global pandemic with estimated 37.9 million people living with HIV(PLHIV) worldwide in which 23.3 million (62%) PLHIV take antiretroviral therapy (ART). In 2018 UNAIDS estimated 7,70,000 people died from AIDS related illness globally. India has around 21,40,000 PLHIV and 69,110 AIDS-related deaths in 2017 according to NACO report. This study aims to know the mortality and survival benefits in PLHIV newly initiated on ART as per test and treat policy.Methods: A prospective observational cohort study was conducted from June 2017 to June 2018, involving 100 ART-naïve PLHIV attending this ART Centre at Hospitals attached to BMCRI, Bangalore, India. Survival analysis was done by Kaplan Meier estimates. Spectrum of opportunistic infections and their role in cause of mortality was studied.Results: The overall survival rate was 92% at 6 months and 91% at one year after ART initiation. The mortality rate at the end of one year was 9%, out of which Pulmonary Tuberculosis is the most common cause of mortality. There was a significant increase in the CD4 count during follow up, the mean increase in the CD4 T-cell count at the end of 6 months and 12 months was 157 cells and 286 cells per cubic millimeter respectively above the baseline value.Conclusions: In this study early initiation of ART is found to be beneficial in clinical and immunological recovery with increase in CD4 counts and reduction in opportunistic infections in PLHIV. Pulmonary Tuberculosis remains the grave risk factor for mortality among PLHIV/AIDS patients on ART.

scholarly journals Antiretroviral therapy, CD4, viral load, and disease stage in HIV patients in Saudi Arabia: a 2001–2013 cross-sectional study

2015 ◽  
Vol 9 (07) ◽  
pp. 765-769 ◽  
Author(s):  
Ziad A Memish ◽  
Jaffar A Al-Tawfiq ◽  
Sanaa M Filemban ◽  
Syed Qutb ◽  
Abdullah Fodail ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Cd4 Count ◽  
Disease Stage ◽  
Care Providers ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Hiv Aids

Introduction: The incidence of HIV/AIDS is increasing worldwide and in the Middle East. In this study, we analyzed the use of antiretroviral therapy (ART), the patterns of CD4 and viral load (VL), and stage of presentation. Methodology: Laboratory variables, ART use, and CD4 count were obtained and analyzed retrospectively. Results: A total of 997 cases from eight HIV/AIDS care providers were included. Of the total cases, 274 (28.3%) had a CD4 count of < 200 cells/mm3, and 413 (42.3%) had a viral load of > 5 log10. Of the total cases, 50% were on highly active antiretroviral therapy (HAART), and the majority of cases were asymptomatic (70%). Of those patients on ART, 247 (39.5%) took tenofovir/emtricitabine combined with either efavirenz (147; 14.7%) or lopinavir/ritonavir (100; 10%), and 158 (15.8%) were on lamivudine and zidovudine with either efavirenz (32; 3.2%) or lopinavir/ritonavir (126; 12.6%). Other combinations were used in 70 (7%) patients. The mean (± standard deviation) of baseline CD4 and viral load were 401 cells/mm3 (322 cells/mm3) and 4.6 log1010 (1.3 log10), respectively. At diagnosis, 72% of patients were asymptomatic; 50% had AIDS and 20% had CD4 count < 350. Conclusions: ART use was in line with international guidelines, but the number of patients receiving ART was lower than expected. Large proportions of cases presented late with AIDS at diagnosis or had CD4 < 350. Further data is needed to evaluate the medical care of patients with HIV/AIDS in the Kingdom of Saudi Arabia.

scholarly journals Rate and predictors of Treatment Failure among pediatric population taking Highly Active Antiretroviral Therapy in Ethiopia

2019 ◽  
Author(s):  
Yimam Getaneh ◽  
Ajanaw Yizengaw ◽  
Agajie Likie ◽  
Mulusew Getahun ◽  
Altaye Feleke ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Viral Load ◽  
Treatment Failure ◽  
Pediatric Patients ◽  
Virologic Failure ◽  
Pediatric Population ◽  
Clinical Stage ◽  
Cd4 Count ◽  
Art Initiation ◽  
Disclosure Status

AbstractBackgroundThough the unprecedented global effort at scaling up universal access to antiretroviral therapy (ART) has decreased the progression of HIV, treatment failure (TF) among pediatric patients receiving ART against human immunodeficiency virus (HIV) is becoming a global public health concern which may impact on treatment outcome. Thus, the aim of this study was to determine the rate and predictors of treatment failure (TF) among HIV-infected pediatric patients taking ART in Ethiopia.MethodsA prospective and retrospective follow-up study was conducted from March 2016 to 2017. Retrospective clinical and laboratory data were captured from patients’ medical record. Socio-demographics and explanatory variables of participants were collected using pre-tested structured questionnaire and study participants were followed for three to six month after baseline viral load has been done to classify virologic failure (VF). TF was ascertained from population who virally failed with the denominator of population taking ART. Chi-square test and multiple logistic regressions were conducted to assess predictors TF. Statistical significance was set at P-value less than 0.05.ResultsA total of 554 pediatrics patients taking ART from 40 selected health facilities were included in the study. Viral load suppression (VLS) (VL<1000 copies/ml) among pediatric population taking ART in Ethiopia were found to be 344 (62.1%). From those who was not virally suppressed at baseline of the study 210 (37.9%), 99 (51.6%) were re-suppressed after three to six month of enhanced adherence and counseling, leading the overall virologic failure (VF) among pediatric population taking ART in Ethiopia to be 93 (17.3%). The mean CD4 count was improved from 490 cells/ml at ART initiation to 921 cells/ml after 80 months of ART exposure. Moreover, the clinical outcome was improved from 42% to 89% at ART initiation and after 80 month of ART experience. CD4 count, clinical stage, Hemoglobin and weight were found to be predictors of VF. Moreover; family HIV and disclosure status, duration on ART, age, being orphan, stigma and medication adherence have significant association with VF.ConclusionsThe low level of VLS (62.1%) and the high level of VF (18.3%) could explain the challenge on the national ART program among pediatric population. The significant improvement on immunologic and clinical outcome could indicate the success of ART on treatment outcome among pediatric population. CD4 count, clinical stage, Hemoglobin and weight could be good predictors of TF among pediatric population. Improving disclosure status, stigma and medication adherence could improve the treatment outcome of pediatric population taking ART in Ethiopia.

Coexistence of disseminated Kaposi sarcoma and multicentric Castleman disease in an HIV-infected patient under viral suppression

2021 ◽  
Vol 32 (3) ◽  
pp. 286-289
Author(s):  
I-Fan Lin ◽  
Jiun-Nong Lin ◽  
Tsung-Heng Tsai ◽  
Chao-Tien Hsu ◽  
Yu-Ying Wu ◽  
...  
Keyword(s):  
Viral Load ◽  
Viral Suppression ◽  
Liposomal Doxorubicin ◽  
Kaposi Sarcoma ◽  
Castleman Disease ◽  
Severe Thrombocytopenia ◽  
Multicentric Castleman Disease ◽  
Progressive Pancytopenia ◽  
One Year ◽  
Cd4 T Cell Count

Coexistence of multicentric Castleman disease and Kaposi sarcoma is rare and might be missed without an experienced pathologists’ interpretation. A 46-year-old man had been diagnosed with HIV infection and treated with combination antiretroviral therapy of dolutegravir/abacavir/lamivudine (Triumeq) for one year. The latest viral load was 49 copies/mL and CD4 T-cell count was 192 cells/uL. He was admitted due to fever off and on, splenomegaly, general lymphadenopathy, and severe thrombocytopenia for two months. Biopsy of a purplish skin lesion and gastric tissue showed Kaposi sarcoma. The pathology of inguinal lymph nodes revealed coexistence of Kaposi sarcoma and multicentric Castleman disease. The plasma Kaposi sarcoma herpesvirus viral load was 365,000 copies/mL. During hospitalization, progressive pancytopenia and spiking fever persisted, and he died of multi-organ failure before completion of chemotherapeutic treatments with rituximab plus liposomal doxorubicin.

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