Kaposi’s Sarcoma in Virally Suppressed People Living with HIV: An Emerging Condition

Since the advent of highly effective combined antiretroviral treatment (cART), and with the implementation of large HIV testing programs and universal access to cART, the burden of AIDS-related comorbidities has dramatically decreased over time. The incidence of Kaposi’s sarcoma (SK), strongly associated with HIV replication and CD4 immunosuppression, was greatly reduced. However, KS remains the most common cancer in patients living with HIV (PLHIV). HIV physicians are increasingly faced with KS in virally suppressed HIV-patients, as reflected by increasing description of case series. Though SK seem less aggressive than those in PLHIV with uncontrolled HIV-disease, some may require systemic chemotherapy. Persistent lack of specific anti-HHV-8 cellular immunity could be involved in the physiopathology of these KS. These clinical forms are a real therapeutic challenge without possible short-term improvement of anti-HHV-8 immunity, and no active replication of HIV to control. The cumulative toxicity of chemotherapies repeatedly leads to a therapeutic dead end. The introduction or maintenance of protease inhibitors in cART does not seem to have an impact on the evolution of these KS. Research programs in this emerging condition are important to consider new strategies.

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Kaposi’s sarcoma in persons living with HIV/AIDS: a case series in a tertiary referral hospital

Anais Brasileiros de Dermatologia ◽

10.1590/abd1806-4841.20186978 ◽

2018 ◽

Vol 93 (4) ◽

pp. 524-528

Author(s):

Carla Andréa Avelar Pires ◽

Marcos Antonio Neves Noronha ◽

Julius Caesar Mendes Soares Monteiro ◽

Albert Luiz Costa da Costa ◽

José Maria de Castro Abreu Júnior

Keyword(s):

Kaposi's Sarcoma ◽

Case Series ◽

Kaposi’S Sarcoma ◽

Referral Hospital ◽

Tertiary Referral ◽

Tertiary Referral Hospital ◽

Persons Living With Hiv ◽

Living With Hiv ◽

Hiv Aids

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Association of IL-6, IL-10 and CXCL10 serum concentrations with visceral Kaposi's sarcoma in people living with HIV/AIDS

Human Immunology ◽

10.1016/j.humimm.2019.11.007 ◽

2020 ◽

Vol 81 (1) ◽

pp. 26-31 ◽

Cited By ~ 2

Author(s):

Thaísa Regina Rocha Lopes ◽

Juliana Prado Gonçales ◽

José Valter Joaquim Silva Júnior ◽

Virginia Maria Barros de Lorena ◽

Ana Luiza Castro Conde Toscano ◽

...

Keyword(s):

Kaposi's Sarcoma ◽

Kaposi’S Sarcoma ◽

People Living With Hiv ◽

Serum Concentrations ◽

Living With Hiv ◽

Hiv Aids

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Epidemiology of Kaposi’s Sarcoma

Cancers ◽

10.3390/cancers13225692 ◽

2021 ◽

Vol 13 (22) ◽

pp. 5692

Author(s):

Sophie Grabar ◽

Dominique Costagliola

Keyword(s):

Hiv Infection ◽

Kaposi's Sarcoma ◽

Human Herpesvirus ◽

Kaposi’S Sarcoma ◽

Sub Saharan Africa ◽

Hiv Replication ◽

Early Access ◽

Sub Saharan ◽

Sex With Men ◽

Living With Hiv

Kaposi’s sarcoma is an angioproliferative tumor caused by human herpesvirus 8 in the context of immunodeficiency, such as that induced by HIV infection or immunosuppressive therapy. Its incidence has dramatically fallen in patients living with HIV (PLHIV) since the introduction of potent antiretroviral combinations 25 years ago due to the restoration of immunity and better control of HIV replication. However, KS is still one of the most frequently occurring cancers in PLHIV, in particular in men who have sex with men and in sub-Saharan Africa, where it is still endemic. Even in the context of restored immunity, the risk of KS is still more than 30 times higher in PLHIV than in the general population. Recent evidence indicates that early initiation of antiretroviral treatment, which is recommended by current guidelines, may reduce the risk of KS but it needs to be accompanied by early access to care. This review mainly focuses on the recent epidemiological features of KS in the context of HIV infection.

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The Kaposi’s Sarcoma-Associated Herpesvirus (KSHV) gH/gL Complex Is the Predominant Neutralizing Antigenic Determinant in KSHV-Infected Individuals

Viruses ◽

10.3390/v12030256 ◽

2020 ◽

Vol 12 (3) ◽

pp. 256 ◽

Cited By ~ 2

Author(s):

Yasaman Mortazavi ◽

Salum J. Lidenge ◽

Tara Tran ◽

John T. West ◽

Charles Wood ◽

...

Keyword(s):

Antigenic Determinant ◽

Neutralizing Antibodies ◽

Kaposi's Sarcoma ◽

Kaposi’S Sarcoma ◽

Sub Saharan Africa ◽

People Living With Hiv ◽

Viral Glycoproteins ◽

Kaposi's Sarcoma Associated Herpesvirus ◽

Sub Saharan ◽

Kaposi’S Sarcoma Associated Herpesvirus

Kaposi’s sarcoma-associated herpesvirus (KSHV) is the etiological agent of Kaposi’s sarcoma (KS), one of the most prevalent cancers of people living with HIV/AIDS in sub-Saharan Africa. The seroprevalence for KSHV is high in the region, and no prophylactic vaccine against the virus is available. In this study, we characterized the antigenic targets of KSHV-specific neutralizing antibodies (nAbs) in asymptomatic KSHV-infected individuals and KS patients with high nAbs titers. We quantified the extent to which various KSHV envelope glycoproteins (gB, ORF28, ORF68, gH, gL, gM, gN and gpK8.1) adsorbed/removed KSHV-specific nAbs from the plasma of infected individuals. Our study revealed that plasma from a majority of KSHV neutralizers recognizes multiple viral glycoproteins. Moreover, the breadth of nAbs responses against these viral glycoproteins varies among endemic KS, epidemic KS and asymptomatic KSHV-infected individuals. Importantly, among the KSHV glycoproteins, the gH/gL complex, but neither gH nor gL alone, showed the highest adsorption of KSHV-specific nAbs. This activity was detected in 80% of the KSHV-infected individuals regardless of their KS status. The findings suggest that the gH/gL complex is the predominant antigenic determinant of KSHV-specific nAbs. Therefore, gH/gL is a potential target for development of KSHV prophylactic vaccines.

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Evidence for Kaposi's sarcoma-associated herpes virus infection in patients with idiopathic pulmonary arterial hypertension: a case series and review of the literature

Current Medical Research and Opinion ◽

10.1185/030079907x199583 ◽

2007 ◽

Vol 23 (sup2) ◽

pp. S83-S87

Author(s):

Naushad Hirani ◽

Alessandra Manes ◽

Carlo Parravicini ◽

Chiara Scalamogna ◽

Massimiliano Palazzini ◽

...

Keyword(s):

Pulmonary Arterial Hypertension ◽

Virus Infection ◽

Arterial Hypertension ◽

Kaposi's Sarcoma ◽

Case Series ◽

Kaposi’S Sarcoma ◽

Idiopathic Pulmonary Arterial Hypertension ◽

Review Of The Literature ◽

Herpes Virus Infection ◽

Pulmonary Arterial

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1325. Inpatient Initiation of ART Improves Short-Term Mortality in People Living with HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1188 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S479-S479

Author(s):

Jamie Campbell ◽

Christopher Polk ◽

Danya Roshdy ◽

Michael Leonard

Keyword(s):

Hospice Care ◽

Intervention Group ◽

People Living With Hiv ◽

Virologic Suppression ◽

Short Term ◽

Patient Admissions ◽

Short Term Mortality ◽

Living With Hiv ◽

The Impact

Abstract Background Treatment of HIV is recommended as soon as possible and early initiation of combined antiretroviral therapy (cART) is associated with improved engagement in care; however, treatment with cART is often deferred in hospitalized patients despite being correlated with improved outcomes. We implemented an institutional intervention to ensure all people living with HIV (PLwH) were on cART during hospitalization to improve patient outcomes. Methods We prospectively identified all PLwH hospitalized at our institution and had ID physicians and pharmacists ensure they were on appropriate cART and linked to outpatient care. We retrospectively collected clinical and lab data to assess the impact of our intervention on inpatient mortality, 30-day mortality, 30-day readmission rate, and frequency of outpatient follow-up. Patients were excluded from analysis if they were admitted for hospice care. Results We identified 389 patient admissions in 275 unique patients, of which 304 admissions were already on cART at admission. After ID physician assessment, 37 of the 85 not on cART at admission were initiated on therapy. We assessed the impact of this intervention on short-term outcomes as listed in Table 1. Despite the intervention group having similar immunologic and virologic baseline characteristics to those not initiated on cART, their inpatient and 30-day mortality was similar to those already on cART. Readmission rates also decreased in the intervention group. Thirteen of 24 patients in the intervention group who could be tracked for long-term follow-up within our system achieved virologic suppression by 90 days after hospital discharge. Conclusion Inpatient treatment with cART during hospitalization improves short-term mortality outcomes. This study also demonstrates the value of inpatient cART treatment as most patients achieved virologic suppression at subsequent outpatient follow-up. Disclosures All authors: No reported disclosures.

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