title: Plasma HHV8 DNA predicts relapse in individuals with HIV-associated multicentric Castleman disease.
abstract: HIV-associated multicentric Castleman disease (HIV-MCD) is a rare lymphoproliferative disorder caused by infection with human herpesvirus-8. The disease follows a relapsing and remitting clinical course, with marked systemic symptoms during an active attack, which can prove fatal. Its incidence is rising, and new data indicate the utility of the anti-CD20 monoclonal antibody rituximab at inducing remissions in both first- and second-line settings, although biomarkers associated with relapse have not been previously identified. In 52 individuals with a histologic diagnosis of HIV-MCD, we performed univariate and multivariate analyses to predict factors associated with an HIV-MCD attack. Although a younger age (< 50 years) was associated with an attack, the strongest association was observed with plasma levels of human herpesvirus-8 DNA. Rising levels predicted an attack (hazard ratio = 2.9; 95% confidence interval, 1.3-6.7), and maintenance therapy with rituximab should be considered in these individuals.
authors.affiliation: Department of HIV Medicine, Imperial College, Chelsea and Westminster Hospital, London, United Kingdom. j.stebbing@imperial.ac.uk
authors.forename: Justin
authors.initials: J
authors.lastname: Stebbing
authors.forename: Caroline
authors.initials: C
authors.lastname: Adams
authors.forename: Adam
authors.initials: A
authors.lastname: Sanitt
authors.forename: Salvinia
authors.initials: S
authors.lastname: Mletzko
authors.forename: Mark
authors.initials: M
authors.lastname: Nelson
authors.forename: Brian
authors.initials: B
authors.lastname: Gazzard
authors.forename: Tom
authors.initials: T
authors.lastname: Newsom-Davis
authors.forename: Mark
authors.initials: M
authors.lastname: Bower
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000097:blood / Q000175:diagnosis / Q000821:virology; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D005871:Castleman Disease / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000821:virology; D004279:DNA, Viral / Q000097:blood* / Q000302:isolation & purification*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D006566:Herpesviridae Infections / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000821:virology; D019288:Herpesvirus 8, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D055815:Young Adult
chemical_list: D015415:Biomarkers; D004279:DNA, Viral