Human Herpesvirus-8 Disease Flashcards
(50 cards)
What is the estimated seroprevalence of human herpesvirus-8 (HHV-8) in the general U.S. population?
1% to 5%
This compares to 10% to 20% in certain Mediterranean countries and 30% to 80% in parts of sub-Saharan Africa.
Which groups are at increased risk for HHV-8 infection in the United States?
Men who have sex with men (MSM) and persons with HIV infection
Among MSM without HIV, seroprevalence ranges from 13% to 20%, increasing to 30% to 35% among MSM with HIV.
What diseases are etiologically associated with HHV-8?
Kaposi sarcoma (KS), primary effusion lymphoma (PEL), multicentric Castleman’s disease (MCD)
KS includes classic, endemic, transplant-related, and AIDS-related forms.
What is the increased risk of developing Kaposi sarcoma for patients with HHV-8 viremia?
Approximately nine-fold
This is relative to those without HHV-8 viremia.
What is the overall prevalence of Kaposi sarcoma in the U.S. among patients with AIDS before effective antiretroviral therapy (ART)?
As high as 30%
The incidence rose steeply between 1981 and 1987, then gradually declined.
What factors contributed to the reduction in Kaposi sarcoma incidence prior to widespread ART availability?
- Deaths of patients with advanced AIDS
- Increasing use of antiviral drugs
Antiviral drugs included zidovudine, ganciclovir, foscarnet, and cidofovir.
True or False: Kaposi sarcoma is one of the most common cancers among the AIDS population in the U.S.
True
HIV infection increases the risk of KS several thousand fold even in the ART era.
What are the common clinical manifestations of Kaposi sarcoma?
- Nontender, hyperpigmented skin lesions
- Oral lesions
- Lymphatic involvement
- Visceral involvement
Oral lesions occur in approximately one-third of patients and may predict pulmonary involvement.
What is the characteristic presentation of primary effusion lymphoma (PEL)?
Effusions isolated within pleural, pericardial, or abdominal cavities
Mass lesions and ‘extracavitary’ disease may also occur.
What are the systemic symptoms associated with multicentric Castleman’s disease (MCD)?
- Fever
- Night sweats
- Generalized adenopathy
- Hepatosplenomegaly
MCD may mimic other inflammatory conditions.
What is the role of serologic testing for HHV-8 antibodies in diagnostics?
Currently not indicated for diagnostic testing or routine screening
This is due to lack of standardization and poor sensitivity and specificity.
What is the suspected primary mode of transmission for HHV-8?
Saliva
Asymptomatic HHV-8 infection is often associated with shedding in saliva.
Fill in the blank: Early initiation of _______ is likely to be the most effective measure for the prevention of Kaposi sarcoma.
ART
This is particularly important for HIV-positive individuals.
What chemotherapy agents are preferred for treating Kaposi sarcoma with visceral involvement?
- Liposomal doxorubicin
- Paclitaxel
Liposomal doxorubicin is preferred due to lower toxicity.
What is a significant concern when using corticosteroids in patients with Kaposi sarcoma?
Potential exacerbation of life-threatening disease
Corticosteroids are associated with the development of KS.
What are the recommended treatments for primary effusion lymphoma?
- Chemotherapy
- ART
Limited data exists due to the rarity of PEL.
What treatment options are available for multicentric Castleman’s disease?
- IV ganciclovir
- Oral valganciclovir
- Rituximab
Combination therapies have shown some benefit.
What is Immune Reconstitution Inflammatory Syndrome (IRIS)?
A condition that may occur among HHV-8-infected patients initiating ART
KS-IRIS can present as unmasking or worsening of KS.
What are the risk factors for developing KS-IRIS?
- Advanced KS tumor stage (T1)
- Pre-treatment HIV viral load >5 log10 copies/mL
- Detectable pre-treatment plasma HHV-8
- Initiation of ART alone without concurrent chemotherapy
KS-IRIS is associated with significant morbidity and mortality.
What are the risk factors for developing KS-IRIS?
Advanced KS tumor stage (T1), pre-treatment HIV viral load >5 log10 copies/mL, detectable pre-treatment plasma HHV-8, initiation of ART alone without concurrent chemotherapy.
KS-IRIS refers to Kaposi’s Sarcoma-Immune Reconstitution Inflammatory Syndrome.
What is the recommended treatment for KS-IRIS?
Systemic chemotherapy and supportive measures. Steroids are strongly discouraged.
Corticosteroid therapy has been associated with exacerbation of pre-existing KS in persons with HIV.
Is there data on how initiation of ART affects primary effusion lymphoma (PEL)?
No data exist on the frequency with which initiation of ART complicates the course of primary effusion lymphoma.
PEL is a type of lymphoma associated with HHV-8.
What has been observed in a small number of patients with HIV-associated MCD upon initiation of ART?
Clinical decompensation.
MCD stands for Multicentric Castleman Disease.
What are the key components of therapy for HHV-8-associated IRIS?
Suppression of HIV replication and immune reconstitution.
Initiation of ART should not be delayed.
