Concurrent HIV viral blips during two episodes of multicentric Castleman disease in an adult on antiretroviral therapy: Implication for HIV persistence
Ilyse Darwish,
Cecilia Costiniuk,
Nadine Kronfli,
David Haegert,
Jean-Pierre Routy
Affiliations
Ilyse Darwish
Division of Infectious Diseases, McGill University Health Centre, Montréal, Quebec, Canada
Cecilia Costiniuk
Division of Infectious Diseases, McGill University Health Centre, Montréal, Quebec, Canada; Chronic Viral Illness Service, McGill University Health Centre, Montréal, Quebec, Canada; Department of Microbiology and Immunology, McGill University, Montréal, Quebec, Canada
Nadine Kronfli
Division of Infectious Diseases, McGill University Health Centre, Montréal, Quebec, Canada; Chronic Viral Illness Service, McGill University Health Centre, Montréal, Quebec, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
David Haegert
Department of Pathology, McGill University Health Centre, Montréal, Quebec, Canada
Jean-Pierre Routy
Chronic Viral Illness Service, McGill University Health Centre, Montréal, Quebec, Canada; Department of Microbiology and Immunology, McGill University, Montréal, Quebec, Canada; Division of Hematology, McGill University Health Centre, Montréal, Quebec, Canada; Correspondence to: McGill University, Research Institute of McGill University Health Centre: Glen site, 1001 Boulevard Décarie, EM 3-3232, Montréal, Quebec H4A 3J1, Canada.
Human herpesvirus-8 (HHV8)-associated multicentric Castleman disease (HHV8-MCD) is a rare nonmalignant lymphoproliferative disorder most commonly observed in PLWH. Herein, we describe an HIV-infected adult male from Cameroon with relapsing HHV8-MCD (HIV+MCD). The patient developed constitutional symptoms, diffuse lymphadenopathy, thrombocytopenia and autoimmune hemolytic anemia. Excisional lymph node biopsy findings were consistent with HHV8-MCD. He was successfully treated with corticosteroids and rituximab. One year later, he developed relapsing disease and was successfully treated again with rituximab. Interestingly, HIV viral load blips correlate with MCD flares, suggesting that low-level viremia is linked with T-cell clonal expansion and/or inflammation, rather than a lack of effective antiretroviral therapy. Rituximab either alone or in combination with chemotherapy for aggressive disease is the standard of care, with approximately 95% of treated patients achieving complete remission. Despite highly effective therapy, HIV+MCD often presents with a relapsing and remitting disease course and carries an increased risk for the development of HHV8-associated lymphoma.
