Castleman's disease and retroviral therapy

The escalating pandemic of the acquired immunodeficiency disease in sub-Saharan Africa is associated with an increasing incidence of the lymphoproliferative disorders where evidence shows that highly active retroviral therapy can reconstitute immunologic competence and, at least in some groups exemplified by Kaposi's sarcoma, result in an outcome comparable to uninfected controls. Paradoxically other subtypes are less responsive exemplified by Burkitt lymphoma and multicentric Castleman's disease, where they are localised and may present after starting treatment. This association provides a model to test the concept that pathogenesis may reflect an aberrant response to antigens including human herpesvirus-8 thereby renewing focus on proactive inclusion of anti-herpes drugs with conventional treatment for retrovirus particularly prior to initiating chemotherapy.