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Identifying Dysregulated Genes Induced by Kaposi's Sarcoma-associated Herpesvirus KSHV
Published on: September 14, 2010
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Immune Reconstitution Inflammatory Syndrome Associated Kaposi Sarcoma
Isabelle Poizot-Martin1, Sylvie Brégigeon2, Romain Palich3
1Assistance Publique-Hôpitaux de Marseille (APHM), Inserm, Institut de Recherche pour le Développement (IRD), SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, APHM Sainte-Marguerite, Service D'immuno-Hématologie Clinique, Aix-Marseille Université, 13009 Marseille, France.
Cancers
|February 25, 2022
Summary
Immune reconstitution inflammatory syndrome (IRIS) can cause new or worsening Kaposi sarcoma (KS) in people with HIV starting antiretroviral therapy (ART). Management requires chemotherapy alongside ART, avoiding glucocorticoids.
Area of Science:
- Immunology
- Infectious Diseases
- Oncology
Background:
- Antiretroviral therapy (ART) is crucial for managing HIV/AIDS but can trigger immune reconstitution inflammatory syndrome (IRIS).
- Kaposi sarcoma (KS) is an AIDS-associated malignancy susceptible to KS-IRIS, presenting as new onset (unmasking) or progression (paradoxical) after ART initiation.
- KS-IRIS incidence varies widely (2.4%–39%) and can occur even in less immunocompromised individuals.
Purpose of the Study:
- To review the occurrence, risk factors, and management of Kaposi sarcoma immune reconstitution inflammatory syndrome (KS-IRIS) in people living with HIV (PLWH).
- To highlight the clinical implications and recommended treatment strategies for KS-IRIS.
Main Methods:
- Literature review and synthesis of existing data on KS-IRIS.
- Analysis of risk factors, including advanced KS tumor stage, high HIV viral load, and KSHV presence.
- Evaluation of treatment outcomes and mortality associated with KS-IRIS.
Main Results:
- Key risk factors for KS-IRIS include advanced KS (T1), pre-treatment HIV viral load >5 log10 copies/mL, and detectable plasma-KSHV.
- Initiation of ART alone without chemotherapy increases KS-IRIS risk.
- Thrombocytopenia at 12 weeks is a predictor of mortality in KS-IRIS patients.
Conclusions:
- KS-IRIS is a significant complication of ART initiation in PLWH with KS, associated with considerable morbidity and mortality.
- Management involves concurrent chemotherapy with ART; glucocorticoids are contraindicated.
- Further research is needed to assess the role of targeted therapies in preventing or treating KS-IRIS.
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