Kaposi sarcoma-associated herpesvirus

Background

• One of the human herpesviruses (family Herpesviridae, subfamily Gammaherpesvirinae)
• Seroprevalence varies by geography and group
  • US general population 1-5%
  • US men who have sex with men 15-20%
  • US MSM with HIV 30-35%
  • Some Mediterranean countries 10-20%
  • Sub-Saharan African countries 30-80%
• Possibly transmitted through saliva or sex

Clinical Manifestations

• Mostly asymptomatic
• Primary infection consists of fever, rash, lymphadenopathy, and bone marrow failure, and may rapidly progress to Kaposi sarcoma
• Kaposi sarcoma (KS)
  • Hyperpigmented macules or nodules
  • Mostly skin but can include mouth, respiratory tract, and GI tract as well
• Primary effusion lymphoma (PEL)
  • Causes effusions isolated to the pleural, pericardial, or abdominal cavities
  • Occasionally causes mass lesions and extracavitary disease within skin, hematopoietic organs, and the GI tract
• Multicentric Castleman disease (MCD)
  • Causes systemic symptoms including fever and night sweats, generalized adenopathy, fever, and hepatosplenomegaly
• Kaposi sarcoma-associated herpesvirus inflammatory cytokine syndrome (KICS)
  • Like MCD but without pathology demonstrating MCD
  • Patients are often critically ill

Management

• For Kaposi sarcoma with symptomatic visceral involvement, chemotherapy is recommended
  • May be indicated for disseminated cutaneous KS as well

Further Reading

• Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. NIH, CDC, HIVMA, and IDSA. Available at https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-opportunistic-infection