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J Int AIDS Soc. 2015 Aug 3;18:20122. doi: 10.7448/IAS.18.1.20122. eCollection 2015.

Characteristics and survival for HIV-associated multicentric Castleman disease in Malawi.

Author information

1
UNC Project-Malawi, Lilongwe, Malawi.
2
Program in Global Oncology, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
3
Department of Medicine, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
4
Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi; gopal@med.unc.edu.
5
Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
6
Department of Medicine, University of Malawi College of Medicine, Blantyre, Malawi.
7
Kamuzu Central Hospital, Lilongwe, Malawi.
8
United Nations Development Program, Lilongwe, Malawi.
9
Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Abstract

INTRODUCTION:

Clinical reports of multicentric Castleman disease (MCD) from sub-Saharan Africa (SSA) are scarce despite high prevalence of HIV and Kaposi sarcoma-associated herpesvirus (KSHV). Our objective is to describe characteristics and survival for HIV-associated MCD patients in Malawi. To our knowledge, this is the first HIV-associated MCD case series from the region.

METHODS:

We describe HIV-positive patients with MCD in Lilongwe, and compare them to HIV-associated lymph node Kaposi sarcoma (KS) and non-Hodgkin lymphoma (NHL) patients treated at our centre. All patients were enrolled into a prospective longitudinal cohort study at a national teaching hospital and cancer referral centre serving half of Malawi's 16 million people. We included adult patients≥18 years of age with HIV-associated MCD (n=6), lymph node KS (n=5) or NHL (n=31) enrolled between 1 June 2013 and 31 January 2015.

RESULTS AND DISCUSSION:

MCD patients had a median age of 42.4 years (range 37.2-51.8). All had diffuse lymphadenopathy and five had hepatosplenomegaly. Concurrent KS was present for one MCD patient, and four had performance status ≥3. MCD patients had lower median haemoglobin (6.4 g/dL, range 3.6-9.3) than KS (11.0 g/dL, range 9.1-12.0, p=0.011) or NHL (11.2 g/dL, range 4.5-15.1, p=0.0007). Median serum albumin was also lower for MCD (2.1 g/dL, range 1.7-3.2) than KS (3.7 g/dL, range 3.2-3.9, p=0.013) or NHL (3.4 g/dL, range 1.8-4.8, p=0.003). All six MCD patients were on antiretroviral therapy (ART) with median CD4 count 208 cells/µL (range 108-1146), and all with HIV RNA <400 copies/mL. Most KS and NHL patients were also on ART, although ART duration was longer for MCD (56.4 months, range 18.2-105.3) than KS (14.2 months, range 6.8-21.9, p=0.039) or NHL (13.8 months, range 0.2-98.8, p=0.017). Survival was poorer for MCD patients than lymph node KS or NHL.

CONCLUSIONS:

HIV-associated MCD occurs in Malawi, is diagnosed late and is associated with high mortality. Improvements in awareness, diagnostic facilities, treatment and supportive care are needed to address this likely under-recognized public health problem in SSA.

KEYWORDS:

HIV; Kaposi sarcoma; Kaposi sarcoma-associated herpesvirus; multicentric Castleman disease; non-Hodgkin lymphoma; sub-Saharan Africa

PMID:
26242311
PMCID:
PMC4524888
DOI:
10.7448/IAS.18.1.20122
[Indexed for MEDLINE]
Free PMC Article

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