Powles T, Stebbing J, Bazeos A, Hatzimichael E, Mandalia S, Nelson M, Gazzard B, Bower M
Department of Medical Oncology, Barts and the London Medical School, London, UK.
Ann Oncol. 2009 Apr;20(4):775-9. doi: 10.1093/annonc/mdn697. Epub 2009 Jan 29.
In HIV cohorts with access to highly active antiretroviral therapy (HAART), the incidence of Kaposi's sarcoma (KS) is falling; however, the incidence of multicentric Castleman's disease (MCD) in HIV has not previously been described.
The incidence of HIV-associated MCD was calculated from a prospective HIV database with 56 202 patient-years of follow-up and compared with KS. Univariate and multivariate analyses were carried out to identify factors associated with MCD. Plasma human herpesvirus (HHV)-8 DNA levels were measured in HIV-seropositive individuals with newly diagnosed MCD (n = 24), KS (n = 72), HIV-associated lymphoma (n = 74) and HIV-positive controls (n = 53).
From 24 cases of HIV-associated MCD, the incidence measured 4.3/10,000 patient-years [95% confidence interval (CI) 2.7-6.4]. The incidence in the pre-HAART (1983-1996), early-HAART (1997-2001) and later HAART (2002-2007) eras were 2.3 (95% CI 0.02-4.2), 2.8 (95% CI 0.9-6.5) and 8.3 (95% CI 4.6-12.6), respectively, representing a statistically significant increase over time (P < 0.05). In contrast, from 1180 cases of KS, the incidence in this cohort decreased with time. Multivariate analysis demonstrated that a nadir CD4 count >200/mm(3), increased age, no previous HAART exposure and non-Caucasian ethnicity were all associated with an increased risk of MCD. Plasma HHV-8 DNA levels were higher in patients with newly diagnosed MCD than with KS, lymphomas or HIV-positive controls (Mann-Whitney U-test, P < 0.0001).
The incidence of HIV-associated MCD is increasing. It appears to occur more frequently in older HIV-positive individuals with well-preserved immune function.
在可获得高效抗逆转录病毒治疗（HAART）的HIV队列中，卡波西肉瘤（KS）的发病率正在下降；然而，HIV相关的多中心Castleman病（MCD）的发病率此前尚未见报道。
根据一个前瞻性HIV数据库计算HIV相关MCD的发病率，该数据库有56202患者年的随访数据，并与KS进行比较。进行单因素和多因素分析以确定与MCD相关的因素。对新诊断为MCD（n = 24）、KS（n = 72）、HIV相关淋巴瘤（n = 74）和HIV阳性对照（n = 53）的HIV血清阳性个体测量血浆人疱疹病毒（HHV）-8 DNA水平。
在24例HIV相关MCD病例中，发病率为4.3/10000患者年[95%置信区间（CI）2.7 - 6.4]。HAART前（1983 - 1996年）、HAART早期（1997 - 2001年）和HAART后期（2002 - 2007年）的发病率分别为2.3（95%CI 0.02 - 4.2）、2.8（95%CI 0.9 - 6.5）和8.3（95%CI 4.6 - 12.6），随时间呈统计学显著增加（P < 0.05）。相比之下，在1180例KS病例中，该队列中的发病率随时间下降。多因素分析表明，最低点CD4细胞计数>200/mm³、年龄增加、既往未接受HAART治疗以及非白种人种族均与MCD风险增加相关。新诊断为MCD的患者血浆HHV - 8 DNA水平高于KS、淋巴瘤或HIV阳性对照患者（曼 - 惠特尼U检验，P < 0.0001）。
HIV相关MCD的发病率正在增加。它似乎在免疫功能保存良好的老年HIV阳性个体中更频繁发生。
