HIV/AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute.
Pharmacy Department, Clinical Center, National Institutes of Health.
AIDS. 2022 Nov 15;36(14):1969-1978. doi: 10.1097/QAD.0000000000003333. Epub 2022 Jul 16.
There are four conditions caused by Kaposi sarcoma herpesvirus (KSHV): Kaposi sarcoma, KSHV-associated multicentric Castleman disease (MCD), primary effusion lymphoma (PEL), and KSHV inflammatory cytokine syndrome (KICS). These KSHV-associated disorders (KADs) often occur in people with HIV and can lead to multiorgan dysfunction requiring admission to the ICU. However, little is known about patient outcomes in this setting.
A retrospective study of patients with KADs admitted to the ICU between 2010 and 2021 was conducted, examining KAD admission diagnoses, HIV characteristics, selected cytokine profiles, and ICU interventions. Primary outcomes were 60-day and median overall survival from ICU admission to death from any cause.
Forty-seven patients (all but one with HIV coinfection) were included. At ICU admission, 44 patients (94%) were on antiretroviral therapy with a median CD4 + count of 88 cells/μl and HIV viral load of 23 copies/ml. The most common presentation was respiratory failure alone (19%) or with hypotension (17%). Twenty-two (47%) patients had presumed KICS (with or without Kaposi sarcoma) at admission and an additional KAD was diagnosed in 36% of these patients. IL-6 levels did not vary across KAD subtype. Twenty (43%) patients received KAD-directed therapy in the ICU. Sixty-day survival was 70% and median overall survival was 9 months.
The majority of patients with HIV and KADs admitted to the ICU had well controlled HIV. Additional KAD were diagnosed during ICU admission in a proportion of patients who presented with presumed KICS. Critical illness did not preclude a subset of patients from receiving KAD-directed therapy in the ICU.
卡波西肉瘤疱疹病毒（KSHV）可引起四种病症：卡波西肉瘤、KSHV 相关多中心 Castleman 病（MCD）、原发性渗出性淋巴瘤（PEL）和 KSHV 炎症细胞因子综合征（KICS）。这些 KSHV 相关疾病（KAD）常发生于 HIV 感染者中，并可导致多器官功能障碍，需要入住 ICU。然而，对于此类患者的预后情况，我们知之甚少。
对 2010 年至 2021 年期间入住 ICU 的 KAD 患者进行了回顾性研究，研究内容包括 KAD 入院诊断、HIV 特征、选定细胞因子谱和 ICU 干预措施。主要结局是从 ICU 入院到因任何原因死亡的 60 天和中位总生存率。
共纳入 47 例患者（除 1 例外均合并 HIV 感染）。入 ICU 时，44 例（94%）患者正在接受抗逆转录病毒治疗，中位 CD4+计数为 88 个/μl，HIV 病毒载量为 23 拷贝/ml。最常见的表现是单纯呼吸衰竭（19%）或伴有低血压（17%）。22 例（47%）患者入院时被诊断为疑似 KICS（伴有或不伴有卡波西肉瘤），其中 36%的患者被诊断出患有其他 KAD。细胞因子 IL-6 水平在不同 KAD 亚型之间没有差异。20 例（43%）患者在 ICU 接受了 KAD 靶向治疗。60 天生存率为 70%，中位总生存率为 9 个月。
大多数入住 ICU 的 HIV 合并 KAD 患者的 HIV 得到了很好的控制。在一部分以疑似 KICS 为表现的患者中，在 ICU 住院期间又诊断出了其他 KAD。危重症并未排除一部分患者在 ICU 接受 KAD 靶向治疗的可能性。
