Abe Seitaro, Nakamoto Takato, Aoki Takahiro, Teruya Katsuji, Gatanaga Hiroyuki
AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan; Department of Respiratory Medicine and Infectious Disease, Niigata Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan; Center for AIDS Research, Kumamoto University, Kumamoto, Japan.
J Infect Chemother. 2025 Oct;31(10):102806. doi: 10.1016/j.jiac.2025.102806. Epub 2025 Sep 1.
HIV-associated multicentric Castleman disease (HIV-MCD) is a rare, life-threatening lymphoproliferative disorder featuring systemic inflammation and marked lymphadenopathy. HIV-MCD is characterized by a human herpesvirus-8 (HHV-8) infection, with an increasing incidence despite advances in antiretroviral therapy (ART). Although HHV-8 viremia is a recognized indicator of disease recurrence, the necessity of intervention for low-level viremia reactivation remains unclear. We present a case of a man with HHV-8-associated HIV-MCD and Kaposi sarcoma (KS) who achieved a prolonged remission despite occasional episodes of low-level viremia. A 58-year-old man with untreated HIV infection presented with fever, night sweats, and fatigue. Histopathological analysis confirmed the diagnosis of HIV-MCD with KS. He received rituximab, liposomal doxorubicin, and ART which induced remission. The patient was followed for 120 weeks with serial monitoring of HHV-8 DNA levels. Although occasional viremia was observed, no relapse occurred. When mild HHV-8 reactivation occurred post-therapy without clinical relapse, we avoided unnecessary treatments with potential drug-related toxicities. No established prevention for MCD flares exists, and prolonged rituximab or valganciclovir use risks pulmonary and hematologic toxicity. Thus, HHV-8 DNA monitoring and selective interventions seem practical. Timely diagnosis and immunochemotherapy, including rituximab and liposomal doxorubicin, are critical for the management of HIV-MCD with concurrent KS. This combination mitigated KS progression. Successful management of HIV-MCD requires early recognition and administration of ART and targeted therapies, which can result in sustained remission. Close HHV-8 DNA monitoring and clinical assessment minimize the need for additional treatment, underscoring the importance of balancing efficacy and safety in individualized HIV-MCD management.
