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HIV-associated multicentric Castleman’s disease 

HIV-associated multicentric Castleman’s disease
Chapter:
HIV-associated multicentric Castleman’s disease
Author(s):

Michael Rayment

DOI:
10.1093/med/9780199665754.003.0005
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date: 21 January 2020

HIV-associated multicentric Castleman’s disease (HIV-MCD) is a rare, life-threatening complication of HIV infection. Its incidence appears to be increasing in the post-HAART era, and the disease may occur at any CD4 count, and in individuals on and off antiretroviral therapy. The links between HIV-MCD, HHV-8, and Kaposi’s sarcoma herpesvirus are described. Insights into the pathophysiology of the disorder have informed new, targeted therapies. Such therapies, including the monoclonal anti-CD20 antibody rituximab, have made this a treatable condition with excellent short- and medium-term outcomes. The condition runs a relapsing and remitting course and patients must be monitored indefinitely. This chapter presents a case study of HIV-MCD with end-organ dysfunction. We describe the clinical features of HIV-MCD, consider useful diagnostic modalities in the work-up of the condition (including histological features, the measurement of human herpes virus-8 (HHV-8) DNA levels, and the use of positron emission tomography), and discuss current treatment options and outcomes. Clinical tips alert clinicians to salient features of the disorder and its management. The putative pathophysiology of HIV-MCD is discussed.

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