KAPOSI'S SARCOMA-ASSOCIATED HERPESVIRUS (KSHV) INFECTION IN PROGRESSIVE HIV-RELATED LYMPHADENOPATHY (HIV-LAP).

Abstract

31 The histologic stages of HIV-LAP, florid follicular hyperplasia (FFH), mixed follicular hyperplasia and involution (MX), follicular involution (FI) and lymphocyte depletion (LD), have been shown to parallel the progression of HIV infection particularly with the development of opportunistic infections and survival. KSHV is associated with the development of HIV-related and unrelated Kaposi's sarcoma (KS), primary effusion lymphoma and multicentric Castleman's disease. The latter often shares histologic features with HIV-LAP, particularly the FI stage. However, the association of KSHV infection with the particular stages of HIV-LAP has not been studied. In addition, the temporal relationship of KSHV infection of HIV-LAP with the development of KS has not been examined. In this study, forty-nine LN (9 FFH, 13 MX, 22 FI, 5 LD) from 28 malc/1 female AIDS/HIV+ persons (1-5 LN per pt; 10 with KS, 19 without KS) were examined for the presence of KSHV by PCR using primers to the KS330223. ORF 74 and/or ORF 75 regions. KSHV was identified in 24/49 (49%) LN: 4 (44%) FFH, 5 (38%) MX, 11 (50%) FI, 4 (80%) LD. Nineteen (80%) KSHV+ LNs were from pts with KS during the course of their disease. Five KSHV+ LNs (2 MX, 3 FI) were from 4 KS negative pts; 3 died of OI (12, 18, 24 mo); the other is alive 7 mo following last LN biopsy. In 4 pts (5 LN) KSHV positivity was identified 3 to 8 mo.(mean=4.5 mo.) prior to the diagnosis of KS. In one pt. 2 LN were KSHV+ prior to the identification of KS lesions. Nineteen of 20 (95%) LN from KS pts were KSHV+. The 1 KSHV negative LN was from a pt who developed KS 9 mo. later. Interestingly, 12 of 13 pts with KSHV+ LN belonged to the homosexual or bisexual risk groups; the remaining KSHV+ pt was an IVDA. Thus, these findings further confirm the strong correlation between KSHV infection and the development of KS and suggest that (1) KSHV infection does not appear to correlate with a specific stage of HIV-LAP and (2) KSHV infection of lymphoid tissue can precede the development of KS lesions.