The increasing incidence of HIV-associated multicentric Castlemans disease

Abstract

7085 Background: Multicentric Castleman's disease (MCD) and Kaposi's sarcoma (KS) are causally related to infection with human herpesvirus-8 (HHV-8). In HIV cohorts with access to highly active antiretroviral therapy (HAART) the incidence of KS is falling; however the incidence of MCD in this setting has not previously been described. Methods: We calculated the incidence of HIV-MCD from a prospective database of HIV patients with 52,035 years of follow up, using HIV-KS incidence as a control. The incidence in specific time periods related to the introduction of HAART was calculated. Results: The event rate for HIV-MCD was 16.3 (95% confidence interval (CI): 10.2–24.2) /10,000 patient years of follow up. The incidence of HIV-MCD in the pre-HAART (1983–1996), initial HAART (1997–2001) and HAART (2002–2007) eras were 2.3 (95% CI: 0.1–12.8), 11.1 (95% CI: 3.6–26.0) and 31.3 (95% CI: 18.2–50.1) respectively, representing a statistically significant increase over time (p <0.05). This incidence was not related to the degree of immunosuppression, the duration of HIV infection, gender, prior AIDS or HAART use. This is in contrast to the incidence of KS, which was commoner in men, fell dramatically with HAART and decreased with improved immune function. Conclusions: Unlike KS, the incidence of HIV-MCD does not appear related to the degree of immunosuppression or gender. The incidence of HIV-MCD is increasing, and this rise is not related to HAART use. No significant financial relationships to disclose.