Download presentation
Presentation is loading. Please wait.
Published byReynold Ford Modified over 8 years ago
1
Prepared by the AETC National Coordinating Resource Center based on recommendations from the CDC, National Institutes of Health, and HIV Medicine Association/Infectious Diseases Society of America Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents Human Herpesvirus-8 Slide Set
2
2 July 2013www.aidsetc.org These slides were developed using recommendations published in July 2013. The intended audience is clinicians involved in the care of patients with HIV. Certain sections have been updated to reflect changes in the published guidelines. Users are cautioned that, because of the rapidly changing field of HIV care, this information could become out of date quickly. Finally, it is intended that these slides be used as prepared, without changes in either content or attribution. Users are asked to honor this intent. – AETC National Coordinating Resource Center http://www.aidsetc.org About This Presentation
3
3 July 2013www.aidsetc.org Epidemiology Clinical Manifestations Diagnosis Prevention Treatment Monitoring Preventing Recurrence Considerations in Pregnancy Human Herpesvirus-8 Disease
4
4 July 2013www.aidsetc.org Associated with Kaposi sarcoma (KS) (all forms) and certain neoplastic and lymphoproliferative disorders (primary effusion lymphoma [PEL]), multicentric Castleman disease) HHV-8 seroprevalence in United States: 1-5% Higher in MSM regardless of HIV serostatus (20-77%) Higher in some Mediterranean countries (10-20%) and parts of sub-Saharan Africa (30-80%) HHV-8 Disease: Epidemiology
5
5 July 2013www.aidsetc.org Pathogenesis of HHV-8 disease is unclear KS and PEL usually seen in advanced immunosuppression (CD4 count <200 cells/µL), but can occur at any CD4 count KS incidence up to 30% among AIDS patients in United States before use of effective ART Dramatically lower incidence in recent years ART prevents and may regress KS lesions Ganciclovir, foscarnet, and cidofovir given for CMV treatment may prevent or suppress KS Castleman disease and PEL remain rare HHV-8 Disease: Epidemiology (2)
6
6 July 2013www.aidsetc.org Most with chronic HHV-8 infection are asymptomatic Acute infection may cause fever, rash, lymphadenopathy, bone marrow failure, occasional rapid progression to KS Castleman disease: generalized adenopathy, fever; may progress to multiorgan failure PEL: pleural, pericardial, or abdominal effusions; mass lesions are less common HHV-8 Disease: Clinical Manifestations
7
HHV-8 Disease: Clinical Manifestations (2) KS presentation varies widely Most have nontender, purplish, indurated skin lesions Intraoral lesions are common Visceral dissemination may occur 7 July 2013www.aidsetc.org Credit: P. Volberding, MD; UCSF Center for HIV Information Image Library
8
8 July 2013www.aidsetc.org Routine screening for HHV-8 is not indicated Quantitation of HHV-8 by PCR has no established role in diagnosis KS: biopsy Consult with specialist for diagnosis of other suspected HHV-8 disease HHV-8 Disease: Diagnosis
9
9 July 2013www.aidsetc.org Preventing Exposure HHV-8 shedding in saliva and genital secretions may transmit HHV-8 to uninfected partners Interventions to prevent exposure to HHV-8 not likely to be highly effective, have not been validated; are not recommended Preventing Disease Toxicity of anti-HHV-8 therapy outweighs potential benefits Early initiation of ART likely to be most effective prevention measure HHV-8 Disease: Prevention
10
10 July 2013www.aidsetc.org ART for all: initiate or optimize Limited studies of HHV-8-specific agents KS: Ganciclovir, foscarnet may regress lesions; cidofovir ineffective in 1 study Chemotherapy if visceral KS; consider if widely disseminated cutaneous KS Castleman disease: Preferred: valganciclovir 900 mg PO BID for 3 weeks or ganciclovir 5 mg/kg IV Q12H for 3 weeks or valganciclovir 900 mg PO BID + zidovudine 600 mg PO Q6H for 7-12 days Alternative: rituximab for 4-8 weeks (effective as alternative or adjunctive therapy; associated with subsequent exacerbation or emergence of KS) PEL: Chemotherapy IV ganciclovir or PO valganciclovir may be useful adjunct Consult with specialist HHV-8 Disease: Treatment
11
11 July 2013www.aidsetc.org Early ART initiation is likely to prevent KS and PEL ART should be given to all with KS, muticentric Castleman disease, or PEL Insufficient evidence to support specific ARV regimens HHV-8 Disease: Starting ART
12
12 July 2013www.aidsetc.org IRIS reported in HHV-8-infected patients who initiate ART KS: new onset KS or exacerbations of previously stable disease Castleman disease: clinical decompensation PEL: no data ART is key component of therapy and should not be delayed HHV-8 Disease: Monitoring and Adverse Events
13
13 July 2013www.aidsetc.org ART recommended for all with HHV-8 disease May prevent KS progression or recurrence HHV-8 Disease: Preventing Recurrence
14
14 July 2013www.aidsetc.org HHV-8 seropositivity does not appear to affect pregnancy outcome; screening for HHV-8 not indicated Antiviral therapy for HHV-8 infection during pregnancy is not recommended Diagnosis as in nonpregnant women For treatment, consult with specialist Perinatal transmission occurs infrequently, higher risk with higher maternal antibody titer; may be associated with increased infant mortality HHV-8 Disease: Considerations in Pregnancy
15
15 July 2013www.aidsetc.org http://www.aidsetc.org http://aidsinfo.nih.gov Websites to Access the Guidelines
16
16 July 2013www.aidsetc.org This presentation was prepared by Susa Coffey, MD, for the AETC National Resource Center in July 2013. See the AETC NRC website for the most current version of this presentation: http://www.aidsetc.org About This Slide Set
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.