Characteristics and survival for HIV-associated multicentric Castleman disease in Malawi

Introduction : Clinical reports of multicentric Castleman disease (MCD) from sub-Saharan Africa (SSA) are scarce despite high prevalence of HIV and Kaposi sarcoma-associated herpesvirus (KSHV). Our objective is to describe characteristics and survival for HIV-associated MCD patients in Malawi. To our knowledge, this is the first HIV-associated MCD case series from the region. Methods : We describe HIV-positive patients with MCD in Lilongwe, and compare them to HIV-associated lymph node Kaposi sarcoma (KS) and non-Hodgkin lymphoma (NHL) patients treated at our centre. All patients were enrolled into a prospective longitudinal cohort study at a national teaching hospital and cancer referral centre serving half of Malawi’s 16 million people. We included adult patients≥18 years of age with HIV-associated MCD ( n= 6), lymph node KS ( n= 5) or NHL ( n= 31) enrolled between 1 June 2013 and 31 January 2015. Results and discussion : MCD patients had a median age of 42.4 years (range 37.2–51.8). All had diffuse lymphadenopathy and five had hepatosplenomegaly. Concurrent KS was present for one MCD patient, and four had performance status ≥3. MCD patients had lower median haemoglobin (6.4 g/dL, range 3.6–9.3) than KS (11.0 g/dL, range 9.1–12.0, p= 0.011) or NHL (11.2 g/dL, range 4.5–15.1, p= 0.0007). Median serum albumin was also lower for MCD (2.1 g/dL, range 1.7–3.2) than KS (3.7 g/dL, range 3.2–3.9, p= 0.013) or NHL (3.4 g/dL, range 1.8–4.8, p= 0.003). All six MCD patients were on antiretroviral therapy (ART) with median CD4 count 208 cells/µL (range 108–1146), and all with HIV RNA <400 copies/mL. Most KS and NHL patients were also on ART, although ART duration was longer for MCD (56.4 months, range 18.2–105.3) than KS (14.2 months, range 6.8–21.9, p= 0.039) or NHL (13.8 months, range 0.2–98.8, p= 0.017). Survival was poorer for MCD patients than lymph node KS or NHL. Conclusions : HIV-associated MCD occurs in Malawi, is diagnosed late and is associated with high mortality. Improvements in awareness, diagnostic facilities, treatment and supportive care are needed to address this likely under-recognized public health problem in SSA. Keywords: HIV; multicentric Castleman disease; Kaposi sarcoma; Kaposi sarcoma-associated herpesvirus; non-Hodgkin lymphoma; sub-Saharan Africa. (Published 3 August 2015) Citation: Gopal S et al. Journal of the International AIDS Society 2015, 18 :20122 http://www.jiasociety.org/index.php/jias/article/view/20122 | http://dx.doi.org/10.7448/IAS.18.1.20122