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Updated: Oct 9 2018

HHV Type 8

  • Snapshot
    • A 45-year-old man with a history of HIV infection presents to his primary care doctor for a rash. He had been on antiretroviral medications for his HIV infection for years. Six months ago, he lost his job and his insurance and ran out of medication 5 months ago. He had been feeling fine until a week ago when he developed a painless rash on his face, trunk, and legs. He has also had some night sweats and low-grade fevers. On physical exam, he has multiple scattered reddish purple macules and papules. There are also purple nodules on his oral mucosa. A skin biopsy reveals neoplastic spindle-shaped cells and a lymphocytic infiltrate.
  • Introduction
    • Classification
      • human herpesvirus-8 (HHV-8)
        • an enveloped, linear double-stranded DNA virus
        • causes Kaposi sarcoma, a neoplasm of endothelial cells
    • Epidemiology
      • demographics
        • endemic in Africa
          • causes soft tissue tumors
        • adults > children
      • location
        • skin, lungs, lymph nodes, and gastrointestinal tract
      • risk factors
        • HIV/AIDS
          • acquired through sexual contact
          • rarely seen in AIDS acquired through injection drug use
        • post-transplant
    • Pathogenesis
      • HHV-8 inhibits tumor suppression pathways
    • Associated conditions
      • diabetes mellitus
      • autoimmune hemolytic anemia
    • Prevention
      • highly active antiretroviral therapy (HAART)
      • annual skin exam in those at risk
    • Prognosis
      • progression is slow
      • recurrence is likely
  • Presentation
    • Symptoms
      • B symptoms (fevers, night sweats, and weight loss)
      • painless skin lesions
      • may have pain associated with internal lesions
    • Physical exam
      • red or purple lesions of varying morphologies
        • macules and patches
        • papules and plaques
        • nodules
      • common on the face, oral mucosa, legs, and torso
      • lymph nodes may be enlarged
  • Studies
    • Labs
      • evaluate CD4+ count if AIDS is suspected
    • Skin biopsy
      • neoplastic spindle-shaped cells that form clefts and vascular channels
      • lymphocytic infiltrate
    • Making the diagnosis
      • based on clinical presentation and confirmed with skin biopsy
  • Differential
    • Bacillary angiomatosis
      • distinguishing factors
        • rash manifests as dark red and purple papules, nodules, and plaques
        • skin biopsy reveals neutrophilic infiltrate
  • Treatment
    • Management approach
      • HAART in those with AIDS-related disease is mainstay of treatment
      • patients should discontinue any immunosuppressants
    • Medical
      • vincristine
        • indication
          • AIDS-related disease
      • interferon
        • indication
          • AIDS-related disease
      • chemotherapy and radiation therapy
        • indication
          • widespread or rapidly progressing disease
  • Complications
    • Metastatic progression of disease
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