The authors concluded that that the prognosis of HIV-related MCD remains poor even after the advent of cART. Unlike other lymphoproliferative disorders, cART did not impact on outcome of HIV-related MCD, suggesting that MCD can ‘escape’ immune reconstitution. A concomitant diagnosis of NHL and uncontrolled MCD seemed to be the main reason for an unfavourable outcome, particularly in the post-cART era. New therapeutic approaches, including rituximab, should therefore aim at avoiding NHL PD0325901 mw transformation and controlling ‘MCD-related cytokine storm’. The risk of lymphoma in patients diagnosed with MCD is high (level of evidence 2C). cART

does not prevent MCD (level of evidence 2D). A rise in plasma HHV8 level can EGFR tumor predict relapse (level of evidence 2D). There are no definitive gold-standard treatments for MCD. Apart from a randomized controlled trial of valganciclovir treatment for suppression of HHV8 replication [36], the best evidence is derived from single-centre cohort studies. Follow-up is generally short. The effect of cART, chiefly in combination with cytotoxic chemotherapy, has been described in seven patients with MCD and HIV infection [37]. Six patients responded to chemotherapy, and immune reconstitution was described in five patients. However, patients

continued to require long-term maintenance chemotherapy to prevent recurrence. The median survival was 48 months, longer

than in the pre-cART era. Therefore, the principle that HIV should be fully controlled during and after treatment for MCD should be adhered to in order to try to prevent relapse of MCD and other HIV-related conditions. The use of an anti-CD20 monoclonal antibody, rituximab, routinely prescribed as therapy for B-cell lymphomas and autoimmune diseases, to target HHV8-infected plasmablasts in MCD is a novel and potentially beneficial approach to the treatment of this disease. It was initially the subject of several case reports. These patients were often pretreated with chemotherapy and follow-up was brief; nine of 11 experienced a complete response [38–44]. The efficacy and safety of rituximab in 21 consecutive patients with plasmablastic MCD have been Methamphetamine investigated [45]. These individuals received four infusions of rituximab 375 mg/m2 at weekly intervals and, of 20 evaluable patients, all achieved clinical remission with biochemical and haematological normalization, and 70% achieved a radiological response. The overall survival and disease-free survival at 2 years were 95% and 79%, respectively, and in three patients who relapsed, retreatment with rituximab was successful [46]. These data corroborate the benefit seen in the aforementioned case reports and demonstrate that rituximab therapy results in an impressive clinical, biochemical and radiological sustained response in HIV-related MCD.