Successful treatment of Castleman's disease with HAART in two HIV-infectedpatients

Castleman's disease is a heterogeneous group of lymphoproliferative disorde rs of unknown aetiology. Recently, human herpesvirus type 8 (HHV-8) has bee n associated with various diseases in individuals with HIV infection, inclu ding Kaposi's sarcoma, B cell non Hodgkin's lymphomas, and Castleman's dise ase. In Castleman's disease it has been hypothesized that HHV-8, encoding a number of various virokines, can be responsible for clinical manifestation s of the disease. Previously, two reports have described a clinical recover y from HIV-associated Castleman's disease: by administration of a monoclona l antibody neutralizing human IL-6 in one case, and in another case by trea tment with highly antiretroviral therapy and anti-herpesvirus therapy, foll owing splenectomy. We report two cases where HAART alone led to clinical re covery from Castleman's disease. In both the cases reported here, although follow-up biopsy was not performed, it is likely that the inhibition of HHV -8 replication and of virokine release, through the restoration of immunity by HAART, was the basis for the disappearance of the clinical symptoms, (C ) 2000 The British Infection Society.