TO THE EDITOR:

Kaposi sarcoma (KS) herpesvirus (KSHV), also known as human herpesvirus-8, is the causative agent for KS and a plasmablastic form of multicentric Castleman disease (MCD; KSHV-MCD). KSHV-MCD is a relapsing and remitting B-cell lymphoproliferative disorder that occurs primarily in people living with HIV.2,3  Patients present with anemia, thrombocytopenia, and inflammatory symptoms associated with elevated cytokines including interleukin-6 (IL-6) and IL-10, elevated levels of C-reactive protein (CRP), and elevated KSHV viral loads (KSHV-VLs). KSHV encodes for viral IL-6 (vIL-6), an analog of human IL-6 (hIL-6), which contributes to KSHV-MCD pathogenesis, in part by driving production of hIL-6.4-6  Treatment options include rituximab (a humanized monoclonal antibody against CD20), rituximab with liposomal doxorubicin or etoposide, or virus-activated cytotoxic therapy with high-dose zidovudine (AZT) and valganciclovir (VGC).7-13  However, some patients do not respond to rituximab, and, when used alone, it is associated with worsening or development...

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