# A Retrospective Cohort Study on HHV-8 Viral Load and Prognosis in HIV-Associated Kaposi Sarcoma Among People Living with HIV in Japan

## TL;DR

This study examines how HHV-8 viral load affects the prognosis of Kaposi sarcoma in HIV patients in Japan.

## Contribution

The study identifies high HHV-8 viral load as a risk factor for mortality in HIV-associated Kaposi sarcoma patients in Japan.

## Key findings

- Older age and high HHV-8 viral load are significantly associated with worse survival in HIV-associated Kaposi sarcoma.
- All patients diagnosed with KICS in the study died, highlighting its poor prognosis.

## Abstract

Background: The characteristics and prognosis of HIV-associated Kaposi sarcoma (KS) among people living with HIV (PLWH), and their association with HHV-8 viral load are not well understood in Japan. Methods: We conducted a retrospective study of PLWH diagnosed with KS at Tokyo Medical University from 2000 to 2023. Results: Seventy cases of KS were identified; HHV-8 viral load data were available for twenty-three of these cases. The median age was 43 years (interquartile range [IQR], 11 years). The median HIV viral load at diagnosis was 150,000 copies/mL (IQR, 560,000 copies/mL). The median CD4 count was 76.0/μL (IQR, 157/μL). Lesions other than those of the skin were observed in the gastrointestinal tract (nine cases, 39.1%), oropharynx (three cases, 13.0%), and bronchial/lung (two cases, 8.7%). The median HHV-8 viral load was 0.0 copies/106 WBC (IQR, 1500 copies/106 WBC). Among the nine deceased PLWH, KS inflammatory cytokine syndrome (KICS) was diagnosed in five PLWH. Older age (≥50 years) and a high HHV-8 viral load (>615 copies/106 WBCs) were significantly associated with worse survival. Conclusion: A high HHV-8 viral load may be a risk factor for mortality in PLWH with KS. Notably, all PLWH diagnosed with KICS in this study died, underscoring the poor prognosis associated with this condition.