Elevated IL-13 in effusions of patients with HIV and primary effusion lymphoma as compared with other KSHV-associated disorders
To assess the cytokine and viral profiles of effusions and peripheral blood among patients diagnosed with HIV and Kaposi sarcoma herpesvirus (KSHV, also known as human herpesvirus 8 [HHV-8]) associated conditions. Retrospective comparative study evaluating clinicopathologic findings in patients with HIV and KSHV-associated conditions presenting with an effusion between 2010-2018. Paired peripheral blood and effusion samples collected at the time of pathological diagnosis of KSHV-associated conditions (Kaposi sarcoma (KS), KSHV-associated multicentric Castleman disease (KSHV-MCD), primary effusion lymphoma (PEL), or KSHV-associated inflammatory cytokine syndrome (KICS)) were evaluated for disease-specific and compartment-specific (effusion versus blood) characteristics. We assessed 12 cytokines, KSHV viral DNA, and Epstein-Barr virus (EBV) viral DNA (KSHV-VL, EBV-VL). Nine patients had PEL, 5 patients had KSHV-MCD, and 8 patients met criteria for KICS; all but 1 patient had concurrent KS in addition to these conditions. PEL effusions had substantially higher levels of IL-13 (median 16.9 pg/ml; interquartile range 9.7-26.9 pg/ml) compared to KSHV-MCD (median <0.114 pg/ml; p = 0.0037) or KICS (median <0.114 pg/ml; p = 0.0003) effusions. IL-13 was also higher in PEL effusions as compared to serum (median <0.12 ng/ml; p = 0.007). KSHV-VL levels were significantly higher in PEL effusions as compared to KICS effusions (median 31x10 vs. 569 copies/million-cell equivalent; p = 0.0005) or KSHV-MCD effusions (median 231,884 copies/million-cell equivalent; p = 0.02). PEL effusions had a distinct profile as compared to other KSHV-associated diseases with regard to elevated IL-13 and KSHV-VL. These findings may provide insights into PEL pathogenesis and aid in diagnosis.