In AIDS-associated Kaposi sarcoma, which virus is the viral requirement and which acts as a cofactor in progression?

In AIDS-associated Kaposi sarcoma, which virus is the viral requirement and which acts as a cofactor in progression?

• A. HHV-8; HIV
• B. EBV; HIV
• C. HHV-6; HIV
• D. HPV; HIV

Answer: (A)

In Kaposi sarcoma the key idea is that infection with HHV-8 (KSHV) provides the viral driver required for the tumor to develop. HHV-8 infects endothelial/spindle cells and expresses oncogenic proteins that promote cell proliferation, angiogenesis, and resistance to apoptosis, which is why the lesion can form and expand. HIV, on the other hand, is not required for KS to occur but acts as a cofactor that drives progression. In the setting of HIV infection, immune surveillance is compromised and there is a pro-inflammatory environment, which accelerates HHV-8–driven tumor growth and leads to more aggressive, widespread disease. This is why AIDS-associated KS tends to be more aggressive than KS in people with intact immune systems. Other viruses listed are associated with different diseases (for example, EBV with certain lymphomas and nasopharyngeal carcinoma, HPV with cervical and other anogenital cancers, and HHV-6 with roseolavirus infections). Thus, HHV-8 is the viral requirement, and HIV is the progression-associated cofactor.

In Kaposi sarcoma the key idea is that infection with HHV-8 (KSHV) provides the viral driver required for the tumor to develop. HHV-8 infects endothelial/spindle cells and expresses oncogenic proteins that promote cell proliferation, angiogenesis, and resistance to apoptosis, which is why the lesion can form and expand.

HIV, on the other hand, is not required for KS to occur but acts as a cofactor that drives progression. In the setting of HIV infection, immune surveillance is compromised and there is a pro-inflammatory environment, which accelerates HHV-8–driven tumor growth and leads to more aggressive, widespread disease. This is why AIDS-associated KS tends to be more aggressive than KS in people with intact immune systems.

Other viruses listed are associated with different diseases (for example, EBV with certain lymphomas and nasopharyngeal carcinoma, HPV with cervical and other anogenital cancers, and HHV-6 with roseolavirus infections). Thus, HHV-8 is the viral requirement, and HIV is the progression-associated cofactor.