Rituximab therapy for HIV-associated multicentric Castleman disease

HIV-associated multicentric Castleman disease (MCD) is a rare lymphoproliferative disorder with marked systemic symptoms attributed to cytokine disarray. Many therapeutic approaches conducted in small series of patients have often proved unsuccessful. Rituximab is a chimeric monoclonal antibody that has been extensively used for B-cell lymphomas and autoimmune disorders. The use of rituximab for HIV–MCD now derives from a collection of case reports, case series and two clinical trials, which has led to rituximab being considered as the gold standard therapy for HIV–MCD. Rituximab infusions have been reported to be well tolerated in most patients with mild-to-moderate infectious complications being the most commonly reported toxicity. The most significant adverse event of rituximab therapy for HIV–MCD is Kaposi sarcoma progression. Further work is required to increase our understanding of the disease process to help refine the optimal therapy for this aggressive disease.