Objective: To compare the clinical course of patients with AIDS-related Kaposi’s sarcoma (KS) with CD4 counts >300 cells/mm3 and undetectable HIV viral loads (VLs) to patients with AIDS-KS with lesser CD4 counts and detectable HIV VLs.
Methods: We retrospectively analyzed a cohort of 91 patients with AIDS-KS in a multispeciality clinic. We used χ2 and Student t tests to analyze intragroup differences; survival was determined by Kaplan-Meier analysis.
Results: Twenty (22%) of the 91 patients had newly diagnosed, persistent or progressive KS despite CD4 counts >300 cells/mm3 and undetectable HIV VLs. Age, gender, ethnicity, mode and duration of HIV acquisition, type of antiretroviral therapy (ART), and KS therapy did not differ significantly (P ≤ .005) between this group and the remaining 71 patients. Although tumor stage and response to KS therapy were similar, there was a significantly greater risk of death among the patients with CD4 counts <300 cells/mm3 and detectable HIV VLs (P = .048).
Conclusions: In the highly active antiretroviral (HAART) era, a substantial proportion of patients with KS had undetectable HIV VLs and CD4 counts greater than the level typically associated with opportunistic diseases. They required systemic therapy to control their KS but were significantly less likely to die and demonstrated a trend toward better 15-year survival than patients having KS with lesser CD4 counts and detectable HIV VLs.
Centers for Disease Control (CDC).Kaposi’s sarcoma and Pneumocystis pneumonia among homosexual men-New York City and California. MMWR Morb Mortal Wkly Rep. 1981; 30(25):305-308.
2.
Friedman-Kien AEDisseminated Kaposi’s sarcoma syndrome in young homosexual men. J Am Acad Dermatol. 1981;5(4): 468-471.
Cattelan AM, Calabro ML, DeRossi A., et al. Long-term clinical outcome of AIDS-related Kaposi’s sarcoma during highly active antiretroviral therapy. Int J Oncol. 2005;27(3):779-785.
5.
Portsmouth S. , Stebbing J., Gill J., et al. A comparison of regimens based on non-nucleoside reverse transcriptase inhibitors or protease inhibitors in preventing Kaposi’s sarcoma. AIDS. 2003 ;17 (11):F17-F22.
6.
Yarchoan R., Tosato G., Little RFTherapy insight: AIDS-related malignancies-the influence of antiviral therapy on pathogenesis and management. Nat Clin Prat Oncol. 2005;2(8):406-415.
7.
Di Lorenzo G. , Konstantinopoulos PA, Pantanowitz L., et al. Management of AIDS-related Kaposi’s sarcoma. Lancet Oncol. 2007;8(2):167-176.
8.
Cattelan AM, Calabro ML, Aversa SM, et al. Regression of AIDS-related Kaposi’s sarcoma following antiretroviral therapy with protease inhibitors: Biological correlates of clinical outcome. Eur J Cancer. 1999;35(13):1809-1815.
9.
Patel P., Hanson DL, Sullivan PS, et al. Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992-2003. Ann Intern Med. 2008;148(10):728-736.
10.
Mocroft A., Kirk O., Clumek N., et al. The changing pattern of Kaposi’s sarcoma in patients with HIV, 1994-2003: the Euro-SIDA study. Cancer. 2004;100(12):2644-2654.
11.
Masys DR, Feng F., Ye I., et al. Preliminary findings on cancer incidents in HIV-infected persons from six countries in Central and South America and the Caribbean. 11th Int Conference on Malignancies and AIDS and Other Acquired Immunodeficiencies, Bethesda, MD, Oct 6-7, 2008, Abstract 047.
12.
Parkin DMThe global health burden of infection-associated cancers in the year 2002 . Int J Cancer. 2006;118(12):3030-3044.
13.
Gallafent JH , Buskin SE, De Turk PB, Aboulafia DMProfile of patients with Kaposi’s sarcoma in the era of highly active antiretroviral therapy. J Clin Oncol. 2005;23(6):1253-1260.
14.
Maurer T., Ponte M., Leslie K.HIV-associated Kaposi’s sarcoma with a high CD4 count and a low viral load. N Engl J Med. 2007;357(13):1352-1353.
15.
Krown SE, Lee JY, Dittmer DPthe AIDS Malignancy Consortium. More on HIV-associated Kaposi’s sarcoma . N Engl J Med. 2008;358(5):535-536.
16.
Stebbing J., Powles T., Bower M.AIDS-associated Kaposi’s sarcoma associated with a low viral load and a high CD4 cell count. AIDS. 2008;22(4):551-552.
17.
Krown SE, Testa MA, Huang J.AIDS-related Kaposi’s sarcoma: prospective validation of the AIDS Clinical Trials Group staging classification. AIDS Clinical Trials Group Oncology Committee . J Clin Oncol. 1997;15(9):3085-3092.
18.
Krown SE, Metroka C., Wernz JCKaposi’s sarcoma in the acquired immune deficiency syndrome: a proposal for uniform evaluation, response, and staging criteria. AIDS Clinical Trials Group Oncology Committee. J Clin Oncol. 1989 ;7(9):1201-1207.
19.
Nasti G., Martellotta F., Berretta M., et al. Impact of highly active antiretroviral therapy on the presenting features and outcome of patients with acquired immunodeficiency syndrome-related Kaposi sarcoma. Cancer. 2003;98(11):2440-2446.
20.
El Amari EB , Toutous-Trellu L., Gayet-Ageron A., et al. Predicting the evolution of Kaposi sarcoma, in the highly active antiretroviral therapy era. AIDS. 2008;22(9):1019-1028.
21.
Martinez V. , Caumes E., Gambotti L., et al. Remission from Kaposi’s sarcoma on HAART is associated with suppression of HIV replication and is independent of protease inhibitor therapy. Br J Cancer. 2006;94(7):1000-1006.
Leidner RS, Aboulafia DMRecrudescent Kaposi’s sarcoma after initiation of HAART: a manifestation of immune reconstitution syndrome. AIDS Patient Care STDS . 2005;19(10):635-644.
24.
Bower M., Nelson M., Young AM, et al. Immune reconstitution inflammatory syndrome associated with Kaposi’s sarcoma. J Clin Oncol. 2005 ;23(22):5224-5228.
25.
Martin JN, Laker M., Cambua A., et al. Kaposi’s sarcoma-associated immune reconstitution inflammatory syndrome (KS-IRIS) in Africa: initial findings from a prospective evaluation . 11th Int Conference on Malignancies and AIDS and Other Acquired Immunodeficiencies, Bethesda, MD, Oct 6-7, 2008, Abstract 046.
26.
Dupin N., Dell Giudice T.Editorial commentary: treatment of Kaposi’s sarcoma in the highly active antiretroviral therapy era. Clin Infec Dis. 2008;47(3):418-420.
27.
Nguyen HQ, Magaret AS, Kitahata MM, Van Rompay SE, Walt A., Casper C.Persistent Kaposi sarcoma in the era of highly active antiretroviral therapy: characterizing the predictors of clinical response. AIDS. 2008;22(8):937-945.
28.
Martín-Carbonero L., Palacios R., Valencia E., et al. Long-term prognosis of HIV-infected patients with Kaposi sarcoma treated with pegylated liposomal doxorubicin . Clin Infect Dis. 2008;47(3):410-417.
29.
Quinlivan EB , Zhang C., Stewart PW, Kolmoltri C., Davis MG, Wehbie RSElevated virus loads of Kaposi’s sarcoma-associated human herpesvirus 8 predict Kaposi’s sarcoma disease progression, but elevated levels of human immunodeficiency virus type 1 do not. J Infect Dis. 2002;185(12):1736-1744.
30.
Pellet C., Chevret S., Blum L., et al. Virologic and immunologic parameters that predict clinical response of AIDS-associated Kaposi’s sarcoma to highly active antiretroviral therapy. J Invest Dermatol. 2001;117(4):858-863.
31.
Skalsky RL, Samols MA, Plaisance KB, et al. Kaposi’s sarcoma-associated herpesvirus encodes an ortholog of miR-155. J Virol. 2007;81(23):12836-12845.
32.
Gottwein E. , Mukherjee N., Sachse C., et al. A viral microRNA functions as an orthologue of cellular miR-155. Nature. 2007;450(7172):1096-1099.
