Changing incidence of AIDS-defining illnesses in the era of antiretroviral combination therapy

Brodt, HR; Kamps, B.; Gute, Peter; Knupp, B.; Staszewski, Shlomo; Helm, E. B.

doi:10.1097/00002030-199714000-00010

Cited by 387 publications

(192 citation statements)

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“…Kaposi's sarcoma (KS) has remained the most common AIDSassociated malignancy since the beginning of the HIV/AIDS pandemic (Brodt et al, 1997). The introduction of highly active antiretroviral therapy (HAART) in 1996 was associated with undetectable HIV plasma viral load in most patients, together with increased CD4 cell counts, increased survival, and fewer opportunistic infections and AIDS-associated malignancies (Li et al, 1998;Palella et al, 1998;Levine and Tulpule, 2001).…”

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Remission from Kaposi's sarcoma on HAART is associated with suppression of HIV replication and is independent of protease inhibitor therapy

et al. 2006

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Highly active antiretroviral therapy (HAART) reduces the incidence and improves the prognosis of Kaposi's sarcoma (KS). This study was designed to identify factors associated with KS clinical responses in HIV-infected patients during HAART. We reviewed the files of 138 HIV-1-infected patients with KS. Epidemiologic and HIV-related clinical and biological parameters were recorded at KS diagnosis (baseline) and every 6 months thereafter. In a subset of 73 antiretroviral-naive patients, we compared the clinical outcome of KS according to the use or nonuse of protease inhibitors (PI). After 6 months of follow-up, KS remission was more frequent in patients who were naive of HAART and who were at ACTG stage S0 at baseline (P ¼ 0.03 and 0.02). Undetectable HIV viral load was strongly associated with KS remission (Pp0.004 at all time points), while CD4 cell count was not. Among the 73 antiretroviralnaive patients at baseline, and who were studied for 24 months, KS outcome did not differ between patients who were prescribed PIcontaining and PI-sparing regimens. Intercurrent multicentric Castleman's disease was associated with poor outcome after 60 months of follow-up (Pp0.0001). Fourteen deaths occurred after a median follow-up of 37.5 months, eight of which were KS related. Suppression of HIV replication appears to be crucial to control KS. Non-PI-based regimens were equivalent to PI-based regimens as regards the clinical and virological outcome of antiretroviral-naive HIV-infected patients with KS.

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Remission from Kaposi's sarcoma on HAART is associated with suppression of HIV replication and is independent of protease inhibitor therapy

et al. 2006

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“…1 The introduction of effective antiretroviral therapies in the 1990s has been associated with significant epidemiologic changes-in particular, a sharp decline in the incidence of KS-and has had a favorable impact on the therapeutic management of KS. [2][3][4][5][6][7][8][9][10] Nonetheless, to our knowledge, there are no published studies evaluating the effects of highly active antiretroviral therapy (HAART) on the clinical characteristics at presentation and the natural history of KS in patients already following a stable HAART regimen at the time of KS diagnosis.…”

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Impact of highly active antiretroviral therapy on the presenting features and outcome of patients with acquired immunodeficiency syndrome–related Kaposi sarcoma

Nasti

Martellotta

Berretta

et al. 2003

Cancer

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BACKGROUNDThe objective of the current study was to evaluate the impact of highly active antiretroviral therapy (HAART) on clinical characteristics of presentation and the natural history of Kaposi sarcoma (KS) in patients already receiving HAART at the time of KS diagnosis.METHODSThe authors conducted a retrospective cohort study comparing epidemiologic, clinical, and outcome data for 160 patients who were naive to HAART at the time of KS diagnosis (KS‐naive) with the corresponding data for 51 patients already receiving HAART at the time of KS diagnosis (KS‐HAART). The analysis included all patients with a diagnosis of KS since January 1996 within two Italian cohorts of patients with human immunodeficiency virus.RESULTSImmunologic and virologic status at the time of KS diagnosis were significantly more favorable in the KS‐HAART group than in the KS‐naive group. The frequency of cutaneous involvement was similar in both groups, but cutaneous disease was more indolent among KS‐HAART patients, with 1 anatomic site of involvement in 9 patients (21%) and less than 10 lesions in 26 patients (60%), compared with 16 patients (12%; P = 0.06) and 47 patients (34%; P = 0.01), respectively, in the KS‐naive group. A smaller proportion of KS‐HAART patients presented with visceral disease (24% vs. 39%; P = 0.06); in particular, gastrointestinal tract involvement was significantly less frequent among KS‐HAART patients (14%) compared with KS‐naive patients (28%; P = 0.05). Median survival was not reached in either group, and the 3‐year survival rates of KS‐HAART patients (64%) and KS‐naive patients (78%) were not significantly different.CONCLUSIONSThe data from the current study indicate that KS exhibits a less aggressive presentation in patients already receiving HAART compared with patients who are naive to HAART at KS diagnosis. Natural history and outcome do not appear to be influenced by the initiation of HAART before development of KS. Cancer 2003. © 2003 American Cancer Society.

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“…Consequently, the incidence of opportunistic infections has declined, changing the natural history of HIV infection. However, opportunistic infections remain a problem among patients with a delayed diagnosis of infection and among non-responders to HAART (Brodt et al 1997, Palella et al 1998, Patton et al 2000.…”

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Multicenter Brazilian Study of Oral Candida Species Isolated from Aids Patients

Santana

Milan

Martínez

et al. 2002

Mem. Inst. Oswaldo Cruz

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Changing incidence of AIDS-defining illnesses in the era of antiretroviral combination therapy

Abstract: The incidence of AIDS-defining events in patients with advanced HIV infection at Frankfurt University Hospital has declined by more than 70% from 1992 to 1996.

Cited by 387 publications

References 29 publications

Remission from Kaposi's sarcoma on HAART is associated with suppression of HIV replication and is independent of protease inhibitor therapy

Remission from Kaposi's sarcoma on HAART is associated with suppression of HIV replication and is independent of protease inhibitor therapy

Impact of highly active antiretroviral therapy on the presenting features and outcome of patients with acquired immunodeficiency syndrome–related Kaposi sarcoma

Multicenter Brazilian Study of Oral Candida Species Isolated from Aids Patients

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