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

Abstract

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.

Kaposi's sarcoma: An update

“…KS risk may be significantly lower in AIDS patients with a history of anti-herpes therapy [6,[103][104][105][106][107]. In addition, anti-herpes virus therapy may have potential for wide use, especially in preventing the development of KS in at risk populations, such as HHV-8 seropositive individuals undergoing transplantation surgery.…”

“…Therapeutic options for KS are often based upon clinical form and stage, progression patterns, and lesion dimensions [2,6,[92][93][94][95][96][97][98][99][100][101][102][103]. One should try to treat KS without compromising the patient's immune system, reconstituting it if it is deficient.…”

Avaliação da resposta tecidual "in situ" do fenótipo, da expressão de HHV-8/LANA e de citocinas em lesões cutâneas de sarcoma de Kaposi clássico e sarcoma de Kaposi associado à AIDS na era pré e pós-terapia anti-retroviral combinada

“…As características demográficas dos pacientes deste estudo assemelham-se aos dados da literatura (Safai, 1984;Friedman-Kien, 1981;Nasti et al, 2003;Ramos da Silva et al, 2007 (Marining et al, 1985, Touloumi et al, 1999Pellet et al, 2006). Os achados da presente pesquisa evidenciaram "in situ" nas lesões cutâneas de pacientes com SK-AIDS, uma diminuição estatisticamente significante no número de linfócitos T CD4+ mensurados por metodologia quantitativa, quando comparados aos das lesões de SKC.…”

“…Esse achado em contraposição aos relatos anteriores, poderia sustentar a hipótese de que a maior produção local dessa citocina estaria na realidade exercendo seu papel protetor nesses pacientes. Essa situação poderia explicar o comportamento menos agressivo respectivamente verificado no SKC (Hengge et al, a;b) e também aquele relatado em pacientes com SK/AIDS em uso de HAART (Nasti et al, 2003).…”

“…Sabe-se que o uso dessa terapia leva à reconstituição imunológica e melhora geral da função imune, tendo também efeitos anti-angiogênicos diretos (através dos inibidores de protease) e diminui a concentração da proteína Tat do HIV (Sgadari et al, 2003;Stebbing et al, 2003;Monini et al, 2004;Martinez et al, 2006;Stebbing et al 2006;Bihl et al, 2007). É relatado que indivíduos que fazem uso de HAART antes de apresentarem SK-AIDS, mostram um comportamento menos agressivo do mesmo quando comparado àqueles indivíduos isentos de tratamento (Nasti et al, 2003;Gallafent et al, 2005).…”