Long-term efficacy on Kaposi's sarcoma of highly active antiretroviral therapy in a cohort of HIV-positive patients

Dupont, Caroline; Vasseur, E.; Beauchet, Alain; Aegerter, Philippe; Berthé, Huguette; Truchis, Pierre de; Zucman, David; Rouveix, É.; Saïag, Philippe

doi:10.1097/00002030-200005260-00010

Cited by 114 publications

(80 citation statements)

References 22 publications

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“…However, we had the opportunity to examine both risk factors for KS and clinical outcomes among patients predominantly treated with NNRTI-based regimens in a KS endemic country. The fact that regression rates in our study are similar to those published for industrialized countries, where clinical responses range from 67 to 85% [8,9], should be somewhat reassuring to patients and physicians who do not have easy access to specific anti-neoplastic therapy or PI-based HAART regimens. Less than half of the patients in this study were able to access any chemotherapy for KS, and only four completed a full course of treatment, which suggests that NNRTI-based HAART may be adequate therapy for most patients who develop KS when starting or while receiving HAART.…”

supporting

confidence: 83%

“…KS was an uncommon diagnosis among HIV-infected individuals initiating HAART in rural Uganda, affecting 3.2% of individuals in this study and having an estimated inci- [8,9], Nevertheless, mortality associated with KS in our study was very high (30% compared with 11% for participants without KS). Our findings are similar to those of a recently reported study from South Africa which found a prevalence of KS of 3.4% among unselected patients in an HIV clinic population and a mortality rate of 25% [12].…”

Section: Discussionmentioning

confidence: 59%

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Clinical outcomes of HIV‐infected patients with Kaposi's sarcoma receiving nonnucleoside reverse transcriptase inhibitor‐based antiretroviral therapy in Uganda

et al. 2011

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BackgroundClinical outcomes for patients with Kaposi's sarcoma (KS) using nonnucleoside reverse transcriptase inhibitor (NNRTI)-based highly active antiretroviral therapy (HAART) in resource-limited settings have not previously been described. MethodsWe evaluated HIV-infected patients aged Ն 18 years, who initiated HAART in the Home-Based AIDS Care (HBAC) project in Tororo, Uganda, between May 2003 and February 2008 and were diagnosed with KS at baseline or during follow-up. We examined independent risk factors for having either prevalent or incident KS and risk factors for death among patients with KS. ResultsOf 1121 study subjects, 17 (1.5%) were diagnosed with prevalent KS and 18 (1.6%) with incident KS over a median of 56.1 months of follow-up. KS was associated with male sex [adjusted odds ratio (AOR) 2.41; 95% confidence interval (CI) 1.20-4.86] and baseline CD4 cell count < 50 cells/mL (AOR 3.25; 95% CI 1.03-10.3). Eleven (65%) of 17 patients with prevalent KS and 13 (72%) of 18 patients with incident KS experienced complete regression (P = 0.137). Eighteen (64%) of 28 patients who remained on NNRTI-based HAART experienced regression of their KS and six (86%) of seven patients who were switched to protease inhibitor-containing HAART regimens had regression of their KS (P = 0.23). Mortality among those with KS was significantly associated with visceral disease (hazard ratio 19.22; 95% CI 2.42-152). ConclusionPrevalent or incident KS was associated with 30% mortality. The resolution of KS lesions among individuals who initiated HAART with NNRTI-based regimens was similar to that found in studies using only protease inhibitor-based HAART.Keywords: Kaposi's sarcoma, highly active antiretroviral therapy, Uganda, sub-Saharan Africa, mortality, HIV [5][6][7]. However, HAART has changed the natural history of AIDS-associated KS in industrialized countries since its introduction more than a decade ago. For HIV-infected individuals with KS in industrialized countries, HAART results in the regression of the size and number of existing lesions [8,9]. At the population level, the use of HAART has been associated with a decreased proportion of new AIDS-related cancers, with a 30-50% reduction in KS incidence in both the USA and Europe [10].Most studies examining the clinical effects of HAART on KS have come from high-income countries and from clinic cohorts where protease inhibitor (PI)-based regimens predominated The clinical effects of HAART on AIDSassociated KS in African countries, where programmes primarily use nonnucleoside reverse transcriptase inhibitor (NNRTI)-based therapy, is not known. To address this question we analysed data collected from individuals with HIV infection receiving NNRTI-based antiretroviral therapy in rural Uganda as part of a randomized clinical trial [11]. We examined factors associated with the diagnosis of KS at baseline and during follow-up and determined which factors were associated with mortality among patients with KS. Methodology Study settingThe Home-Based AIDS Care (HBAC) prog...

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confidence: 83%

Section: Discussionmentioning

confidence: 59%

Clinical outcomes of HIV‐infected patients with Kaposi's sarcoma receiving nonnucleoside reverse transcriptase inhibitor‐based antiretroviral therapy in Uganda

et al. 2011

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“…Two studies have shown a correlation between KS remission and a high CD4 cell count or a strong increase in the CD4 cell count. Dupont et al (2000) found that an increase in the CD4 cell count of more than 150 Â 10 6 l À1 after 12 months of HAART was predictive of complete remission from KS at month 24 in HIV-infected patients. Similarly, Cattelan et al (1999) found a positive correlation between the CD4 cell count and KS control during antiretroviral therapy.…”

Section: Discussionmentioning

confidence: 91%

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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“…10 These findings may be attributable both to specific cancer characteristics in HIV-infected individuals (a more aggressive behavior and an advanced stage at diagnosis) [6][7][8]11,12 and to subject characteristics (immunodeficiency, low performance status). The use of HAART improved short-and medium-term survival in HIV-infected patients with cancer, 8 especially those with ADM [13][14][15] and some types of NADM (e.g., HD) 16,17 and reduced the difference from the general population. 8 However, very few studies described 10-year survival in patients with HIV and cancer, and the only published data are limited to subjects with NHL, Kaposi's sarcoma (KS), and anal cancer.…”

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confidence: 99%

Ten‐year survival among HIV‐1‐infected subjects with AIDS or non‐AIDS‐defining malignancies

Spagnuolo

Galli

Salpietro

et al. 2011

Intl Journal of Cancer

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Few data are available regarding the 10‐year survival among subjects with HIV and cancer. The aim of this study was to evaluate the 10‐year survival of HIV‐infected subjects with AIDS‐defining malignancies (ADM) or non‐AIDS‐defining malignancies (NADM). This was a single center, retrospective, observational study of subjects with HIV infection and a subsequent cancer diagnosis; the data were collected from January 1991 to April 2010. Malignancies were divided into ADM or NADM on the basis of the Centre of Diseases Control‐1993 classification. Survival curves were estimated using Kaplan–Meyer method and compared by the log‐rank test. Six hundred and fifteen (9.5%) of the 6,495 subjects recorded in the San Raffaele Infectious Diseases Database developed a malignancy: 431 (70%) an ADM and 184 (30%) a NADM. In the case of ADM, survival was more favorable when cancer was diagnosed during post‐highly active antiretroviral therapy (HAART) era (10‐year survival: 43.2% ± 4.4%) than when diagnosed during the pre‐HAART era (10‐year survival: 16.4% ± 2.7%; log‐rank test: p < 0.001). The same was true in the case of NADM (10‐year survival: 44.7% ± 5.5% vs. 33.3 ± 9.6%; log‐rank test: p = 0.03). An evaluation of survival probability by cancer type showed higher survival rates during the post‐HAART era in the case of non‐Hodgkin lymphoma (10‐year survival: 42.1% ± 5.3% vs. 11.4% ± 3.3%; log‐rank test: p = <0.001), Kaposi's sarcoma (10‐year survival: 44.0% ± 8.4% vs. 23.5% ± 3.9%; log‐rank test: p < 0.001) and Hodgkin's disease (10‐year survival: 49.5% ± 14.5% vs. 40.0% ± 12.7%; log‐rank test: p = 0.005). Despite the better cancer prognosis during the post‐HAART era, the 10‐year survival of HIV‐infected subjects with an ADM or NADM is poor.

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Long-term efficacy on Kaposi's sarcoma of highly active antiretroviral therapy in a cohort of HIV-positive patients

Abstract: HAART appears to have prolonged efficacy on AIDS-KS, even without specific KS therapy, and this effect appears to be linked to the restoration of immune function.

Cited by 114 publications

References 22 publications

Clinical outcomes of HIV‐infected patients with Kaposi's sarcoma receiving nonnucleoside reverse transcriptase inhibitor‐based antiretroviral therapy in Uganda

Clinical outcomes of HIV‐infected patients with Kaposi's sarcoma receiving nonnucleoside reverse transcriptase inhibitor‐based antiretroviral therapy in Uganda

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

Ten‐year survival among HIV‐1‐infected subjects with AIDS or non‐AIDS‐defining malignancies

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