Steroids are a risk factor for Kaposi's sarcoma-immune reconstitution inflammatory syndrome and mortality in HIV infection

Abstract

Objectives:To investigate the association between Kaposi's sarcoma-associated immune reconstitution inflammatory syndrome (KS-IRIS) and mortality, with the use of glucocorticoids in HIV-infected individuals.Design:Case–control study.Methods:We reviewed the medical records of 145 individuals with HIV-associated Kaposi's sarcoma receiving antiretroviral therapy. The association of different variables with KS-IRIS and Kaposi's sarcoma-related mortality was explored by univariate and multivariate analyses. The main exposure of interest was the use of glucocorticoids. We also compared the time to KS-IRIS and the time to death of individuals treated with glucocorticoids vs. those nontreated with glucocorticoids, and the time to death of individuals with KS-IRIS vs. those without KS-IRIS by hazards regression.Results:Sixty of 145 individuals received glucocorticoids (41.4%) for the management or suspicion of Pneumocystis jirovecii pneumonia. Fifty individuals had KS-IRIS (37%). The use of glucocorticoids was more frequent in individuals with KS-IRIS than in those without KS-IRIS (54.9 vs. 36.47%, P = 0.047). Kaposi's sarcoma-related mortality occurred in 17 cases (11.7%), and glucocorticoid use was more frequent in this group (76.47 vs. 36.7%, P = 0.003). Glucocorticoid use was a risk factor for mortality (adjusted odds ratio = 4.719, 95% confidence interval = 1.383–16.103, P = 0.0132), and was associated with shorter periods to KS-IRIS (P = 0.03) and death (P = 0.0073). KS-IRIS was a risk factor for mortality (P = 0.049).Conclusion:In HIV-infected individuals, the use of glucocorticoids is a risk factor for KS-IRIS and Kaposi's sarcoma-associated mortality. In addition, KS-IRIS is a risk factor for mortality. Therefore, glucocorticoid administration in this population requires careful consideration based on individualized risk–benefit analysis.

Rapid Progression of Kaposi’s sarcoma complicated with hemophagocytic syndrome in a severely immunosuppressed patient with HIV-infection: a case report

“…A number of clinical studies have confirmed that glucocorticoids could increase the incidence, accelerate the progression and increase the mortality of KS in HIV-infected individuals. For these reasons, glucocorticoids are not recommended for AIDS-related KS patients [ 14 , 17 , 18 ]. Liposomal doxorubicin and cART were administrated for this patient of KS complicated with HPS rather than glucocorticoids.…”

HIV and Autoimmune Hepatitis: A Case Series and Literature Review

“…In vitro studies suggest that AIDS-KS cells have high levels of glucocorticoid receptor proteins. Retrospective analysis has confirmed steroid use as a risk factor for KS associated mortality [13,14]. Therefore, physicians should use caution when treating patients for AIH-associated IRIS with prednisone who have a history of HIV-associated Kaposi' sarcoma.…”

AIDS-Related Kaposi Sarcoma, Version 2.2019

“…Initiation of ART may result in immune reconstitution inflammatory syndrome (IRIS) within 3 to 6 months in a reported 6%-39% of patients with AIDS-related Kaposi sarcoma. [79][80][81][82] IRIS is characterized by marked lesional swelling, increased tenderness, and peripheral edema. Individuals with pulmonary involvement, concurrent or recent use of glucocorticoids, and/or advanced immunosuppression may be at increased risk.…”

“…Individuals with pulmonary involvement, concurrent or recent use of glucocorticoids, and/or advanced immunosuppression may be at increased risk. 79,80,82 In contrast with management of IRIS for some opportunistic infections, glucocorticoids are generally contraindicated in Kaposi sarcoma, as well as in Kaposi sarcoma-associated IRIS, because of the potential for life-threatening Kaposi sarcoma exacerbation resulting from stimulatory effects of glucocorticoids on Kaposi sarcoma spindle cells. 83,84 Management of Kaposi sarcoma-associated IRIS should involve coordination with an HIV specialist.…”