Prior to the HAART era, treatment
for AIDS-related KS had been mainly palliative, involving the use of chemotherapy
that resulted in minimal or short-term response.
Use of HAART by patients
with AIDS-related KS has been associated with improved survival and prolonged
time to treatment failure. Cases of complete KS resolution with antiretroviral
therapy alone have been documented, but few studies have examined the response
to HAART in a clinical setting.
Patients with advanced KS rarely respond
to HAART alone, but antiretroviral therapy in combination with chemotherapy improves
response rates to 50%-82%. Neither the relative roles of HAART and chemotherapy,
nor the predictors of response to both HAART and chemotherapy in persons with
KS have been extensively studied. In addition, evaluations of treatment with both
HAART and chemotherapy in primary care settings, where adherence may be an issue,
do not exist.
The objective of the current retrospective study, published
in the May 11, 2008 issue of AIDS, was to evaluate the role of HAART and
chemotherapy on tumor response and to identify factors associated with response
among patients with AIDS-related KS in routine primary care at 2 HIV clinics (University
of Washington and the Fred Hutchinson Cancer Research Center, Seattle, WA).
A
total of 114 patients from these clinics with a diagnosis of AIDS-related KS were
identified via a clinical database. Records were reviewed to confirm the KS diagnosis
and abstract clinical and chemotherapy information. Demographics, laboratory values
and HAART use were abstracted electronically. Cox's proportional hazards models
identified predictors of KS improvement and resolution.
Results
•
Among 64 patients
with confirmed KS, 36 months following diagnosis, the rate of improvement was
77% and the rate of complete resolution was 51%.
•
In univariate
analyses, recent chemotherapy was associated with KS improvement.
•
Lower recent
HIV viral load and HAART were associated with both improvement and resolution.
•
No measured
baseline characteristics (tumor stage, year of diagnosis, CD4
cell count, HIV viral load, prior HAART) or recent CD4 count predicted KS
improvement or resolution.
•
In multivariate
analyses, recent chemotherapy and HAART were predictors of KS improvement.
•
Only recent
HAART was associated with resolution.
•
KS response
was not associated with type of HAART (non-nucleoside reverse transcriptase inhibitor,
protease inhibitor, or ritonavir-boosted protease inhibitor-based regimens).
Conclusion
Kaposi's
sarcoma, seen here on the thigh, was once a rare malignancy of the blood vessels,
but is now associated with AIDS.
Based
on these results, the study authors concluded, "Highly active antiretroviral
therapy and chemotherapy are important in clinical Kaposi sarcoma response."
In
addition, they noted that despite the widespread availability of HAART, KS continues
to be a clinical problem.
Finally,
with only half the patients in the cohort achieving complete resolution of KS,
the authors concluded that, "New therapeutic approaches are needed."
Department
of Epidemiology, Department of Laboratory Medicine, Department of Medicine, University
of Washington; Program in Biostatistics and Vaccine and Infectious Disease Institute,
Fred Hutchinson Cancer Research Center, Seattle, WA.
5/09/08
Reference HQ
Nguyen, AS Magaret, MM Kitahata, and others. Persistent Kaposi sarcoma in the
era of highly active antiretroviral therapy: characterizing the predictors of
clinical response. AIDS 22(8): 937-945. May 11, 2008.
Results
