Recurrence of Kaposi's Sarcoma after Initiation of HAART:
A Manifestation of Immune Reconstitution Syndrome
By
Ronald Baker, PhD
The
primary objective of this literature review is to characterize
the clinical course and prognosis of HIV patients who experience
Kaposi's
sarcoma (KS) flare during HAART.
This disorder is referred to as immune reconstitution
inflammatory syndrome (IRIS). The article appears
in the October 2005 issue of AIDS Patient Care and STDs.
IRIS-associated KS flare is a sometimes fatal immune
disorder that occurs 3-8 weeks after initiation of HAART.
In this review, the authors cite the medical records
from a single institution of 9 HIV-infected patients with KS flare
after virologic and immunologic response
to HAART were reviewed. An additional 10 cases were abstracted
by computerized search of the medical literature.
Results
In the cases outlined, the mean
time to onset of KS flare was 5 weeks.
Pretreatment
mean CD4+
count was 190 cells/mm3
and mean HIV viral load was
153,934 copies per milliliter.
During
flare, mean CD4+ count was 256 cells/mm3
and mean HIV viral load was 1156 copies per milliliter.
Similar
aggregate results are represented in the literature.
Six
fatalities
are reported, 4 from pulmonary KS and 2 from unrelated causes.
Systemic
chemotherapy universally led to tumor regression, but was administered
in only 10 of 19 cases.
In
no instance was HAART discontinued.
Onset
of IRIS-associated KS flare is observed as early as 3 weeks, with
most cases diagnosed within 2 months after immunologic and virologic
response to HAART.
Such
a flare does not necessarily portend a poor prognosis.
In conclusion, the authors write, “Even for those patients
with rapidly symptomatic KS, early systemic chemotherapy is
effective in suppressing IRIS-associated flare.”
“Close clinical supervision is warranted for the KS
patient initiating, changing, or resuming HAART. Particular
vigilance is recommended for pulmonary involvement.”
Division of General Internal Medicine and the University
of Washington, Division of Hematology/Oncology, Seattle, Washington,
and Division of Hematology/ Oncology and the University of Washington,
Division of Hematology/Oncology, Seattle, Washington.
10/24/05
Reference
R
S. Leidner and D M Aboulafia. Recrudescent
Kaposi's Sarcoma After Initiation of
HAART: A Manifestation of Immune Reconstitution Syndrome. AIDS
Patient Care and STDs 19(10):
849-858. October 2005.
Related
Articles
Kaposi's
Sarcoma-associated Inflammation Seen after HAART (HIV
and Hepatitis.com)
Toward
Defining the Incidence, Risk Factors and Long-term Outcome of
a Unique, HAART-related Disease: Immune Reconstitution Inflammatory
Syndrome (IRIS) (HIV and Hepatitis.com)
To
Avoid Immune Reconstitution Inflammatory Syndrome (IRIS), Patients
Should Initiate HAART Before CD4 Count
Falls Below 100 Cells (HIV and Hepatitis.com)
Immune
reconstitution inflammatory syndrome associated with Kaposi's
sarcoma. J Clin Oncol. 2005 Aug 1;23(22):5224-8.
Virologic and immunologic parameters that predict clinical response of AIDS-associated
Kaposi's sarcoma to highly active antiretroviral therapy. J Invest Dermatol. 2001 Oct;117(4):858-863
Long-term
clinical outcome of AIDS-related Kaposi's sarcoma during highly
active antiretroviral therapy. Int
J Oncol. 2005 Sep;27(3):779-785.
Profile
of patients with Kaposi's sarcoma in the era of highly active
antiretroviral therapy. J Clin Oncol.
2005 Feb 20;23(6):1253-1260.
Regression
of acquired immunodeficiency syndrome-related pulmonary Kaposi's
sarcoma after highly active antiretroviral therapy.
Mayo Clin Proc. 1998 May;73(5):439-443.
