Clinical Response of AIDS-associated Kaposi's Sarcoma to HAART
The purpose of this study was to assess the predictive value of
biologic factors on the efficacy of HAART alone or combined with chemotherapy forn AIDS-associated Kaposi's sarcoma.
Twenty-six AIDS-Kaposi's sarcoma patients who started therapy with
protease
inhibitors were investigated. No baseline chemotherapy
was associated with less severe initial clinical status. Median
follow-up was 652 days.
The main outcome measures were as follows:
Best Kaposi's sarcoma clinical response;
Kaposi's-sarcoma-associated
herpes viral load
in peripheral blood mononuclear cells using real-time quantitative
polymerase chain reaction (non-detectable if less than 100 copies
per microgram);
Human
immunodeficiency viral load
in plasma (non-detectable if less than 200 copies per ml); and
CD4 lymphocyte
count.
Time
to undetectable Kaposi's-sarcoma-associated herpes viral load,
time to undetectable human immunodeficiency viral load, and time
to CD4 >or= 150 per microliter were also recorded over time,
from 2 month measurements.
Patients were staged according to the AIDS Clinical Trials Group-based
tumor, immune, systemic staging system criteria.
Results
At baseline, Kaposi's
sarcoma was progressive for 25 (96%) of the 26 enrolled patients.
Complete
or partial response to HAART alone or combined with chemotherapy
was achieved in 22 patients (85%).
Median
time to clinical response was estimated at 251 days (d).
Clinical response was
faster in patients without chemotherapy at baseline (p = 0.003)
as well as in patients not previously treated with reverse
transcriptase inhibitors (p = 0.0012).
Using
univariable analyses, predictive factors of clinical response
were undetectable Kaposi's-sarcoma-associated herpes viremia (p
= 0.013), undetectable human immunodeficiency viremia (p = 0.03),
and relative variation of CD4 lymphocytes (p = 0.004).
Using
multivariable analysis, undetectable Kaposi's-sarcoma-associated
herpes viremia (p = 0.009) and relative variation of CD4 (p =
0.005) were independently selected as having a predictive value
for clinical response.
Occurrence
of non detection of either Kaposi's-sarcoma-associated herpesvirus
or human immunodeficiency virus was not associated with baseline
CD4 value.
Based on these findings, the study authors conclude, “Kaposi's-sarcoma-associated
herpesvirus quantitative viral load is an independent predictive
factor of the efficacy of HAART on AIDS-Kaposi's sarcoma.”
“Our results support immune reconstitution as a mechanism of response
of Kaposi's sarcoma to HAART.”
Laboratory of Pharmacology, Hopital Saint-Louis,
Paris, France.
10/26/05
Reference
C
Pellet and others. Virologic and immunologic parameters that predict
clinical response of AIDS-associated Kaposi's sarcoma to highly
active antiretroviral therapy. Journal
of Investigative Dermatology 117(4): 858-863.
October 2001.
