Kaposi's Sarcoma-associated Inflammation Seen after HAART

Immune reconstitution inflammatory syndrome (IRIS) may mimic progression of Kaposi's sarcoma (KS) in HIV-infected patients treated with highly active antiretroviral therapy (HAART), according to a case report in the December 15th issue of Clinical Infectious Diseases.

As lead researcher Dr. Elizabeth Connick of the University of Colorado Health Sciences Center, Denver, told Reuters Health, "the apparent progression of KS in the setting of HAART may well represent IRIS rather than true HIV disease progression, and does not indicate antiretroviral treatment failure."

Dr. Connick and colleagues report on their experience with one KS patient who developed rapidly progressive KS lesions with lymphadenopathy and tissue swelling during antiretroviral therapy, despite increased CD4+ T cell counts and decreased HIV viral load.

During the second week of HAART, the authors report, the patient developed swelling of the face and neck, multiple new cervical lymph nodes, and a more violaceous and nodular appearance of his pre-existing KS lesions.

"The temporal relationship between the initiation of HAART, the increased CD4+ lymphocyte count, and the sudden onset of facial swelling and lymphadenopathy is consistent with IRIS," the investigators point out.

By seven weeks after HAART was initiated, the patient had developed new KS lesions, so paclitaxel therapy was begun. This resulted in fading of the new lesions and resolution of the edema by week 10 of HAART.

Thus Dr. Connick said, "IRIS to KS can be effectively treated with HAART and chemotherapy."

However, IRIS will raise significant treatment challenges, Dr. Connick continued. "In many African countries where HAART is being introduced, there is quite limited access to chemotherapy for KS. Stopping HAART will obviously alleviate symptoms; however, it will also inevitably lead to further progression of immune deficiency and death."

Thus, she concluded, "alternative and cheaper ways of treating KS IRIS besides chemotherapy may need to be explored."

01/03/05

Clin Infect Dis 2004;39:1852-1855.