A Retrospective Analysis of AIDS-Associated Kaposi’s Sarcoma in Patients With Undetectable HIV Viral Loads and CD4 Counts Greater Than 300 cells/mm3

Abstract

In the highly active antiretroviral (HAART) era, a substantial proportion of patients with KS had undetectable HIV VLs and CD4 counts greater than the level typically associated with opportunistic diseases. They required systemic therapy to control their KS but were significantly less likely to die and demonstrated a trend toward better 15-year survival than patients having KS with lesser CD4 counts and detectable HIV VLs.

Is Kaposi's sarcoma occurring at higher CD4 cell counts over the course of the HIV epidemic?

“…Similar to other studies in the HAART era [9, 10, 15], 35% of participants were on HAART and 9% had an HIV RNA level <400 copies/ml at KS diagnosis. Such cases are somewhat surprising since HAART has reduced the number of KS cases by its effects on HIV suppression and potential anti-angiogenic effects [10, 16].…”

“…Such cases are somewhat surprising since HAART has reduced the number of KS cases by its effects on HIV suppression and potential anti-angiogenic effects [10, 16]. Some KS cases in the setting of HAART may be related to the immune reconstitution inflammatory syndrome (IRIS) [17, 18]; however, most of our cases were not associated with HAART introduction.…”

Do we still need chemotherapy for AIDS-associated Kaposi’s sarcoma?

“…It is our clinical experience that KS relapse similarly may occur despite excellent virological control of HIV and high CD4 + T-cell counts. A frequently used treatment strategy for these patients is systemic chemotherapy, and although this has been found to be an effective strategy to control the KS in a series of 20 patients [80], no comparative studies have been published.…”

A Review of Human Herpesvirus 8, the Kaposi's Sarcoma-Associated Herpesvirus, in the Pediatric Population

“…Globally, however, ART coverage is estimated to reach only 28% of qualifying children (57% of qualifying adults), and, despite improved ART distribution, sub-Saharan Africa has yet to demonstrate the same decline in epidemic KS [32,33]. In addition, in countries with longstanding access to ART, approximately one-third of HIV-infected people presenting with KS are receiving HAART and have fully suppressed HIV and CD4 counts >200 cells/µL [34,35]. Reasons for KS disease in HAART-treated individuals remain unclear because immunodeficiency is thought to play a key role in pathogenesis.…”