Clinical characteristics, predictors of immune reconstitution inflammatory syndrome and long-term prognosis in patients with Kaposi sarcoma

Abstract

ObjectiveTo investigate the predictive factors for the development of Kaposi sarcoma-related immune reconstitution inflammatory syndrome (KS-IRIS) and long-term prognosis in patients starting combined antiretroviral therapy (cART).MethodsWe studied a retrospective-cohort of consecutive antiretroviral-naïve patients with KS initiating cART from January 2005 to December 2011 and followed through June 2013. KS-IRIS was defined as ≥2 of the following: abrupt increase in number of KS lesions, appearance or exacerbation of lung-opacities or lymphedema, concomitantly with an increase in CD4+ cell-count ≥50 cells/mm3 and a decrease of >1 log in viral-load once started cART. We compared individuals who met KS-IRIS criteria with those that did not and described the long-term follow-up.ResultsWe included 89 patients, 88 males; 35 (39%) developed KS-IRIS at a median of 10 weeks (IQR 4–16). KS-IRIS patients had more pulmonary-involvement (60% vs. 16.6% of patients; p < 0.0001), eight died attributed to pulmonary-KS. Thrombocytopenia <100,000/mm3 at follow-up occurred in 36% of KS-IRIS vs. 4% in non-KS-IRIS patients (p = 0.0002), 45% KS-IRIS patients with thrombocytopenia died, non without KS-IRIS. Chemotherapy (bleomicyn–vincristine) was more frequently prescribed in KS-IRIS patients (88.6% vs. 29.6%) with no differences in outcome; 80% of all patients achieve KS complete remission, 52% of them never received chemotherapy. No difference between groups in the long-term follow-up (mean 52.4 ± 27.4 months) was found, only one patient developed a secondary malignancy (1.12%).ConclusionsLung-involvement was predictive of IRIS development. Thrombocytopenia in KS-IRIS patients at week 12 follow-up after cART initiation was associated with high mortality. Over a third of patients with KS achieve remission without chemotherapy. Individuals that survive the initial period of KS-IRIS adhere to cART had a good long-term prognosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12981-017-0156-9) contains supplementary material, which is available to authorized users.

Clinical manifestations and risk factors for oral immune reconstitution inflammatory syndrome in Mexico

“…While the values found for oral KS‐IRIS (1.9%) in the present study and in the previous one (1.4%) (Ramírez‐Amador et al., 2009) are low, KS is a well‐recognized manifestation in IRIS‐affected individuals developed in up to 39.3% of them; 77% of the cases involve mucosae (Volkow, Cesarman‐Maus, Garciadiego‐Fossas, Rojas‐Marin, & Cornejo‐Juárez, 2017). In this respect, we found that in 2 of the 3 KS cases, skin KS lesions preceded the development of oral KS.…”

Pediatric Kaposi's sarcoma associated with immune reconstitution inflammatory syndrome

“…There is no universally accepted definition for KS‐IRIS . However, four features (see Table ) must be present . Based on these features, our case meets the criteria for pediatric KS‐IRIS.…”

Intractable pleural effusion in Kaposi sarcoma following antiretroviral therapy in a Caucasian female infected with HIV

“…Pulmonary KS-associated immune reconstitution inflammatory syndrome (IRIS) has been described. Volkow et al demonstrated that the median time from starting ART to pulmonary KS-associated IRIS was around 10 weeks 26. A recent retrospective series suggested that starting ART containing integrase inhibitors (particularly raltegravir) in patients with low CD4 count was independently associated with an increased risk of IRIS, but this remains controversial 27.…”