Remission from Kaposi's sarcoma on HAART is associated with suppression of HIV replication and is independent of protease inhibitor therapy

Abstract

Highly active antiretroviral therapy (HAART) reduces the incidence and improves the prognosis of Kaposi's sarcoma (KS). This study was designed to identify factors associated with KS clinical responses in HIV-infected patients during HAART. We reviewed the files of 138 HIV-1-infected patients with KS. Epidemiologic and HIV-related clinical and biological parameters were recorded at KS diagnosis (baseline) and every 6 months thereafter. In a subset of 73 antiretroviral-naive patients, we compared the clinical outcome of KS according to the use or nonuse of protease inhibitors (PI). After 6 months of follow-up, KS remission was more frequent in patients who were naive of HAART and who were at ACTG stage S0 at baseline (P ¼ 0.03 and 0.02). Undetectable HIV viral load was strongly associated with KS remission (Pp0.004 at all time points), while CD4 cell count was not. Among the 73 antiretroviralnaive patients at baseline, and who were studied for 24 months, KS outcome did not differ between patients who were prescribed PIcontaining and PI-sparing regimens. Intercurrent multicentric Castleman's disease was associated with poor outcome after 60 months of follow-up (Pp0.0001). Fourteen deaths occurred after a median follow-up of 37.5 months, eight of which were KS related. Suppression of HIV replication appears to be crucial to control KS. Non-PI-based regimens were equivalent to PI-based regimens as regards the clinical and virological outcome of antiretroviral-naive HIV-infected patients with KS.

Non-AIDS-related Kaposi's sarcoma: A single-institution experience

“…Infection with this virus is a necessary condition, but it is not sufficient alone to cause KS, highlighting how genetic and angiogenic factors and the production of several inflammatory cytokines play a role in the multistep pathogenesis of KS [4] . As KS can be considered to be an opportunistic tumour, the restoration of immune competence is associated with remission in organ transplant recipients [5] and in acquired immune deficiency syndrome (AIDS)-related KS [6] . In classic KS, the cause of the underlying immunodeficiency is more difficult to identify and therefore to target by treatment.…”

Kaposi’s Sarcoma-Associated Herpesvirus: Epidemiology, Biological Characteristics and Pathogenesis

“…KS regression and HIV suppression may also be achieved using non-PI-based HAART regimens [ 261 ]. Moreover, persistent or de novo KS was also reported in clusters of AIDS patients with high CD4+ T-lymphocyte counts and low or undetectable HIV-1 viremia [ 224 , 266 ], indicating that some patients may experience effective HIV-1 suppression and restoration of immune function not accompanied by KS remission.…”

Treatment for Kaposi sarcoma herpesvirus: great challenges with promising accomplishments

“…Indinavir inhibited matrix metalloprotease 2 (MMP-2) proteolytic activation and angiogenesis in a hepatocellular carcinoma model [24]. However, a recent retrospective analysis of 138 patients with AIDS-associated KS showed that the response to KS was not associated with the type of HAART regimen used [25]. Undetectable HIV viral load was strongly associated with KS remission, while CD4 cell count was not.…”