Highly active anti-retroviral therapy (HAART) prolongs time to treatment failure in Kaposi's sarcoma.
OBJECTIVE
To evaluate the impact of highly active antiretroviral therapy (HAART) on Kaposi's sarcoma.


METHODS
Retrospective study of patients who had received systemic or local treatment for AIDS-related Kaposi's sarcoma who subsequently commenced HAART.


METHODS
Case note review to determine time to treatment failure for Kaposi's sarcoma before and after starting HAART. Time to treatment failure was calculated from the end of last therapy to the start of the next new treatment for Kaposi's sarcoma.


RESULTS
The cohort contained 78 patients. Only 38% had good risk Kaposi's sarcoma (stage T0I0) at presentation. The median time to treatment failure before starting HAART was 0.5 years. Initial HAART therapy was three or more drugs including a protease inhibitor for 38 (49%), three or more drugs without a protease inhibitor for 27 (35%) and a two-drug protease combination for 13 (16%). The median follow-up after starting HAART was 12 months (range, 0.5-52 months) and anti-Kaposi's sarcoma treatment has been required for 24 (31%) patients. The median time to treatment failure for Kaposi's sarcoma from the start of HAART is 1.7 years. This is statistically longer than the time to treatment failure for the same cohort of patients before they started HAART (log rank chi2 = 16.5, P < 0.0001). The serum HIV RNA viral load (VL) at the time of Kaposi's sarcoma progression revealed virological failure of HAART (defined as VL > 5000 copies/ml) in 14 of 24 (58%) and good control (VL < 200 copies/ml) in five of 24 (21%).


CONCLUSIONS
HAART is associated with prolonged time to treatment failure in Kaposi's sarcoma. Progression of Kaposi's sarcoma while on HAART is not necessarily associated with virological failure as determined by rising viral RNA titre.
Bower
M
M
Department of Oncology, Chelsea and Westminster Hospital, London, UK. m.bower@cxwms.ac.uk
Fox
P
P
Fife
K
K
Gill
J
J
Nelson
M
M
Gazzard
B
B
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D012514:Sarcoma, Kaposi / Q000188:drug therapy* / Q000209:etiology / Q000532:radiotherapy; D016019:Survival Analysis; D013997:Time Factors; D017211:Treatment Failure; D019562:Viral Load
D019380:Anti-HIV Agents; D000970:Antineoplastic Agents; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors