Effect of highly active antiretroviral therapy on survival among HIV-infected men with Kaposi sarcoma or non-Hodgkin lymphoma.
The effect of highly active antiretroviral therapy (HAART) on survival in HIV-infected patients with Kaposi sarcoma (KS) or non-Hodgkin lymphoma (NHL) is unknown. Our study examines survival after HAART for these 2 malignancies. Analyses were performed using data from 387 HIV-infected men in the Multicenter AIDS Cohort Study (MACS) after a diagnosis of either KS or NHL in 1990-99. Potential prognostic factors, including HAART, were evaluated in univariate analyses using Kaplan-Meier survival curves and log-rank tests. Multivariate survival analyses were conducted using Cox's time-dependent proportional hazards models, adjusting for CD4(+) cell levels at the time of cancer diagnosis and other covariates. Forty-three of 287 KS patients (15%) and 13 of 100 NHL patients (13%) had been treated with HAART. HAART treatment was associated with improved survival for KS and NHL patients (log-rank p = 0.0001 for each group). In multivariate analyses, HAART was associated with an 81% reduced risk of death among KS patients [relative hazard (RH) 0.19, 95% confidence limits (CL) (0.08, 0.45)], compared to those not exposed to HAART and an 84% reduced risk [RH 0.16, 95% CL (0.04, 0.64)] among NHL patients. Relative hazards estimates were similar for those with HAART initiation before and after NHL diagnosis. The use of HAART prolongs overall survival among HIV-positive men diagnosed with KS and NHL. HAART appears to be effective in improving survival even when initiated after the diagnosis of NHL and KS.
Tam
Henry K
HK
School of Public Health, University of California, Los Angeles, CA 90095-1772, USA.
Zhang
Zuo-Feng
ZF
Jacobson
Lisa P
LP
Margolick
Joseph B
JB
Chmiel
Joan S
JS
Rinaldo
Charles
C
Detels
Roger
R
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D015497:HIV-1 / Q000502:physiology; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D008297:Male; D011446:Prospective Studies; D012514:Sarcoma, Kaposi / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D015996:Survival Rate; D016896:Treatment Outcome
D019380:Anti-HIV Agents; D000970:Antineoplastic Agents