Prospective study of the effects of antiretroviral therapy on Kaposi sarcoma--associated herpesvirus infection in patients with and without Kaposi sarcoma.
OBJECTIVE
To investigate the effect of highly active antiretroviral therapy (HAART) on circulating Kaposi sarcoma (KS)-associated herpesvirus (KSHV) load in HIV-infected individuals with and without KS.


METHODS
Twenty-nine HIV-infected subjects (21 with KS and 8 without KS) were recruited for the study; they were prospectively studied before and at regular intervals during HAART.


METHODS
Patients with KS were clinically assessed using Adult Clinical Trials Group (ACTG) criteria, and sequential blood samples were obtained from all patients for determination of plasma HIV-1 load, CD4 cell count, titer of antibody to KSHV, and KSHV load.


RESULTS
Ten of 21 patients with KS had a favorable KS response (complete response, 6; partial response, 4) with HAART alone. Of the 20 subjects with detectable KSHV viremia prior to HAART, over one half (12 [60%]) had an undetectable KSHV load with antiretroviral therapy. There was no significant difference between subjects receiving protease inhibitor- or nonnucleoside reverse transcriptase inhibitor-based treatment combinations. Achieving undetectable KSHV viremia is associated with a better clinical outcome in patients with KS.


CONCLUSIONS
To our knowledge, we demonstrate for the first time that both protease inhibitor-based and nonnucleoside reverse transcriptase inhibitor-based antiretroviral treatment combinations may lead to an undetectable KSHV load and confirm that an undetectable KSHV load is associated with KS regression. There was no clear association between CD4 cell count response and KS response to HAART, but there was a significant relationship between HIV load response to HAART and clinical improvement of KS.
Gill
Jasjit
J
Chelsea and Westminster Hospital, London, England, United Kingdom.
Bourboulia
Dimitra
D
Wilkinson
John
J
Hayes
Peter
P
Cope
Alethea
A
Marcelin
Anne-Genevieve
AG
Calvez
Vincent
V
Gotch
Frances
F
Boshoff
Christopher
C
Gazzard
Brian
B
D000328:Adult; D019380:Anti-HIV Agents / Q000145:classification / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D006566:Herpesviridae Infections / Q000188:drug therapy*; D019288:Herpesvirus 8, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D008297:Male; D016133:Polymerase Chain Reaction; D012514:Sarcoma, Kaposi / Q000188:drug therapy* / Q000503:physiopathology; D013997:Time Factors; D019562:Viral Load
D019380:Anti-HIV Agents; D000998:Antiviral Agents