Effect of protease inhibitor-based highly active antiretroviral therapy on survival in HIV-associated advanced Kaposi's sarcoma patients treated with chemotherapy.
OBJECTIVE
To determine whether the use of protease inhibitor (PI)-based antiretroviral (ARV) therapy had an impact on the survival of patients with human immunodeficiency virus (HIV) infection-associated Kaposi's sarcoma (KS) who were receiving systemic chemotherapy.


METHODS
Records of 48 AIDS patients with extensive KS who received chemotherapy from 1995 to 1999 were reviewed. Analysis by presence or absence of PI treatment was undertaken, and patients who were receiving nonnucleoside reverse transcriptase inhibitors (NNRTIs) were excluded from the analysis.


RESULTS
Median age was 38 years, and 47 patients were men having sex with men. Half of the patients (54%) had at least one prior AIDS-defining event. Median CD4 count at diagnosis of KS was 28 cells/microL (range, 1-625). Visceral KS was present in 33 patients (69%), and the remainder of patients had extensive and symptomatic cutaneous and/or mucous membrane involvement. All patients received at least one cycle of chemotherapy, including vincristine/bleomycin or an anthracycline-containing regimen. There was a significant difference in the median survival (MS) between the 28 patients (58%) treated with PI-based antiretroviral therapy (31 months [range, 1.8-48]) and the group not receiving PI (7 months [range, 1-28], p =.0001). In addition, 81% of patients in the PI group were alive at 18 months from initiation of chemotherapy versus 12% in the non-PI group. Twenty patients (71%) in the PI-treated group were able to discontinue chemotherapy for at least 1 month after remission of KS, in comparison to 3 of 20 (15%) patients in the group of patients who did not receive PI (p =.00001). Death due to KS occurred in 6 of 28 (21%) patients (total 9 deaths) in the PI group and 14 of 20 (70%) patients (total 18 deaths) in the non-PI group (p =.001).


CONCLUSIONS
In a nonselected group of patients with advanced and extensive KS in a real-life clinical setting, our results show a survival benefit and a decrease in KS-related death for patients receiving chemotherapy and PI-based ARV therapy when compared to patients not receiving PI-based therapy. Discontinuation of chemotherapy in patients receiving PI-based antiretroviral therapy appears to be feasible in patients who attain remission of KS.
Leitch
Heather
H
British Columbia Cancer Agency, Division of Medical Oncology, University of British Columbia, Vancouver, Canada.
Trudeau
Marc
M
Routy
Jean-Pierre
JP
D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012514:Sarcoma, Kaposi / Q000150:complications* / Q000188:drug therapy*; D016019:Survival Analysis
D000970:Antineoplastic Agents; D017320:HIV Protease Inhibitors