title: The efficacy of ritonavir in the prevention of AIDS-related Kaposi's sarcoma.
abstract: Angiogenesis is thought to play a major role in the development of Kaposi's sarcoma (KS), considered by many to be a hyperplastic disorder caused in part by local production of inflammatory cytokines. The antiangiogenic effects of protease inhibitors, in particular ritonavir, have been suggested in laboratory work to lead to regression of KS, and recent data have shown the importance of ritonavir as a model of pharmaceutical development. As our clinical cohort data has shown that non-nucleoside reverse transcriptase inhibitor-based regimens are not inferior to protease inhibitor-based therapy in the prevention of KS, we investigated the specific contribution of ritonavir to chemoprevention of this AIDS-defining illness. In a logistic regression analysis, we found that ritonavir-based therapy confers no advantages compared to other regimens in the prevention of KS. This is consistent with data suggesting that regression of KS is mediated by an overall improvement in immune function and not by the effects of specific antiretrovirals.
authors.affiliation: Department of Immunology, Division of Investigative Science, Faculty of Medicine, Imperial College of Science, Technology and Medicine, The Chelsea and Westminster Hospital, London, United Kingdom. j.stebbing@ic.ac.uk
authors.forename: Justin
authors.initials: J
authors.lastname: Stebbing
authors.forename: Simon
authors.initials: S
authors.lastname: Portsmouth
authors.forename: Mark
authors.initials: M
authors.lastname: Nelson
authors.forename: Sundhiya
authors.initials: S
authors.lastname: Mandalia
authors.forename: Hala
authors.initials: H
authors.lastname: Kandil
authors.forename: Nic
authors.initials: N
authors.lastname: Alexander
authors.forename: Liz
authors.initials: L
authors.lastname: Davies
authors.forename: Cathryn
authors.initials: C
authors.lastname: Brock
authors.forename: Mark
authors.initials: M
authors.lastname: Bower
authors.forename: Brian
authors.initials: B
authors.lastname: Gazzard
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000150:complications / Q000517:prevention & control*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D015497:HIV-1; D006801:Humans; D019469:Indinavir / Q000627:therapeutic use; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D019438:Ritonavir / Q000627:therapeutic use*; D012514:Sarcoma, Kaposi / Q000150:complications / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; D019469:Indinavir; D019438:Ritonavir