Long-term clinical outcome of AIDS-related Kaposi's sarcoma during highly active antiretroviral therapy.
The long-term impact of highly active antiretroviral therapy (HAART) in AIDS patients with Kaposi's sarcoma (KS) was evaluated in 22 consecutive, HAART-naïve KS patients attending a single Italian referral centre for HIV/AIDS. Clinical, virologic and immunologic responses to HAART were assessed at baseline and every three months during the follow-up. Peripheral blood mononuclear cell (PBMC)-associated human herpesvirus 8 (HHV-8) load was also evaluated by real-time PCR in 13 patients with durable clinical KS complete response (CR). In a median follow-up of 40 months (range 17-78), the KS overall clinical response rate was 91%: 18 complete and 2 partial responses were achieved, and two patients experienced disease progression. CR persisted in all 18 patients, including the 5 poor-risk KS patients in whom CR lasted for > 60 months, and was significantly linked to an increase in CD4+ cell counts and a drop in HIV-1-RNA copies. Compared to baseline levels, a decrease in PBMC HHV-8 load was observed at CR, and a significant further reduction was found at the end of follow-up. In this monocentric study, AIDS-KS patients treated with HAART showed high clinical response rate. Patients with CR showed a prolonged remission, lasting more than 5 years in a group of poor-risk patients, and a persistent reduction in circulating HHV-8-infected cells. These findings highlight that HAART deeply modifies the natural history of this tumour in AIDS patients, and that this long-lasting approach may be considered a first-line treatment for the majority of HIV-1-infected patients developing KS.
Cattelan
Anna Maria
AM
Department of Infectious Diseases, General Hospital and University of Padova, I-35121 Padova, Italy. amcattelan@libero.it
Calabrò
Maria Luisa
ML
De Rossi
Anita
A
Aversa
Savina Maria Luciana
SM
Barbierato
Massimo
M
Trevenzoli
Marco
M
Gasperini
Paola
P
Zanchetta
Marisa
M
Cadrobbi
Paolo
P
Monfardini
Silvio
S
Chieco-Bianchi
Luigi
L
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D004279:DNA, Viral / Q000097:blood; D005500:Follow-Up Studies; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics; D019288:Herpesvirus 8, Human / Q000187:drug effects / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012514:Sarcoma, Kaposi / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
D019380:Anti-HIV Agents; D004279:DNA, Viral; D012367:RNA, Viral