Prognostic significance of immune subset measurement in individuals with AIDS-associated Kaposi's sarcoma.
OBJECTIVE
A prognostic index for AIDS-associated Kaposi's sarcoma (KS) diagnosed in the era of highly active antiretroviral therapy (HAART) was based on routine clinical and laboratory characteristics. Because immune subset measurement is often performed in HIV-positive individuals, we examined whether these were predictive of mortality independently of the prognostic index, or could predict time to progression of KS.


METHODS
We performed univariate and multivariate Cox regression analyses on a data set of 326 individuals with AIDS-associated KS to identify immune subset covariates predictive of overall survival and time to progression. Adaptive (CD8 T cell and CD19 B cell) and innate (CD16/56 natural-killer cell) immune parameters were studied by flow cytometry.


RESULTS
In univariate analyses, all three immune subsets had significant effects on overall survival (P < .025). In multivariate analyses including the prognostic index, only CD8 counts remained significant (P = .026), although its effect on the overall prognostic index is small. An increase of 100 cells/mm3 in the CD8 count confers a 5% improvement in overall survival. Individuals with a higher CD8 count did not have an increased time to progression. Patients who were already on HAART at the time of KS diagnosis did not have a shorter time to progression than those who were antiretroviral naïve at KS diagnosis.


CONCLUSIONS
The CD8 count appears to provide independent prognostic information in individuals with AIDS-associated KS. Measurement of the CD8 count is clinically useful in patients with KS.
Stebbing
Justin
J
Imperial College of Science, Medicine, and Technology, Department of Oncology, The Chelsea and Westminster Hospital, London, United Kingdom. j.stebbing@imperial.ac.uk
Sanitt
Adam
A
Teague
Alastair
A
Powles
Tom
T
Nelson
Mark
M
Gazzard
Brian
B
Bower
Mark
M
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy; D015703:Antigens, CD / Q000032:analysis; D018941:Antigens, CD19 / Q000032:analysis; D023241:Antiretroviral Therapy, Highly Active; D019002:CD56 Antigen / Q000032:analysis; D058851:GPI-Linked Proteins; D006801:Humans; D018655:Lymphocyte Count; D015999:Multivariate Analysis; D011379:Prognosis; D017452:Receptors, IgG / Q000032:analysis; D012514:Sarcoma, Kaposi / Q000276:immunology / Q000401:mortality*; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology
D015703:Antigens, CD; D018941:Antigens, CD19; D019002:CD56 Antigen; C428200:FCGR3B protein, human; D058851:GPI-Linked Proteins; D017452:Receptors, IgG